New York: Monkeypox virus disaster emergency orders
We want to make sure you have up to date information about the New York statewide monkeypox virus disaster emergency declaration and its provisions for member cost sharing. To help you manage claim administration and patient billing, here’s a quick overview of the governor’s executive orders.
Temporary suspension of member cost share
Effective Aug. 28, 2022, UnitedHealthcare will temporarily cover monkeypox virus initial diagnosis and vaccine administration without cost sharing (copay, coinsurance or deductible) during the state’s disaster emergency period. This applies specifically to commercial and Community Plan (Medicaid) members as outlined below.
- Commercial health plans sitused in New York state, including fully insured plans, Individual and Family plans and Empire plans (you can see the situs state on the member’s ID card):
- Diagnosis — when done via telehealth or at an in network provider’s office, urgent care center or other outpatient provider setting, or an emergency department of a hospital
- Testing — when performed at an in network laboratory to diagnose the monkeypox virus
- Immunization — when the virus immunization and administration is done by an in- or out of network health care professional
- Community Plan (Medicaid): Initial diagnostic evaluations, lab testing and vaccine administration when provided by a Medicaid certified health care professional or laboratory
Treatment for the monkeypox virus is covered according to the patient’s health plan. Cost share may be imposed for any treatment or follow up care.
Please update your patient intake procedures
As outlined by the New York State Department of Health, health care professionals and laboratories are prohibited from collecting any cost share (copay, coinsurance or deductible) from patients for these services. Please update your patient intake and billing processes, as needed, to help ensure members aren’t charged for these items during the disaster emergency.
Additional information and resources
If you have questions or need additional information:
- Governor Kathy Hochul’s Executive Order No. 20.2
- New York State Medicaid Update, August 2022 Volume 38 | Number 9
- Insurance Circular Letter No. 12 from the New York State Department of Financial Services
The monkeypox virus emergency order is currently in effect through Oct. 27 , 2022. The end date of the emergency order may be extended, based on public health data trends. We encourage you to monitor the New York State Department of Health for updates.
Thank you for your continuous efforts to keep our members healthy and informed.
