§ 38.2-3418.16. Coverage for telemedicine services.
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing toissue individual or group accident and sickness insurance policies providinghospital, medical and surgical, or major medical coverage on anexpense-incurred basis; each corporation providing individual or groupaccident and sickness subscription contracts; and each health maintenanceorganization providing a health care plan for health care services shallprovide coverage for the cost of such health care services provided throughtelemedicine services, as provided in this section.
B. As used in this section, "telemedicine services," as it pertains to thedelivery of health care services, means the use of interactive audio, video,or other electronic media used for the purpose of diagnosis, consultation, ortreatment. "Telemedicine services" do not include an audio-only telephone,electronic mail message, or facsimile transmission.
C. An insurer, corporation, or health maintenance organization shall notexclude a service for coverage solely because the service is provided throughtelemedicine services and is not provided through face-to-face consultationor contact between a health care provider and a patient for servicesappropriately provided through telemedicine services.
D. An insurer, corporation, or health maintenance organization shall not berequired to reimburse the treating provider or the consulting provider fortechnical fees or costs for the provision of telemedicine services; however,such insurer, corporation, or health maintenance organization shall reimbursethe treating provider or the consulting provider for the diagnosis,consultation, or treatment of the insured delivered through telemedicineservices on the same basis that the insurer, corporation, or healthmaintenance organization is responsible for coverage for the provision of thesame service through face-to-face consultation or contact.
E. Nothing shall preclude the insurer, corporation, or health maintenanceorganization from undertaking utilization review to determine theappropriateness of telemedicine services, provided that such appropriatenessis made in the same manner as those determinations are made for the treatmentof any other illness, condition, or disorder covered by such policy,contract, or plan. Any such utilization review shall not requirepre-authorization of emergent telemedicine services.
F. An insurer, corporation, or health maintenance organization may offer ahealth plan containing a deductible, copayment, or coinsurance requirementfor a health care service provided through telemedicine services, providedthat the deductible, copayment, or coinsurance does not exceed thedeductible, copayment, or coinsurance applicable if the same services wereprovided through face-to-face diagnosis, consultation, or treatment.
G. No insurer, corporation, or health maintenance organization shall imposeany annual or lifetime dollar maximum on coverage for telemedicine servicesother than an annual or lifetime dollar maximum that applies in the aggregateto all items and services covered under the policy, or impose upon any personreceiving benefits pursuant to this section any copayment, coinsurance, ordeductible amounts, or any policy year, calendar year, lifetime, or otherdurational benefit limitation or maximum for benefits or services, that isnot equally imposed upon all terms and services covered under the policy,contract, or plan.
H. The requirements of this section shall apply to all insurance policies,contracts, and plans delivered, issued for delivery, reissued, or extended inthe Commonwealth on and after January 1, 2011, or at any time thereafter whenany term of the policy, contract, or plan is changed or any premiumadjustment is made.
I. This section shall not apply to short-term travel, accident-only, limitedor specified disease, or individual conversion policies or contracts, nor topolicies or contracts designed for issuance to persons eligible for coverageunder Title XVIII of the Social Security Act, known as Medicare, or any othersimilar coverage under state or federal governmental plans.
§ 38.2-3418.16. Coverage for telemedicine services.
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing toissue individual or group accident and sickness insurance policies providinghospital, medical and surgical, or major medical coverage on anexpense-incurred basis; each corporation providing individual or groupaccident and sickness subscription contracts; and each health maintenanceorganization providing a health care plan for health care services shallprovide coverage for the cost of such health care services provided throughtelemedicine services, as provided in this section.
B. As used in this section, "telemedicine services," as it pertains to thedelivery of health care services, means the use of interactive audio, video,or other electronic media used for the purpose of diagnosis, consultation, ortreatment. "Telemedicine services" do not include an audio-only telephone,electronic mail message, or facsimile transmission.
C. An insurer, corporation, or health maintenance organization shall notexclude a service for coverage solely because the service is provided throughtelemedicine services and is not provided through face-to-face consultationor contact between a health care provider and a patient for servicesappropriately provided through telemedicine services.
D. An insurer, corporation, or health maintenance organization shall not berequired to reimburse the treating provider or the consulting provider fortechnical fees or costs for the provision of telemedicine services; however,such insurer, corporation, or health maintenance organization shall reimbursethe treating provider or the consulting provider for the diagnosis,consultation, or treatment of the insured delivered through telemedicineservices on the same basis that the insurer, corporation, or healthmaintenance organization is responsible for coverage for the provision of thesame service through face-to-face consultation or contact.
E. Nothing shall preclude the insurer, corporation, or health maintenanceorganization from undertaking utilization review to determine theappropriateness of telemedicine services, provided that such appropriatenessis made in the same manner as those determinations are made for the treatmentof any other illness, condition, or disorder covered by such policy,contract, or plan. Any such utilization review shall not requirepre-authorization of emergent telemedicine services.
