Telemedicine Benefits & Compliance Issues

Telemedicine is becoming increasingly popular, and with good reason … a telemedicine program allows individuals to use technology such as videoconferencing in order to access medical care without actually visiting a provider. For many less-complex medical issues, a virtual visit to a medical professional can be a big saver of time and money.

There are, however, some compliance concerns for employers offering telemedicine benefits, which we’ll briefly summarize here:

The Affordable Care Act (ACA): The reasoning is complex, but the guidance is simple: in most cases, a telemedicine benefit that is a component of a group medical plan will be free of compliance issues. A stand-alone telemedicine benefit may not comply, and may even run afoul of the ACA’s preventive care mandate, triggering an excise tax of $100 per day for each individual to whom the failure to comply relates.

The Employee Retirement Security Act (ERISA): Employers commonly integrate (or wrap) their telemedicine benefits with their group medical plans, and combining these under one ERISA plan eases the task of satisfying ERISA reporting requirements. A telemedicine plan, for example, may be described within the group’s medical plan SPD and included in the plan’s Form 5500 filing, if applicable. As with all ERISA requirements, government entities and churches are exempt.

COBRA: Telemedicine benefits are considered group health plans that are subject to COBRA because they provide medical care. When those benefits are integrated, an employer should design its COBRA practices so that only qualified beneficiaries who elect COBRA for the group medical plan are eligible for telemedicine benefits.

HSA Eligibility: Employers offering high-deductible health plans (HDHPs) compatible with health savings accounts (HSAs) should consider how a telemedicine benefit may impact their participants’ HSA eligibility.  Although the IRS has not yet specifically addressed the impact of telemedicine on HSA eligibility, as a general rule, telemedicine programs that provide free or reduced-cost medical benefits before the HDHP deductible is satisfied are disqualifying coverage for purposes of HSA eligibility.

Questions about compliance concerns associated with telemedicine coverage, or other benefits issues? Contact Consolidated Insurance.