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Is Our Self-Insured Health Plan Subject to Any Special Rules Regarding Telehealth During the COVID-19 Emergency?



QUESTION: Our company’s self-insured ERISA group health plan offers telehealth services. We understand that federal agencies have issued COVID-19-related guidance relating to telehealth. Is there anything special we need to know?

ANSWER: In connection with the COVID-19 emergency, several agencies have issued guidance regarding the provision of telehealth services, but not all of it applies to self-insured ERISA group health plans. Here are highlights:

  • Required Coverage. Group health plans (whether insured or self-insured) must cover certain COVID-19 diagnostic tests without cost-sharing, prior authorization, or other medical management requirements. This includes diagnostic services and items provided during telehealth provider visits (as well as in-person, urgent care, emergency room, or other visits) that result in an order for or administration of a covered diagnostic test. (See our Checkpoint article.)
  • High Deductible Health Plans (HDHPs). If your plan includes an HDHP option (so that participants may be eligible to contribute to an HSA), it may (without losing HDHP status) cover telehealth and other remote care services without a deductible for plan years beginning on or before December 31, 2021. This temporary safe harbor applies broadly—it is not limited to coverage for COVID-19-related services. (See our Checkpoint article.)
  • Other Guidance. COVID-19-related guidance from CMS encouraging insurers to promote the use of telehealth, and from OCR providing HIPAA enforcement relief to health care providers offering telehealth services, does not apply to self-insured health plans. (See our Checkpoint article.)

Because telehealth services are health benefits, telehealth arrangements also raise other compliance considerations, including issues under the Affordable Care Act, ERISA, COBRA, and HIPAA. Providing telehealth through an employer-sponsored group health plan, as your company does, eases many of these concerns. Compliance may be more difficult if telehealth is provided as a separate arrangement—for example, if it is offered to all employees, rather than only to group health plan participants.

For more information, see EBIA’s Self-Insured Health Plans manual at Section XI.E.5 (“Trends in Self-Insured Health Plan Design: Telemedicine”). See also EBIA’s Group Health Plan Mandates manual at Section XVI.C (“Mandated Coverage of Diagnostic and Preventive Services”) and EBIA’s Consumer-Driven Health Care manual at Section X.I (“Telehealth and Other Remote Care Services”). You may also be interested in our upcoming free webinar, “COVID-19 Compliance Update for Group Health Plans” (live on July 23, 2020).

Contributing Editors: EBIA Staff.

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