District of Columbia § 31-3862 Private reimbursement.

District of Columbia Statutes

§ 31-3862 — Private reimbursement.

District of Columbia·Title 31 Insurance and Securities.·Ch. 38D Telehealth Reimbursement.

(a)A health insurer offering a health benefits plan in the District may not deny coverage for a healthcare service on the basis that the service is provided through telehealth if the same service would be covered when delivered in person.

(b)A health insurer shall reimburse the provider for the diagnosis, consultation, or treatment of the insured when the service is delivered through telehealth.

(c)A health insurer shall not be required to:

(1)Reimburse a provider for healthcare service delivered through telehealth that is not a covered under the health benefits plan; and

(2)Reimburse a provider who is not a covered provider under the health benefits plan.

(d)A health insurer may require a deductible, copayment, or coinsurance amount for a healthcare service delivered throug

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(a) A health insurer offering a health benefits plan in the District may not deny coverage for a healthcare service on the basis that the service is provided through telehealth if the same service would be covered when delivered in person.

(b) A health insurer shall reimburse the provider for the diagnosis, consultation, or treatment of the insured when the service is delivered through telehealth.

(c) A health insurer shall not be required to:

(1) Reimburse a provider for healthcare service delivered through telehealth that is not a covered under the health benefits plan; and

(2) Reimburse a provider who is not a covered provider under the health benefits plan.

(d) A health insurer may require a deductible, copayment, or coinsurance amount for a healthcare service delivered through teleheath; provided, that the deductible, copayment, or coinsurance amount may not exceed the amount applicable to the same service when it is delivered in person.

(e) A health insurer shall not impose any annual or lifetime dollar maximum on coverage for telehealth services other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services under the health benefits plan.

(f) Nothing in this chapter shall preclude the health insurer from undertaking utilization review to determine the appropriateness of telehealth as a means of delivering a healthcare service; provided, that the determinations shall be made in the same manner as those regarding the same service when it is delivered in person.

District of Columbia § 31-3862 (Private reimbursement.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.