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Telemedicine Cost Share Waiver for Non-COVID-19-Related Services to End

There is a change to the waiver of out-of-pocket costs related to a new state law, P.L. 2021, c.310. This law expands coverage for all forms of health care services delivered via telehealth or telemedicine, however it repeals previous laws which required health plans to waive cost share for telemedicine and telehealth services. Effective February 3, 2022, the cost share waiver for non-COVID-19-related telemedicine and telehealth visits, which Horizon implemented at the beginning of the COVID-19 pandemic, will end. This means patients who are covered by a fully insured health plan, the State Health Benefits Program (SHBP) or the School Employees’ Health Benefits Program (SEHBP) will once again be responsible for cost sharing if the purpose of the telemedicine or telehealth visit is for anything other than an individualized clinical assessment that results in an order for COVID-19 testing. These members will be responsible for applicable cost sharing under the terms and conditions of their plan.

This aligns with the change that was effective on January 1, 2022 for self-insured members.

This change does not affect Horizon Medicare Advantage, Braven Health or Medicaid members at this time. We will provide any updates as needed.