2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3217-H - Telehealth Delivery of Services.

§  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.