Federal Telehealth Flexibilities in Private Health Insurance During the COVID-19 Public Health Emergency: In Brief

Federal Telehealth Flexibilities in Private Health Insurance During the COVID-19 Public Health Emergency: In Brief

Federal Telehealth Flexibilities in Private
Health Insurance During the COVID-19
Public Health Emergency: In Brief
February 14, 2023
Congressional Research Service
https://crsreports.congress.gov
R47424

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Telehealth Flexibilities in Private Health Insurance During the COVID-19 PHE

Contents
Telehealth Coverage in Private Health Insurance ..................................................................... 1
Federal Telehealth Flexibilities for Private Health Insurance Coverage Introduced
During the COVID-19 Public Health Emergency .................................................................. 2
Allowing Midyear Plan Design Changes to Increase Telehealth Coverage ........................ 3
Allowing Certain Employers to Offer Coverage Only for Services Provided via
Telehealth and Other Remote Care Services ................................................................... 4
Allowing Telehealth Coverage Pre-deductible for Catastrophic Plans ............................... 4
Allowing Telehealth Coverage Pre-deductible for Health Savings Account-
Qualified High Deductible Health Plans.......................................................................... 4
Providing That COVID-19 Testing Coverage Requirements Apply with Regard to
Telehealth Visits ............................................................................................................... 5
State Laws and Private Health Insurance Telehealth Coverage ................................................ 7
Considerations for Telehealth After the COVID-19 PHE ......................................................... 7

Tables
Table 1. Summary of Federal Telehealth Flexibilities and Applicability to Plan Types .................. 5

Contacts
Author Information .......................................................................................................................... 8

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he Coronavirus Disease 2019 (COVID-19) public health emergency (PHE), first declared
by the Secretary of the Department of Health and Human Services (HHS) on January 31,
T 2020, was most recently renewed on January 11, 2023, and the Biden Administration has
announced plans to end the emergency on May 11, 2023.1 Prior to the COVID-19 PHE, there
were no federal requirements that private health insurance plans offer telehealth coverage, nor
were there prohibitions on such coverage. Certain other federal requirements presented
difficulties for private health insurance plans that sought to quickly add telehealth coverage as
part of their response to the COVID-19 PHE. The following sections describe the federal
flexibilities created in response to such issues and when those flexibilities are to end.
Telehealth Coverage in Private Health Insurance
Generally, telehealth is the use of electronic information and telecommunication technologies to
support remote clinical health care, patient and professional health-related education, public
health, and other health care delivery functions. There is no federal definition of telehealth for the
purposes of private health insurance coverage, but a stakeholder group, the Center for Connected
Health Policy (CCHP), refers to telehealth as “a collection of means or methods, not a specific
clinical service, to enhance care delivery and education.”2 By this definition, telehealth is not a
distinct clinical service but a mode of service delivery. In other words, generally, a private health
insurance plan does not “cover telehealth” in addition to other covered benefits; rather, a plan
may provide coverage for a particular benefit or service when provided in person or via
telehealth. The types of telehealth modalities covered by a plan also may vary. For example, some
plans may cover certain services when provided via audio technology only and other services
when provided via live video technology.
Private health insurance plans may offer telehealth services in various ways. Some plans have
providers in their network that offer services via telehealth only and others both in-person and via
telehealth. Additionally, some health plans offer services through specialized telemedicine service
providers, such as Teledoc, Doctor on Demand, or MDLIVE (not an acronym). Some plans may
cover almost all of the offered benefits solely via telehealth, whereas others may provide
coverage for only a few services via telehealth and may cover largely in-person services. Plans
also may have some but not all health services available via telehealth.
Prior to the COVID-19 PHE, regulation of telehealth coverage (i.e., benefits/services provided via
telehealth) in private health insurance generally occurred at the state level for those types of plans
that states have the ability to regulate. Therefore, telehealth coverage varied greatly between plans
due to differing state requirements. For additional information regarding telehealth at the state
level, see “State Laws and Private Health Insurance Telehealth,” below.

