QUESTION: Throughout the COVID-19 pandemic, we established a telehealth-only plan to supply advantages to people who weren’t eligible for protection below our common group well being plan. Can we proceed to supply this profit?

ANSWER: Throughout the COVID-19 pandemic, telehealth-only advantages have been exempt from sure necessities that in any other case apply to group well being plans. This reduction is linked to the COVID-19 public well being emergency (PHE), which seems slated to finish on Could 11, 2023 (see our Checkpoint article). As soon as the exemption is now not accessible, a telehealth-only plan might proceed but it surely must meet these necessities.

As group well being plans, telehealth plans should adjust to the numerous guidelines relevant to group well being plans below ERISA, COBRA, HIPAA, and the Reasonably priced Care Act (ACA) (see our Checkpoint Query of the Week). The COVID-19 telehealth reduction exempts sure plans from the ACA’s prohibition on annual and lifelong limits and its preventive providers mandate—however not from different ACA mandates (see our Checkpoint article). The reduction applies to any association sponsored by a big employer (usually, one with not less than 51 workers) that gives solely telehealth and different remote-care advantages and is obtainable solely to workers or dependents who will not be eligible for protection below another group well being plan supplied by that employer.

The reduction took impact in 2020 and applies during any plan yr starting earlier than the top of the COVID-19 PHE. If the PHE ends on Could 11, 2023, a calendar yr telehealth-only plan might stay lined by the exemption till the top of 2023. But when the plan yr is, for instance, June 1–Could 31, the reduction applies solely till the top of the present plan yr on Could 31, 2023; as of June 1, 2023, that plan must adjust to the preventive providers mandate and the prohibition on annual and lifelong limits.

For extra info, see EBIA’s Self-Insured Well being Plans guide at Part XI.E.5 (“Telehealth”) and EBIA’s Well being Care Reform guide at Sections V.N (“Telehealth-Solely Plans”) and XIV (“Insurance coverage Mandates”).

Contributing Editors: EBIA Employees.