Commercial Payer Policies
TELEHEALTH DEFINITION: “The delivery of health care services through the use of HIPAA-compliant interactive audio-video.” Does not include audio-only, email, text, mail, or fax.
SERVICE PARITY: “No health insurer may exclude a service for coverage solely because the service is provided through telehealth and not provided through in-person consultation or contact between a health care professional and a patient.” Additionally, insurers “may not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth.”
- These requirements DO NOT apply to policies that ONLY provide coverage for: Specified disease; Hospital indemnity; Fixed indemnity; Accident-only; Credit accident and health insurance; Vision; Prescription drug; Medicare supplement; Long-term care; Disability income insurance; Coverage issued as a supplement to liability insurance; Workers' compensation or similar insurance; Automobile medical payment insurance; or Individual health benefit plans of six-months or less duration that are not renewable.
Temporary COVID-19 Policies (SD Commercial Payers)
WAIVED REQUIREMENTS: Audio-only telehealth can be used
- Telehealth may be used before patient-provider relationship has been established
- Providers can prescribe medication via telehealth
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