1 See Department of Health and Human Services (HHS), Administration for Strategic Preparedness and Readiness,
“Declarations of a Public Health Emergency,” at https://aspr.hhs.gov/legal/PHE/Pages/default.aspx. The Biden
Administration released a policy statement on January 30, 2023, indicating it intends to end the Coronavirus Disease
2019 (COVID-19) public health emergency (PHE) declaration on May 11, 2023. See Executive Office of the President,
Office of Management and Budget, “Statement of Administration Policy: H.R. 382—A Bill to Terminate the Public
Health Emergency Declared with Respect to COVID-19,” January 30, 2023, at https://www.whitehouse.gov/wp-
content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf.
2 Center for Connected Health Policy, “A Framework for Defining Telehealth,” at
https://cchp.nyc3.digitaloceanspaces.com/2021/04/Telehealth-Definintion-Framework-for-TRCs_0.pdf. This
understanding is similar to other definitions for telehealth in public insurance programs. For example, in the Medicaid
program, the Centers for Medicare & Medicaid Services (CMS) define Medicaid telehealth as “the use of
telecommunications and information technology to provide access to health assessment, diagnosis, intervention,
consultation, supervision and information across distance.” See Medicaid.gov, “Telemedicine,” at
https://www.medicaid.gov/medicaid/benefits/telemedicine/index.html.
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Telehealth Flexibilities in Private Health Insurance During the COVID-19 PHE

Federal Telehealth Flexibilities for Private Health Insurance
Coverage Introduced During the COVID-19 Public Health
Emergency
The COVID-19 pandemic accelerated interest in telehealth as a way to protect health care
providers and to maintain or improve patients’ access to care and safety. After the COVID-19
PHE declaration, the Centers for Medicare & Medicaid Services (CMS, an agency in HHS) and
the Departments of HHS, Labor, and the Treasury (collectively referred to as the Tri-agencies)
issued guidance creating some time-limited federal flexibilities for group and non-group health
plans (for information on types of private health insurance plans, see the text box below).
Types of Private Health Insurance Plans
Federal requirements (and flexibilities) may apply to some or all types of private health insurance plans.
Broadly, private health insurance includes group plans of several types and non-group plans. Group plans largely
refer to health benefits provided to employees (and their dependents) by employers that sponsor such benefits.
Employers and other group health plan sponsors may purchase coverage from a state-licensed insurer and offer it
to their group (i.e., they may fully insure). Alternatively, sponsors may finance coverage themselves (i.e., they may
self-insure). Ful y insured plans may be purchased in the large- or small-group markets. For purposes of private
health insurance regulation, a small group is typically defined as a group of up to 50 individuals (e.g., employees) and
a large group is typically defined as one with 51 or more individuals.
Consumers purchase non-group plans directly from an insurer. In general, non-group plans are ful y insured. The
non-group market (also called the individual market) and the small-group market include plans sold on and off the
health insurance exchanges—the individual exchanges and the Small Business Health Options Program (SHOP)
exchanges, respectively. Private health insurance regulations apply differently to different types of private health
insurance plans.
Note: For more information on private health insurance plans, see CRS Report R45146, Federal Requirements on
Private Health Insurance Plans.
The Tri-agencies’ guidance generally encouraged all private health insurance plans in each
agency’s jurisdiction to promote the use of telehealth services.3 The guidance suggested specific
steps plans could take to do so, including by (1) notifying consumers of the availability of
telehealth and other remote care services; (2) ensuring telehealth access to a robust suite of such
services, including mental health and substance use disorder services; and (3) covering telehealth
and other remote care services without cost-sharing or medical-management requirements.4 This
and/or subsequent agency guidance also provided certain specific flexibilities to facilitate
telehealth coverage. In addition, Congress passed legislation enacting time-limited flexibilities or
changes to telehealth coverage requirements.

