COVID-19: The Road Ahead for Commercial Health Insurance

Examine the Evolving Challenges That Lie Ahead for Healthcare Stakeholders and State Regulators—and What You Can Do Now to Prepare and Protect Your Organization—at a New Manatt Webinar.

Effective health insurance coverage is key to combating COVID-19, enabling access to and payment for both testing and treatment. State regulators, health insurers, providers, employers, unions and consumers all will face daunting coverage challenges as they work to address the fallout from the COVID-19 outbreak.

Federal and state actions related to commercial health insurance are already underway—and healthcare stakeholders and state regulators will have to manage a rising tide of emerging developments and new regulations in the coming days, weeks and months. What are the most pressing issues that lie ahead? What new questions will you need to answer? And how can you prepare your organization for a radically and rapidly changing environment for commercial insurance? In a new webinar, Manatt Health provides the answers. Key issues covered include:

  • Premium Payment Grace Periods. Should states require grace periods for health insurance not covered by the Affordable Care Act (ACA) grace periods for individuals with Advance Premium Tax Credits (APTCs)? If so, who bears responsibility if the consumer cannot pay?
  • Cost-Sharing Waiver for Treatment, Not Just Testing. As COVID-19 progresses, how will the focus expand from ensuring testing access to easing treatment access?
  • Networks and Coverage of Alternative Treatment Settings. Should insurers have to cover out-of-network providers and, if so, at what rate? To what extent will insurers or regulators adapt network coverage rules to cover alternative facilities?
  • Surprise Out-of-Network Billing and Networks. Do states with surprise billing laws need to adapt them to the COVID-19 crisis? Do states without such laws need to address out-of-network challenges?
  • Special Enrollment Periods (SEPs). How can states with state-based marketplaces use their SEPS most effectively, including to support coordination between marketplaces and state Medicaid agencies? Should there be a national SEP?
  • Appeals and Complaints. Wil insurers, providers and consumers seek extensions of statutory or contractual time frames for appeals? Will stakeholders seek relief from information requirements, such as clinical information for utilization review?
  • Claim Payment Time Frame Extensions. Will regulators extend time frames for consumers, providers and insurers to submit and adjudicate claims as COVID-19 progresses?
  • Audit and Reporting Requirements. Will there be new requirements for insurers to conduct audits to identify erroneous or fraudulent claims? Are government examiners likely to audit health insurers for compliance with emerging federal or state rules?
  • Premium Rate Increases. How will COVID-19 impact 2021 rates, considering both COVID-19 costs and pent-up demand from delayed services? Should 2021 rate filing deadlines allow for COVID-related changes?
  • Risk Adjustment. Will federal risk adjustment adequately account for regional differences in COVID-19 cases?
  • Reserves. Will COVID-19 costs impact solvency for some insurers? What flexibility do states have if risk-based capital (RBC) levels fall?
  • Non-ACA-Compliant Products. How might states revisit current regulations that cover insurers who are not ACA compliant?
  • ERISA Preemption of Self-Insured Insurers. Does broad preemption of state insurance regulation make sense when states are on the front lines of battling a pandemic?
  • New Vaccine Coverage. How can insurers, regulators and other stakeholders minimize cost and utilization review hurdles for consumers to obtain any new vaccine?


Joel Ario, Managing Director, Manatt Health
Troy Oechsner, Partner, Manatt Health

For regular updates on the major challenges companies are facing, please visit our COVID-19 resources page, and subscribe for timely updates in your inbox here.

Date and Time

Thursday, April 23, 2020

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