ASK: During the COVID-19 pandemic, we established a telehealth-only plan to provide benefits to people who were not eligible for coverage under our regular group health plan. Can we continue to offer this benefit?

ANSWER: During the COVID-19 pandemic, exclusive telehealth benefits have been exempt from certain requirements that otherwise apply to group health plans. This relief is related to the COVID-19 public health emergency (PHE), which appears to end on May 11, 2023 (see our Checkpoint article). Once the waiver is no longer available, a telehealth-only plan can continue, but it would have to meet those requirements.

As group health plans, telehealth plans must comply with the many rules applicable to group health plans under ERISA, COBRA, HIPAA, and the Affordable Care Act (ACA) (see our Checkpoint question of the week). The COVID-19 telehealth relief exempts certain plans from the ACA’s annual and lifetime cap ban and its preventive services mandate, but not from other ACA mandates (see our Checkpoint article). The relief applies to any arrangement sponsored by a large employer (generally, one with at least 51 employees) that provides only telehealth and other remote care benefits and is offered only to employees or dependents who are not eligible for coverage under any other plan. group health. plan offered by that employer.

The relief took effect in 2020 and applies for the duration of any plan year beginning before the end of the COVID-19 PHE. If the PHE ends on May 11, 2023, one telehealth-only plan per calendar year could remain covered by the waiver until the end of 2023. But if the plan year is, for example, June 1 through May 31, relief applies only through the end of the current plan year on May 31, 2023; As of June 1, 2023, such a plan would have to comply with the preventive services mandate and the prohibition on annual and lifetime limits.

For more information, see EBIA’s Self-Insured Health Plans manual at Section XI.E.5 (“Telehealth”) and EBIA’s Healthcare Reform manual at Sections VN (“Telehealth Plans Only”) and XIV (“Insurance obligations”).

Contributing editors: EBIA staff.

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