N.Y. Insurance Law Section 4306-G
Telehealth delivery of services

* (a) (1) A corporation shall not exclude from coverage a service that is otherwise covered under a contract 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 a corporation may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the contract. A corporation 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. A corporation 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)

A corporation 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 the distant site occur within the clinic or other facility. The superintendent may promulgate regulations to implement the provisions of this section.

(3)

A corporation 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, 2024 * (a) A corporation shall not exclude from coverage a service that is otherwise covered under a contract 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 a corporation may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the contract. A corporation 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. A corporation 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, 2024 (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.

Source: Section 4306-G — Telehealth delivery of services, https://www.­nysenate.­gov/legislation/laws/ISC/4306-G (updated Apr. 22, 2022; accessed Nov. 25, 2023).

4301
Organization of corporation 4302
Permit and license to do business 4303
Benefits 4303–A
Prescription synchronization 4304
Individual contracts 4305
Group contracts 4306
Required contract provisions 4306–A
Health insurance coverage for full-time students on medical leaves of absence 4306–B
Primary and preventive obstetric and gynecologic care 4306–C
Grievance procedure and access to specialty care 4306–D
Choice of health care provider 4306–E
Prohibition on lifetime and annual limits 4306–F
Maternal depression screenings 4306–G
Telehealth delivery of services 4306–H
Essential health benefits package and limit on cost-sharing 4306–I
Coverage for medically fragile children 4307
Providers of services 4308
Supervision of superintendent 4309
Limitation on expenses 4310
Investments 4312
Employment of solicitors 4313
Applicability of other provisions of this chapter 4314
Not to affect provisions of workers’ compensation law 4315
Arbitration 4316
Individual contracts 4317
Rating of individual and small group health insurance contracts 4318
Pre-existing condition provisions 4318–A
Certification of creditable coverage by corporations organized under this article 4320
Limitations on administrative services and stop-loss coverage 4321
Standardization of individual enrollee direct payment contracts offered by health maintenance organizations prior to October first, two t... 4321–A
Fund for standardized individual enrollee direct payment contracts 4322
Standardization of individual enrollee direct payment contracts offered by health maintenance organizations which provide out-of-plan ben... 4322–A
Fund for standardized individual enrollee direct payment contracts which provide out-of-plan benefits 4323
Marketing materials 4324
Disclosure of information 4325
Prohibitions 4326
Standardized health insurance contracts for qualifying small employers and individuals 4327
Stop loss funds for standardized health insurance contracts issued to qualifying small employers and qualifying individuals 4328
Individual enrollee direct payment contracts offered by health maintenance organization on and after October first, two thousand thirteen 4329
Prescription drug coverage 4330
Discrimination because of sex or marital status in hospital, surgical or medical expense insurance
Green check means up to date. Up to date

Accessed:
Nov. 25, 2023

Last modified:
Apr. 22, 2022

§ 4306-G’s source at nysenate​.gov

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