N.Y. Insurance Law § 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, 2028

* (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, 2028

(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.