3 CMS, “FAQs on Availability and Usage of Telehealth Services Through Private Health Insurance Coverage in
Response to Coronavirus Disease 2019 (COVID-19),” March 24, 2020, at https://www.cms.gov/files/document/faqs-
telehealth-covid-19.pdf (hereinafter CMS FAQ, March 2020); Departments of Labor (DOL), HHS, and the Treasury,
“FAQS About Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act
Implementation, Part 42,” April 11, 2020, at https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/
resource-center/faqs/aca-part-42.pdf#page=10 (hereinafter Tri-agency FAQ 42, April 2020).
4 CMS also issued a letter to nonfederal governmental plans encouraging them to cover telehealth services. See Letter
from Samara Lorenz, Director of Oversight Group, Center for Consumer Information and Insurance Oversight, CMS,
to Sponsors of non-Federal governmental plans, June 5, 2020, at https://www.cms.gov/files/document/COVID-19-
Letter-to-Non-Federal-Governmental-Plans.pdf (hereinafter CMS, Nonfederal Plans Letter, June 2020. For more
information on these types of plans, please see CRS In Focus IF11359, Applicability of Federal Requirements to
Selected Health Coverage Arrangements: An Overview.
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The following sections describe each telehealth flexibility introduced during the COVID-19 PHE.
See Table 1 for a summary of each flexibility and its applicability to different types of plans.
Allowing Midyear Plan Design Changes to Increase Telehealth Coverage
Both CMS, for the plans it regulates, and the Tri-agencies, for the plans they regulate, issued
guidance to permit midyear plan design changes to increase telehealth coverage in fully insured
health plans, both group and non-group, and in self-insured health plans. Generally, once a health
insurance product is approved for sale,5 which happens prior to the open enrollment period,6
insurers offering individual and group insurance plans are not allowed to modify benefits or cost
sharing associated with the approved product per federal requirements. In March 2020, CMS
released guidance stating that it would not take enforcement action against insurers that made
midyear changes to products to provide greater coverage for telehealth services or to reduce or
eliminate cost-sharing requirements for telehealth (even if such changes were not related to
COVID-19).7 CMS stated that such changes must be consistent with state law and encouraged
state regulators to take similar actions.
Similarly, the Tri-agencies issued guidance in April 2020 allowing insurers offering non-group
and group plans, including self-insured group health plans, to add telehealth and other remote
health services midyear without providing the required 60-day advance notice.8 The Tri-agencies
stipulated that group health plans may not limit or eliminate other benefits or increase cost
sharing to offset the costs of those services and must provide notice of changes to enrollees as
soon as reasonably practicable.
Both CMS and the Tri-agencies indicated they would continue to take enforcement action against
plans that limit or eliminate other benefits, or increase cost sharing, to offset the costs of
increased telehealth benefits. Both of these nonenforcement policies regarding midyear plan
design changes to increase telehealth coverage are to end when the PHE declaration expires.9 This
flexibility has been in effect during the entire PHE, but it may have been more salient when the

5 A health insurance product is a particular set of benefits and cost sharing offered by an insurer.
6 An open enrollment period is a timeframe in which an eligible person may enroll in health plan coverage (eligible
individuals may also enroll at other times if they have a qualifying life event, for example). Many plans offer an open
enrollment period annually, though the timeframe may differ depending on the source of the coverage (for example,
different employers may have different open enrollment periods).
7 See question 2 in CMS FAQ, March 2020.
8 See question 14 in Tri-agency FAQ 42, April 2020. In later guidance, the Tri-agencies provided information to plans
on meeting the advance notice requirements at the end of the PHE. See question 13 in HHS, DOL, Treasury, “FAQs
About Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act
Implementation Part 43, June 23, 2020, p. 11 (hereinafter Tri-agency FAQ 43, June 2020).
9 The Tri-agency guidance also specified that grandfathered health plans would not lose their grandfathered status if,
during the COVID-19 PHE, they provided greater coverage for telehealth services or reduce or eliminate cost-sharing
requirements for telehealth. The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended)
provided that group health plans and health insurance coverage in which at least one individual was enrolled as of
enactment of the ACA (March 23, 2010) could be grandfathered. For as long as a plan maintains its grandfathered
status, it is exempt from specified federal health insurance requirements established under the ACA. See question 15 in
Tri-agency FAQ 43, June 2020. Also, to the extent that state and local laws prohibit midyear changes for nonfederal
governmental plans, CMS encouraged states and local authorities not to take any enforcement actions against
nonfederal governmental plans that make midyear changes to provide greater coverage for telehealth services or to
reduce or eliminate cost-sharing requirements for telehealth. See CMS, Nonfederal Plans Letter, June 2020. For more
information on these types of plans, please see CRS In Focus IF11359, Applicability of Federal Requirements to
Selected Health Coverage Arrangements: An Overview.
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Telehealth Flexibilities in Private Health Insurance During the COVID-19 PHE

