Relief for Telehealth Coverage Under HDHPs … but There’s a Catch!

The following article was first posted on Shipman & Goodwin LLP’s Employment Law Letter. It is reposted here with permission.

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The Consolidated Appropriations Act 2022, signed into law by President Biden earlier this month, allows high deductible health plans to provide first-dollar coverage for telehealth and other remote care services for the period from April 1, 2022 to Dec. 31, 2022. 

This is an extension of relief first brought about by the Coronavirus Aid, Relief, and Economic Security Act, which permitted HDHPs to cover telehealth and remote care prior to the satisfaction of the HDHP deductible, and stand-alone coverage for telehealth and remote care pre-deductible, without impacting a participant’s ability to contribute to his or her health savings account.

The CARES Act relief was only available from Jan. 1, 2020 until Dec. 31, 2021 (for calendar year plans), so the CAA extends that relief from April to December 2022. 

The catch for calendar year plans is that no relief has been granted retroactively for January, February or March 2022.

By way of background, Internal Revenue Code section 223, and IRS notices issued thereunder, provide that an individual will not be eligible to contribute to an HSA if he or she has health coverage other than through a compatible HDHP. 

HSA Eligibility

Although there is no direct IRS guidance on how medical services provided by telehealth fit under these rules, the IRS has said that an HDHP will not be compatible with an HSA if it provides significant benefits in the nature of medical care before the minimum statutory deductible is satisfied (subject to certain exceptions, such as for preventive care, or dental or vision services). 

So, if a telehealth program provides significant medical benefits before the deductible is met, the covered individual would generally not be eligible to contribute to an HSA.

If a telehealth program provides significant medical benefits before the deductible is met, the covered individual would generally not be eligible to contribute to an HSA.

The CARES Act and CAA, read together, permit (but do not require) an HDHP to offer telehealth services pre-deductible without jeopardizing HSA eligibility, from Jan. 1, 2020 to Dec. 31, 2021 (for calendar year plans) and from April 1 to Dec. 31, 2022, but there is no provision in the CAA with respect to January, February or March 2022. 

As a result, the HDHP deductible would need to be applied to telehealth services for these three months in order for participants to maintain HSA eligibility.

Health plan sponsors should consider whether they want to take advantage of this relief for April through December 2022, and, if so, should amend their plans and SPDs (or issue SMMs) accordingly. 

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About the author: Kelly Smith Hathorn is a partner with Shipman & Goodwin LLP, who works with public and private sector employers on a variety of employee benefits issues.