High Deductible Health Plan Telehealth Relief, Extended Again! | Snell and Wilmer

If you are sponsoring a high-deductible (“HDHP”) health plan and have followed telehealth relief, your head may be spinning and rightly so! Various laws and guidelines have impacted HDHPs and telehealth since 2020 and more recently new legislation has extended the relief for the 2023 and 2024 plan years. The relief allows, but does not require, that HDHPs provide telehealth and other remote care services on a pre-deductible basis without rendering participants’ Health Savings Accounts (“HSA”) ineligible.

Below is a brief summary of laws impacting HDHPs and telehealth since 2020:

  • Long-standing pre-COVID-19 Internal Revenue Service (“IRS”) telehealth rule – Under Section 223 of the Internal Revenue Code (“Code”), if an HDHP provides non-preventive care, including telehealth and other remote care services to a participant before the minimum deductible is satisfied, the plan will not be an HDHP, disqualifying individuals covered by the HDHP from being eligible to make or receive tax-advantaged HSA contributions.
  • Section 6001 of the Coronavirus Response Act First for Families (“FFCRA”) – In response to COVID-19, Congress passed legislation that requires group health plans to cover (without cost-sharing, prior authorization, or medical management requirements) certain COVID-19 diagnostic tests and related services provided during visits telehealth (as well as in-person, urgent care, and emergency room visits) until the COVID-19 public health emergency is over.
  • IRS Notice 2020-15 – The IRS made an exception allowing HDHPs to cover COVID-19 testing and treatment on a pre-deductible basis, but provided no relief for waiving HDHP deductibles for telehealth visits that are not not intended for testing or treatment of COVID-19.
  • Coronavirus Aid, Recovery and Economic Security Act (the “CARES Act”) Section 3701 and IRS Notice 2020-29 – Congress amended the Code so that an HDHP may provide telehealth and other remote care services on a pre-deductible basis, without affecting an individual’s ability to contribute to an HSA, for services provided on or after January 1, 2020 and plan years beginning on or before December 31, 2021.
  • Consolidated Appropriations Act 2022 (“CAA 2022”), Section 307– Congress extended HDHP telehealth relief under the CARES Act from April 1, 2022 to December 31, 2022, including leaving a three-month gap between January 1, 2022 and March 31, 2022.
  • Consolidated Appropriations Act, 2023 (“CAA 2023”) Section 4151- Congress extended HDHP telehealth relief under the 2022 CAA to plan years beginning before January 1, 2025. For calendar year plans, this extension means the plan can provide the relief telehealth for plan years 2023 and 2024. However, for non-calendar plan years, this may leave a gap in coverage.

Below are some additional questions that employers may want to consider:

  • CAA 2023 Telehealth Relief is optional. Employers may, but are not required to, provide telehealth and other remote care services on a pre-deductible basis. However, employers who choose not to provide telehealth on a pre-deductible basis must still comply with the FFCRA which, as noted above, requires group health plans to cover (without cost sharing, prior authorization or medical management requirements) certain COVID-19 diagnostic tests and related services provided during telehealth visits until the end of the public health emergency.
  • The 2023 CAA telehealth relief is temporary. Although various organizations are pushing to make this relief permanent, it is currently scheduled to expire on December 31, 2024 for calendar year plans.
  • Whether or not an HDHP is taking advantage of the 2023 CAA Telehealth relief, the plan sponsor must clearly state whether they are providing telehealth and other remote care services on a pre-deductible basis. This may require a plan amendment, revised SPD, or summary of material changes and is particularly important for non-calendar year plans that cannot provide telehealth and other remote care services on a predeductible basis for months of the year of the plan 2022 which fall in 2023 .
High Deductible Health Plan Telehealth Relief, Extended Again! | Snell and Wilmer

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