guidance was issued in 2020 than in subsequent years, as health plans could have sought approval
for plan design changes relating to telehealth prior to open enrollment in those years.
Allowing Certain Employers to Offer Coverage Only for Services Provided via
Telehealth and Other Remote Care Services
Generally, health plans that provide medical care, including through telehealth, and otherwise
meet the definition of a group health plan must meet federal requirements that are applicable to
such plans. However, Tri-agency guidance provided temporary relief from specified federal
requirements for certain telehealth-only group health plans, permitting a large employer to offer
coverage only for telehealth and other remote care services to employees who are not eligible for
any other group health plans offered by the employer.10 Such a plan might cover only a certain
number of virtual primary care visits, for example. The guidance specifies which requirements
would still apply to such plans. This flexibility is permitted for the duration of any plan year
beginning before the end of the COVID-19 PHE.
Allowing Telehealth Coverage Pre-deductible for Catastrophic Plans
CMS also permitted an additional flexibility for catastrophic plans. Catastrophic plans are offered
on the non-group (or individual) market and are available to individuals under the age of 30 and
those who are over 30 but meet certain criteria. Although catastrophic plans cover a set of
essential health benefits, as do other non-group plans, catastrophic plans generally may only
provide pre-deductible coverage of at least three primary care visits and certain preventive
services.11
CMS allowed insurers to modify their catastrophic plans to provide pre-deductible coverage for
telehealth services, as well, and still meet the requirements to be a catastrophic plan.12 Pre-
deductible coverage for telehealth services allows an enrollee’s health plan to cover some of the
costs associated with services provided via telehealth before the enrollee pays the full amount of
the deductible. This non-enforcement policy is to end when the PHE declaration expires.
Allowing Telehealth Coverage Pre-deductible for Health Savings Account-
Qualified High Deductible Health Plans
A health savings account (HSA) is a tax-advantaged account that individuals can use to pay for
unreimbursed medical expenses (e.g., deductibles, co-payments, coinsurance, services not
covered by insurance). Individuals are eligible to establish and contribute to an HSA if they have
coverage under an HSA-qualified high deductible health plan (HDHP), do not have disqualifying
coverage, and cannot be claimed as a dependent on another person’s tax return. To be considered
an HSA-qualified HDHP, a health plan must meet several criteria: (1) it must have a deductible
above a certain minimum level, (2) it must limit out-of-pocket expenditures for covered benefits
to no more than a certain maximum level, and (3) it can cover only certain preventive services
and (for limited time periods) telehealth services before the deductible is met.

