§ 3217-H — Telehealth delivery of services

§ 3217-h. Telehealth delivery of services. * (a) (1) An insurer shall\nnot exclude from coverage a service that is otherwise covered under a\npolicy that provides comprehensive coverage for hospital, medical or\nsurgical care because the service is delivered via telehealth, as that\nterm is defined in subsection (b) of this section; provided, however,\nthat an insurer may exclude from coverage a service by a health care\nprovider where the provider is not otherwise covered under the policy.\nAn insurer may subject the coverage of a service delivered via\ntelehealth to co-payments, coinsurance or deductibles provided that they\nare at least as favorable to the insured as those established for the\nsame service when not delivered via telehealth. An insurer may subject\nthe coverage of a service delivered via telehealth to reasonable\nutilization management and quality assurance requirements that are\nconsistent with those established for the same service when not\ndelivered via telehealth.\n (2) An insurer that provides comprehensive coverage for hospital,\nmedical or surgical care shall reimburse covered services delivered by\nmeans of telehealth on the same basis, at the same rate, and to the same\nextent that such services are reimbursed when delivered in person;\nprovided that reimbursement of covered services delivered via telehealth\nshall not require reimbursement of costs not actually incurred in the\nprovision of the telehealth services, including charges related to the\nuse of a clinic or other facility when neither the originating site nor\ndistant site occur within the clinic or other facility.\n (3) An insurer that provides comprehensive coverage for hospital,\nmedical, or surgical care with a network of health care providers shall\nensure that such network is adequate to meet the telehealth needs of\ninsured individuals for services covered under the policy when medically\nappropriate.\n * NB Effective until April 1, 2026\n * (a) An insurer shall not exclude from coverage a service that is\notherwise covered under a policy that provides comprehensive coverage\nfor hospital, medical or surgical care because the service is delivered\nvia telehealth, as that term is defined in subsection (b) of this\nsection; provided, however, that an insurer may exclude from coverage a\nservice by a health care provider where the provider is not otherwise\ncovered under the policy. An insurer may subject the coverage of a\nservice delivered via telehealth to co-payments, coinsurance or\ndeductibles provided that they are at least as favorable to the insured\nas those established for the same service when not delivered via\ntelehealth. An insurer may subject the coverage of a service delivered\nvia telehealth to reasonable utilization management and quality\nassurance requirements that are consistent with those established for\nthe same service when not delivered via telehealth.\n * NB Effective April 1, 2026\n (b) For purposes of this section, "telehealth" means the use of\nelectronic information and communication technologies by a health care\nprovider to deliver health care services to an insured individual while\nsuch individual is located at a site that is different from the site\nwhere the health care provider is located.\n