What is the Status of Telemedicine Benefits in 2025?

There is bipartisan support to keep extending flexibility for telemedicine and to even make flexibility permanent. While Congress explores possible flexibility, here is the status of telemedicine with respect to employee benefits:

• HSA Qualified High Deductible Health Plan (QHDHP) plan years starting in 2025 must ensure that non-preventive telehealth services charge the member a fair market value for those services until the federal minimum deductible is met.
  • QHDHP plan years that started in 2024 were the last allowed to have low- or no-cost telehealth services.
     
• Employer-sponsored telemedicine benefits are considered group health plans, making them subject to many compliance obligations, including but not limited to:
  • Must be “integrated” with the employer’s major medical plan (i.e., the only individuals who should be allowed access to the telemedicine program are employees and family members enrolled in the employer’s major medical plan)
  • Must be included on the Summary of Benefits and Coverage (SBC) or have its own SBC.
  • Must have a plan document/SPD.
  • Must be included in COBRA offers.
  • Must comply with MHPAEA, including the required parity analysis and NQTL analysis.
  • Must comply with HIPAA.
  • Must not have prohibited gag clauses in service agreements.
  • Must provide data to support RxDC reporting requirements and other CAA-21 transparency requirements.

While telemedicine is a popular benefit for many employers, it is important to understand that these benefits are viewed as group health plans themselves, and carry with them many compliance obligations.
 
In addition, employers offering an HSA QHDHPs with a telemedicine component should ensure the fair market value for telemedicine services is charged for plan years beginning in 2025.  Otherwise, low or no-cost telehealth services paid prior to the minimum deductible are considered disqualifying coverage for purposes of HSA eligibility.