Sec. 22. (a) An individual contract or a group contract must provide coverage for telehealth services in accordance with the same clinical criteria as the individual contract or the group contract provides coverage for the same health care services delivered to an enrollee in person.
(b) Coverage for telehealth services required by subsection (a) may not be subject to a dollar limit, copayment, or coinsurance requirement that is less favorable to an enrollee than the dollar limit, copayment, or coinsurance requirement that applies to the same health care services delivered to an enrollee in person.
(c) Any annual or lifetime dollar limit that applies to telehealth services must be the same annual or lifetime dollar limit that applies in the aggregate to all items and services covered under the individual contract or the group contract.
(d) This section does not do any of the following:
(1) Require an individual contract or a group contract to provide coverage for a telehealth service that is not a covered health care service under the individual contract or group contract.
(2) Require the use of telehealth services when the treating provider has determined that telehealth services are inappropriate.
(3) Prevent the use of utilization review concerning coverage for telehealth services in the same manner as utilization review is used concerning coverage for the same health care services delivered to an enrollee in person.
(e) A separate consent for telehealth services may not be required.
(f) If a policy provides coverage for telehealth services via:
(1) secure videoconferencing;
(2) store and forward technology; or
(3) remote patient monitoring technology;
between a provider in one (1) location and a patient in another location, the policy may not require the use of a specific information technology application for those services.
As added by P.L.185-2015, SEC.27. Amended by P.L.85-2021, SEC.32.
Structure Indiana Code
Article 13. Health Maintenance Organizations
Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage
27-13-7-0.1. Application of Certain Amendments to Chapter
27-13-7-1. Persons Entitled to Copies of Contracts
27-13-7-2. Deceptive Contract Provisions Prohibited
27-13-7-3. Contract Provisions
27-13-7-4. Compliance With Requirements; Ten Day Grace Period
27-13-7-5. Evidence of Coverage
27-13-7-6. Evidence of Coverage; Prohibited Provisions
27-13-7-7. Evidence of Coverage; Required Statement
27-13-7-7.5. Prohibition on Coverage of Abortion; Exceptions; Coverage Through Rider or Endorsement
27-13-7-8. Readability Standards
27-13-7-9. Approval of Forms by Commissioner
27-13-7-10. Coverage Outside Indiana; Commissioner's Approval Not Required
27-13-7-12. Additional Information Required by Commissioner
27-13-7-13. Continuation of Coverage Statement
27-13-7-14. Post-Mastectomy Coverage
27-13-7-14.5. Coverage for Nonexperimental, Surgical Treatment of Morbid Obesity
27-13-7-14.7. Coverage for Autism Spectrum Disorders
27-13-7-15. Dental Care Provisions Required
27-13-7-15.3. Breast Cancer Screening Mammography
27-13-7-16. Prostate Specific Antigen Test
27-13-7-17. Coverage for Colorectal Cancer Screening; Exception for Grandfathered Health Plans
27-13-7-18. Inherited Metabolic Disease Coverage
27-13-7-19. Coverage for Orthotic Devices and Prosthetic Devices
27-13-7-20. Prohibition on Chemotherapy Coverage Limitations
27-13-7-20.2. Coverage for Care Related to Cancer Clinical Trials
27-13-7-20.4. Applicability; Coverage for Methadone for Treatment of Pain
27-13-7-21. High Breast Density
27-13-7-23. Step Therapy Protocol
27-13-7-24. Coverage for Anatomical Gifts, Transplantation, or Related Health Care Services
27-13-7-24.5. Coverage for Chronic Pain Management
27-13-7-26. Coverage for Pediatric Neuropsychiatric Disorders