10 See question 14 in Tri-agency FAQ 43, June 2020.
11 A deductible is the amount an enrollee is required to pay for health care services or products before the enrollee’s
insurance plan begins to provide coverage. For more information on the essential health benefits, see CRS Report
R44163, The Patient Protection and Affordable Care Act’s Essential Health Benefits (EHB).
12 See question 3 in CMS FAQ, March 2020.
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Section 3701 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-
136) allowed pre-deductible coverage of telehealth by HSA-qualified HDHPs for services that
began on or after January 1, 2020, and for plan years that began on or before December 31,
2021.13 This provision was extended in subsequent legislation; most recently, Section 4151 of the
Consolidated Appropriations Act, 2023 (P.L. 117-328), allowed the policy to continue for plan
years beginning after December 31, 2022, and before January 1, 2025.14
Providing That COVID-19 Testing Coverage Requirements Apply with Regard
to Telehealth Visits
The Families First Coronavirus Response Act (FFCRA; P.L. 116-127), as amended by the
CARES Act, required most plans to cover COVID-19 testing, test administration, and related
items and services, as defined by the acts. Section 6001(a)(2) of FFCRA required plans and
issuers to provide coverage of these items and services furnished to an individual in various ways
as specified (including telehealth visits) without consumer cost sharing. This testing coverage
requirement, including as related to telehealth, applies only during the COVID-19 PHE.15
Table 1. Summary of Federal Telehealth Flexibilities and Applicability to Plan Types
Individual
Small
(Non-
Large Group
Self-
Expiration
Source(s)
Flexibility
Group
Insured
group)
Allowing midyear
Yes, to the
Yes, to
Yes, to the
Yes
Until
CMS FAQ,
plan design changes
extent
the
extent
COVID-19
March 2020;
to increase telehealth
consistent
extent
consistent with
PHE ends
Tri-agency
coveragea
with state
consistent state law
FAQ 42,
law
with state
April 2020
law
Allowing certain
NA
NA
Yes
Yes, for
Until end of Tri-agency
employers to offer
large
the plan
FAQ 43,
coverage only for
employersb year during
June 2020
services provided via
which the
telehealth and other
COVID-19
remote care services
PHE ends

