§ 4306-G — Telehealth delivery of services

§ 4306-g. Telehealth delivery of services. * (a) (1) A corporation\nshall not exclude from coverage a service that is otherwise covered\nunder a contract that provides comprehensive coverage for hospital,\nmedical or surgical care because the service is delivered via\ntelehealth, as that term is defined in subsection (b) of this section;\nprovided, however, that a corporation may exclude from coverage a\nservice by a health care provider where the provider is not otherwise\ncovered under the contract. A corporation 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. A corporation may subject the coverage of a service\ndelivered via telehealth to reasonable utilization management and\nquality assurance requirements that are consistent with those\nestablished for the same service when not delivered via telehealth.\n (2) A corporation 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\nthe distant site occur within the clinic or other facility. The\nsuperintendent may promulgate regulations to implement the provisions of\nthis section.\n (3) A corporation 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) A corporation shall not exclude from coverage a service that is\notherwise covered under a contract 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 a corporation may exclude from coverage\na service by a health care provider where the provider is not otherwise\ncovered under the contract. A corporation 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. A corporation may subject the coverage of a service\ndelivered via telehealth to reasonable utilization management and\nquality assurance requirements that are consistent with those\nestablished for the 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