Legislation

Search OpenLegislation Statutes

This entry was published on 2024-05-03
The selection dates indicate all change milestones for the entire volume, not just the location being viewed. Specifying a milestone date will retrieve the most recent version of the location before that date.
SECTION 4306-G
Telehealth delivery of services
Insurance (ISC) CHAPTER 28, ARTICLE 43
§ 4306-g. Telehealth delivery of services. * (a) (1) A corporation
shall not exclude from coverage a service that is otherwise covered
under a contract 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 a corporation may exclude from coverage a
service by a health care provider where the provider is not otherwise
covered under the contract. A corporation 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. A corporation 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) A corporation 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
the distant site occur within the clinic or other facility. The
superintendent may promulgate regulations to implement the provisions of
this section.

(3) A corporation 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) A corporation shall not exclude from coverage a service that is
otherwise covered under a contract 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 a corporation may exclude from coverage
a service by a health care provider where the provider is not otherwise
covered under the contract. A corporation 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. A corporation 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.