13 Internal Revenue Service, Internal Revenue Bulletin: 2020-22, May 26, 2020, at https://www.irs.gov/irb/2020-
22_IRB#NOT-2020-29. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136) also
included a provision allowing individuals to enroll in a plan covering only telehealth and other remote care services,
and such a plan would not be considered disqualifying coverage for the purposes of health savings account eligibility
for plan years beginning on or before December 31, 2021. The Consolidated Appropriations Act, 2022 (P.L. 117-103),
allowed this policy to continue for months after March 31, 2022, and before January 1, 2023. The Consolidated
Appropriations Act, 2023 (P.L. 117-328), allowed this policy to continue for plan years beginning after December 31,
2022, and before January 1, 2025. For additional information, see CRS Report R45277, Health Savings Accounts
(HSAs).
14 Section 307 of the Consolidated Appropriations Act, 2022 (P.L. 117-103), allowed the policy to continue for months
after March 31, 2022, and before January 1, 2023.
15 For more information on this requirement, see CRS Report R46481, COVID-19 Testing: Frequently Asked
Questions.
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Individual
Small
(Non-
Large Group
Self-
Expiration
Source(s)
Flexibility
Group
Insured
group)
Allowing telehealth
Already
Already
Already
Already
Permitted
CMS FAQ,
coverage pre-
permitted
permitted permitted for
permitted
for
March 2020
deductible for
for most
for most
most PHI plans
for most
catastrophic
catastrophic plans
PHI plans
PHI plans
prior to PHE
PHI plans
plans until
prior to
prior to
prior to
the
PHE,
PHE
PHE
COVID-19
extended
PHE ends
to
catastrophic
plans
Allowing telehealth
Already
Already
Already
Already
Permitted
CARES Act;
coverage pre-
permitted
permitted permitted for
permitted
for HSA-
CAA 2022;
deductible for HSA-
for most
for most
most PHI plans
for most
HDHP
CAA 2023
qualified HDHPs
PHI plans
PHI plans
prior to PHE,
PHI plans
plans for
prior to
prior to
extended to
prior to
plan years
PHE,
PHE,
HSA-HDHP
PHE,
beginning
extended
extended
plans during
extended
before
to HSA-
to HSA-
PHE
to HSA-
January 1,
qualified
qualified
qualified
2025
HDHP
HDHP
HDHP
plans
plans
plans
during
during
PHE
PHE
Providing that
Yes
Yes
Yes
Yes
Until
FFCRA;
COVID-19 testing
COVID-19
CARES Act
coverage
PHE ends
requirements apply
with regard to
telehealth visits
Sources: Congressional Research Service analysis of Centers for Medicare & Medicaid Services (CMS), “FAQs
on Availability and Usage of Telehealth Services Through Private Health Insurance Coverage in Response to
Coronavirus Disease 2019 (COVID-19),” March 24, 2020, at https://www.cms.gov/files/document/faqs-
telehealth-covid-19.pdf (referred to as CMS FAQ, March 2020); Departments of Labor (DOL), Health and
Human Services (HHS), and the Treasury, “FAQS About Families First Coronavirus Response Act and
Coronavirus Aid, Relief, and Economic Security Act Implementation, Part 42,” April 11, 2020, at
https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-42.pdf
(referred to as Tri-agency FAQ 42, April 2020); HHS, DOL, and Treasury, “FAQS About Families First
Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation, Part 43,”
June 23, 2020, at https://www.cms.gov/files/document/FFCRA-Part-43-FAQs.pdf (referred to as Tri-agency FAQ
43, June 2020; Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136); Consolidated
Appropriations Act, 2022 (CAA 2002; P.L. 117-103); Consolidated Appropriations Act, 2023 (CAA 2023; P.L.
117-328); Families First Coronavirus Response Act (FFCRA; P.L. 116-127).
Notes: HDHP = high deductible health plan; HSA = health savings account; NA = not applicable; PHE = public
health emergency; PHI = private health insurance.
a. The Tri-agency guidance specified that grandfathered health plans would not lose their grandfathered status
if, during the COVID-19 PHE, they provided greater coverage for telehealth services or reduce or eliminate
cost-sharing requirements for telehealth. See question 15 in Tri-agency FAQ 43, June 2020. The Patient
Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) provided that group health plans and
health insurance coverage in which at least one individual was enrol ed as of enactment of the ACA (March
23, 2010) could be grandfathered. For as long as a plan maintains its grandfathered status, it is exempt from
specified federal health insurance requirements established under the ACA. For more information on these
types of plans, please see CRS In Focus IF11359, Applicability of Federal Requirements to Selected Health
Coverage Arrangements: An Overview.
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b. A small group is typically defined as a group of up to 50 individuals (e.g., employees), and a large group is
typically defined as one with 51 or more individuals.
State Laws and Private Health Insurance Telehealth Coverage
Regulation of private health insurance coverage of telehealth at the state level existed prior to the
COVID-19 PHE and continued during the PHE. Two of the main types of laws at the state level
addressing telehealth coverage in private health insurance are as follows:16
 Coverage parity laws, which are requirements on health plans to provide
telehealth coverage on the same terms as in-person services, including having the
same cost-sharing requirements and the same medical management (e.g., prior
authorization) requirements
 Payment parity laws, which are requirements on health plans to pay providers at
the same rate whether a service was provided in person or via telehealth
States have taken various approaches to health plans during the COVID-19 PHE. Some states that
did not have parity laws in place prior to the PHE issued orders to require coverage or payment
parity (or both). For example, Alaska requires telehealth coverage, including requiring that non-
network telehealth services are covered if there is coverage for non-network in-person services.
Arizona requires that cost sharing for telehealth be lower than cost sharing for in-person services
to encourage use of telehealth during the PHE.17 Some states have made these changes to
telehealth coverage permanent; others have modified or ended these policies. The CCHP
developed and continually updates a survey of state laws/regulations generally and during the
COVID-19 PHE.18
Considerations for Telehealth After the COVID-19 PHE
As listed in Table 1, between federal guidance and legislation, telehealth flexibilities for private
health insurance during the COVID-19 PHE have included the following for certain types of
plans, as specified:
 Allowing midyear plan design changes to increase telehealth coverage
 Allowing certain employers to offer coverage only for services provided via
telehealth and other remote care services
 Allowing telehealth coverage pre-deductible for catastrophic plans
 Allowing telehealth coverage pre-deductible for HSA-qualified HDHPs

