Bill Would Pave Way for Stand-Alone Telehealth Coverage

A bipartisan group of House legislators in February reintroduced legislation from 2022 that would pave the way for employer-sponsored, stand-alone telehealth benefits plans.

The bill is important as the current law allowing health insurers to cover telehealth benefits sunsets at the end of 2024, which would be difficult for many patients and providers who have grown accustomed to telehealth visits with their physicians.

The legislation, however, takes a different approach by instead making telehealth benefits separate from a health plan.

A similar measure died in committee last year due to congressional inertia during an election year. The current legislation has bipartisan support with sponsorship by Rep. Angie Craig, D-Minnesota, Rep. Ron Estes, R-Kansas, Rep. Mikie Sherrill, D-New Jersey, and Rep. Rick Allen, R-Georgia.

The bill

The goal of the Telehealth Benefit Expansion for Workers Act would be to make stand-alone telehealth benefits separate, and not a replacement for a group health plan. Instead, employers would be able to offer them under a group health plan or group health insurance coverage as excepted benefits.

Excepted benefits are additional coverages that employers can, but are not required to, offer, like vision or dental insurance. Federal law dictates what qualifies as an excepted benefit, which necessitates the legislation to add telehealth services to the mix.

Telehealth benefits, under the legislation, would apply to all workers, even those who work part-time or seasonally.

Why is the legislation needed?

Prior to the COVID-19 pandemic, health plans were unable to cover telehealth services under the law. But, when the outbreak first started, followed by lockdowns, telemedicine was sometimes the only option patients had to get face time with their physicians.

As a result, lawmakers enacted laws that allow health plans to cover patients’ video and phone visits with their doctors. Those laws were set to sunset 151 days after the COVID-19 public health emergency expires.

But the budget bill signed into law at the end of 2022 extends and expands telehealth flexibilities under the law through Dec. 31, 2024. Those flexibilities include:

  • Expanding originating sites to include any sites where patients are located, including their homes.
  • Extending coverage and payment for audio-only telehealth services.

What’s next

This measure has only just been introduced, but since it was crafted by Democrats and Republicans, and considering the eventual sunsetting of telehealth provisions, there is some urgency in getting permanent legislation on the books.

However, as telemedicine grows in use and popularity, elected representatives may feel pressured to make permanent the current law that allows health plans to cover video and telephone visits with their physicians.

HDHPs Can Continue Covering Telehealth with No Cost-Sharing under New Law

An expired provision that authorized high-deductible health plans to reimburse for telehealth and other remote health care services before the deductible has been met, has been revived.

The provision was extended from April 1 through Dec. 31 after President Biden signed the Consolidated Appropriations Act of 2022.

Due to the COVID-19 pandemic and ensuing emergency legislation, HDHPs had been required to cover telehealth services with no out-of-pocket costs for the health plan enrollee, but those rules expired at the end of 2021.

The extension was included in the budget bill as telemedicine has grown in popularity because it’s convenient particularly for people who have to travel far to their appointments. It also expands provider choice and access, proponents say.

HDHPs are usually only required to cover preventative care and 10 essential services mandated by the Affordable Care Act with no out-of-pocket costs for the policyholder. All other medical care must be paid for by the enrollees until they meet their deductible.

If a health plan were to violate this rule, it would result in the enrollee being barred from contributing to their attached health savings account (HSA).

The HDHP exemption was initially codified by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), a sweeping relief package to keep the economy afloat at the start of the pandemic.

The technical language of the act stated that HDHPs remain qualified for the purposes of HSA contributions if they cover telehealth or remote medical services before the enrollee has met their deductible. The exemption expired on Dec. 31, 2021.

That means there is a gap of three months through March 31 when coverage for telehealth before meeting their deductible would result in an HDHP enrollee being ineligible from contributing to their HSA.

This could result in confusion among enrollees, so employers need to be prepared for this.

What employers should do

As a result of this change, you should review your plan documents and summary plan descriptions to see if they have been updated to reflect this new HDHP exemption starting April 1.  If not, contact your insurer to get updated documents.

You should also inform your staff about the changes via usual company communications, memos and as an agenda item at your next company meeting.