Pennsylvania § 4803 - Insurance coverage of telemedicine.

§ 4803. Insurance coverage of telemedicine.

(a) General rule.--

(1) A health insurance policy offered, issued or renewed in this Commonwealth shall provide coverage for medically necessary health care services provided through telemedicine and delivered by a participating network provider who provides a covered health care service through telemedicine consistent with the insurer's medical policies. A health insurance policy may not exclude a health care service from coverage solely because the health care service is provided through telemedicine.

(2) Subject to paragraph (1), an insurer shall pay or reimburse a participating network provider for covered health care services delivered through telemedicine and pursuant to a health insurance policy in accordance with the terms and conditions of the contract as negotiated between the insurer and the participating network provider. A contract that includes payment or reimbursement for covered health care services delivered through telemedicine may not prohibit payment or reimbursement solely because a health care service is provided by telemedicine. Payment or reimbursement may not be conditioned upon the use of an exclusive or proprietary telemedicine technology or vendor.

(b) Applicability.--

(1) Subsection (a) does not apply if the telemedicine-enabling device, technology or service fails to comply with the Health Insurance Portability and Accountability Act of 1996, the Health Information Technology for Economic and Clinical Health Act or other applicable statute, regulation or guidance.

(2) For a health insurance policy for which either rates or forms are required to be filed with the Federal Government or the department, this section shall apply to a policy for which a form or rate is first filed on or after 180 days after the effective date of this paragraph.

(3) For a health insurance policy for which neither rates nor forms are required to be filed with the Federal Government or the department, this section shall apply to a policy issued or renewed on or after 180 days after the effective date of this paragraph.

(c) Construction.--This section may not be construed to:

(1) Prohibit an insurer from paying or reimbursing other health care providers for covered health care services provided through telemedicine.

(2) Require an insurer to pay or reimburse an out-of-network health care provider for health care services provided through telemedicine.

(3) Require an insurer to pay or reimburse a participating network provider if the provision of the health care service through telemedicine would be inconsistent with the standard of care.