F. An insurer, corporation, or health maintenance organization may offer ahealth plan containing a deductible, copayment, or coinsurance requirementfor a health care service provided through telemedicine services, providedthat the deductible, copayment, or coinsurance does not exceed thedeductible, copayment, or coinsurance applicable if the same services wereprovided through face-to-face diagnosis, consultation, or treatment.
G. No insurer, corporation, or health maintenance organization shall imposeany annual or lifetime dollar maximum on coverage for telemedicine servicesother than an annual or lifetime dollar maximum that applies in the aggregateto all items and services covered under the policy, or impose upon any personreceiving benefits pursuant to this section any copayment, coinsurance, ordeductible amounts, or any policy year, calendar year, lifetime, or otherdurational benefit limitation or maximum for benefits or services, that isnot equally imposed upon all terms and services covered under the policy,contract, or plan.
H. The requirements of this section shall apply to all insurance policies,contracts, and plans delivered, issued for delivery, reissued, or extended inthe Commonwealth on and after January 1, 2011, or at any time thereafter whenany term of the policy, contract, or plan is changed or any premiumadjustment is made.
I. This section shall not apply to short-term travel, accident-only, limitedor specified disease, or individual conversion policies or contracts, nor topolicies or contracts designed for issuance to persons eligible for coverageunder Title XVIII of the Social Security Act, known as Medicare, or any othersimilar coverage under state or federal governmental plans.
§ 38.2-3418.16. Coverage for telemedicine services.
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing toissue individual or group accident and sickness insurance policies providinghospital, medical and surgical, or major medical coverage on anexpense-incurred basis; each corporation providing individual or groupaccident and sickness subscription contracts; and each health maintenanceorganization providing a health care plan for health care services shallprovide coverage for the cost of such health care services provided throughtelemedicine services, as provided in this section.
B. As used in this section, "telemedicine services," as it pertains to thedelivery of health care services, means the use of interactive audio, video,or other electronic media used for the purpose of diagnosis, consultation, ortreatment. "Telemedicine services" do not include an audio-only telephone,electronic mail message, or facsimile transmission.
C. An insurer, corporation, or health maintenance organization shall notexclude a service for coverage solely because the service is provided throughtelemedicine services and is not provided through face-to-face consultationor contact between a health care provider and a patient for servicesappropriately provided through telemedicine services.
D. An insurer, corporation, or health maintenance organization shall not berequired to reimburse the treating provider or the consulting provider fortechnical fees or costs for the provision of telemedicine services; however,such insurer, corporation, or health maintenance organization shall reimbursethe treating provider or the consulting provider for the diagnosis,consultation, or treatment of the insured delivered through telemedicineservices on the same basis that the insurer, corporation, or healthmaintenance organization is responsible for coverage for the provision of thesame service through face-to-face consultation or contact.
E. Nothing shall preclude the insurer, corporation, or health maintenanceorganization from undertaking utilization review to determine theappropriateness of telemedicine services, provided that such appropriatenessis made in the same manner as those determinations are made for the treatmentof any other illness, condition, or disorder covered by such policy,contract, or plan. Any such utilization review shall not requirepre-authorization of emergent telemedicine services.
F. An insurer, corporation, or health maintenance organization may offer ahealth plan containing a deductible, copayment, or coinsurance requirementfor a health care service provided through telemedicine services, providedthat the deductible, copayment, or coinsurance does not exceed thedeductible, copayment, or coinsurance applicable if the same services wereprovided through face-to-face diagnosis, consultation, or treatment.
G. No insurer, corporation, or health maintenance organization shall imposeany annual or lifetime dollar maximum on coverage for telemedicine servicesother than an annual or lifetime dollar maximum that applies in the aggregateto all items and services covered under the policy, or impose upon any personreceiving benefits pursuant to this section any copayment, coinsurance, ordeductible amounts, or any policy year, calendar year, lifetime, or otherdurational benefit limitation or maximum for benefits or services, that isnot equally imposed upon all terms and services covered under the policy,contract, or plan.
H. The requirements of this section shall apply to all insurance policies,contracts, and plans delivered, issued for delivery, reissued, or extended inthe Commonwealth on and after January 1, 2011, or at any time thereafter whenany term of the policy, contract, or plan is changed or any premiumadjustment is made.
I. This section shall not apply to short-term travel, accident-only, limitedor specified disease, or individual conversion policies or contracts, nor topolicies or contracts designed for issuance to persons eligible for coverageunder Title XVIII of the Social Security Act, known as Medicare, or any othersimilar coverage under state or federal governmental plans.
