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DFS Guidance on Monkeypox Coverage

The New York State Department of Financial Services has issued Insurance Circular Letter No. 12 – 2022 as guidance to health plans related to the requirements for coverage of monkeypox virus testing, diagnosis, and immunization under comprehensive health insurance policies and contracts, pursuant to Governor Kathy Hochul’s Executive Order (EO) No. 20.1.

The executive order temporarily modifies and/or suspends certain sections of state Insurance Law and Public Health Law to require health plans to cover the monkeypox vaccine and vaccine administration for all persons who are eligible for the vaccine – without cost sharing any cost-sharing when provided in-network or out-of-network. This includes persons covered under grandfathered plans, regardless of whether they fall within the specific vaccine recommendation provided by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC).

Additionally, the executive order also requires the waiver of copayments, coinsurance, and annual deductibles for: (1) in-network laboratory testing to diagnose the monkeypox virus; and (2) office visits to diagnose the monkeypox virus at certain provider locations, including through telehealth such as an in-network provider’s office, an in-network urgent care center, any other in-network outpatient provider setting able to diagnose monkeypox, or an emergency department of a hospital. Copayments, coinsurance and annual deductibles may be imposed for follow-up care or treatment in accordance with the applicable policy or contract.