16 Health plans offered by state-licensed insurers are subject to state health insurance requirements. Because self-
insured group plans are financed directly by the plan sponsor, such plans generally are not subject to such requirements.
17 State of Alaska, Department of Commerce, Community, and Economic Development, letter from Lori Wing-Heier,
director of the Division of Insurance, to all health insurers in the state of Alaska and other interested parties, Bulletin
20-18, October 2, 2020, at https://www.commerce.alaska.gov/web/Portals/11/Pub/INS_B20-18.pdf; State of Arizona,
Executive Order 2020-07, “Proactive Measures to Protect Against COVID-19,” March 11, 2020, at
https://azgovernor.gov/sites/default/files/eo_2020-07.pdf. Emergencies declared by a state governor or other state
organizations also may affect state laws.
18 For example, CCHP, “Private Payer Laws,” at https://www.cchpca.org/topic/private-payer-covid-19/. Others are
available at https://www.cchpca.org/policy-trends/. Some of the state laws/regulations highlighted in the survey are
broader than just private health insurance and cover telehealth policies with respect to other coverage types, such as
Medicaid.
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 Providing that COVID-19 testing coverage requirements apply with regard to
telehealth visits
As noted in Table 1, some of the policies are to end with the end of the COVID-19 PHE. Others
are to continue until the end of the applicable plan year or longer, in the case of telehealth
coverage pre-deductible for HSA-HDHPs.
As the COVID-19 PHE winds down, telehealth is likely to remain an important part of private
health insurance coverage.19 Many employers offer telehealth benefits to employees. According to
a 2022 survey, 87% of employers with 50-199 employees (considered small employers for the
purposes of this survey) offer telehealth benefits and 96% of employers with 200 or more
employees (considered large employers in this survey) offer telehealth benefits.20 Of surveyed
employers with 50 or more employees, about one-third (34%) expect telehealth use will increase
over the next year, whereas only 14% indicated it was likely to decrease.21 Telehealth for
behavioral health services was particularly emphasized; data indicate that 67% of small
employers and 86% of large employers noted that telehealth would be “very important” or
“important” to providing behavioral health services in the future.22
Congress may wish to monitor telehealth moving forward to determine if any of the flexibilities
offered for private health insurance plans during the COVID-19 PHE should be made permanent.
For example, legislation was introduced, but not enacted, in the 117th Congress that would have
added telehealth as an excepted benefit, allowing telehealth-only plans.23 Although such plans
may be useful in providing coverage, there may be questions as to the use and robustness of such
plans that Congress could choose to consider.

Author Information

Katherine M. Kehres

Analyst in Health Care Financing

19 See https://www.whitehouse.gov/wp-content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf.
20 Gary Claxton et al., Employer Health Benefits 2022 Annual Survey, Kaiser Family Foundation, October 27, 2022, pp.
191-195, at https://www.kff.org/health-costs/report/2022-employer-health-benefits-survey/. The number of small
employers offering telehealth benefits decreased from 94% in 2021 to 87% in 2022.
21 Ibid, see figure 13.8, p. 195. In addition, 42% of employers expect telehealth use to stay about the same and 10% said
they did not know.
22 Ibid, see figure 13.7, p. 194. Of the surveyed small employers, 36% indicated telehealth would be “very important”
for providing behavioral health services and 31% said it would be “important.” For large employers, 55% indicated
telehealth would be “very important” and 31% said it would “important.”
23 For example, H.R. 7353, the Telehealth Benefit Expansion for Workers Act of 2022.
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Telehealth Flexibilities in Private Health Insurance During the COVID-19 PHE

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Congressional Research Service
R47424 · VERSION 1 · NEW
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