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This entry was published on 2024-05-03
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SECTION 3217-H
Telehealth delivery of services
Insurance (ISC) CHAPTER 28, ARTICLE 32
³ 3217-h. Telehealth delivery of services. * (a) (1) An insurer shall
not exclude from coverage a service that is otherwise covered under a
policy that provides comprehensive coverage for hospital, medical or
surgical care because the service is delivered via telehealth, as that
term is defined in subsection (b) of this section; provided, however,
that an insurer may exclude from coverage a service by a health care
provider where the provider is not otherwise covered under the policy.
An insurer may subject the coverage of a service delivered via
telehealth to co-payments, coinsurance or deductibles provided that they
are at least as favorable to the insured as those established for the
same service when not delivered via telehealth. An insurer may subject
the coverage of a service delivered via telehealth to reasonable
utilization management and quality assurance requirements that are
consistent with those established for the same service when not
delivered via telehealth.

(2) An insurer that provides comprehensive coverage for hospital,
medical or surgical care shall reimburse covered services delivered by
means of telehealth on the same basis, at the same rate, and to the same
extent that such services are reimbursed when delivered in person;
provided that reimbursement of covered services delivered via telehealth
shall not require reimbursement of costs not actually incurred in the
provision of the telehealth services, including charges related to the
use of a clinic or other facility when neither the originating site nor
distant site occur within the clinic or other facility.

(3) An insurer that provides comprehensive coverage for hospital,
medical, or surgical care with a network of health care providers shall
ensure that such network is adequate to meet the telehealth needs of
insured individuals for services covered under the policy when medically
appropriate.

* NB Effective until April 1, 2026

* (a) An insurer shall not exclude from coverage a service that is
otherwise covered under a policy that provides comprehensive coverage
for hospital, medical or surgical care because the service is delivered
via telehealth, as that term is defined in subsection (b) of this
section; provided, however, that an insurer may exclude from coverage a
service by a health care provider where the provider is not otherwise
covered under the policy. An insurer may subject the coverage of a
service delivered via telehealth to co-payments, coinsurance or
deductibles provided that they are at least as favorable to the insured
as those established for the same service when not delivered via
telehealth. An insurer may subject the coverage of a service delivered
via telehealth to reasonable utilization management and quality
assurance requirements that are consistent with those established for
the same service when not delivered via telehealth.

* NB Effective April 1, 2026

(b) For purposes of this section, "telehealth" means the use of
electronic information and communication technologies by a health care
provider to deliver health care services to an insured individual while
such individual is located at a site that is different from the site
where the health care provider is located.