FOR INFORMATION ON COVID-19 AND TELE-HEALTH / TELE-MEDICINE IN NEW JERSEY, SEE INFORMATION BELOW FROM THE STATE OF NJ. |
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COVID-19 and Telehealth and Telemedicine (NJ)
Frequently Asked Questions
What is telehealth? Can I use it to visit my doctor?
Telehealth or telemedicine allows you to have a live telephone or video consultation with your doctor without visiting their office in person. During the COVID-19 emergency, telehealth is quickly becoming a widely used option for patients across New Jersey to receive care.
Did the state expand access to telehealth and telemedicine?
Yes. Legislation (A3860 and A3862) signed on March 19, 2020 expands access to telehealth services in response to COVID-19 and allows professional and occupational licensing boards to expedite licensure of out-of-state professionals during the state of emergency and public health emergency.
Telehealth allows you to access care for many conditions without leaving your home and risking COVID-19 exposure. It also protects health care workers by reducing their exposure.
Telehealth visits with various types of providers are now covered by most insurance plans. Additional information is available in this press release.
Will my insurance cover telehealth visits?
Your coverage will depend on your specific health insurance plan. For the duration of the state of emergency and public health emergency declared by Governor Murphy, fully insured health plans issued in New Jersey must cover, without cost-sharing (i.e., copayments, deductibles, or coinsurance), any healthcare services or supplies delivered or obtained via telemedicine or telehealth as required by a recently enacted law, P.L. 2020, c.7. The Department of Banking and Insurance is requiring that rates of payment by insurers to in-network providers for services delivered via telemedicine or telehealth are not lower than the rates of payment established by the carrier for the same services when delivered in-person.
Other types of coverage, such as Medicare, the State Health Benefits Plan and the School Employees Health Benefits Plans, and other self-funded health benefits plans may have different rules.
Will services be covered the same if I visit an in-network or an out-of-network provider?
For fully insured health plans, telehealth and telemedicine services are covered without cost sharing to the consumer for services by in-network providers. Additionally, if an in-network provider is not available, carriers must grant an in-plan exception and allow the consumer to see an out-of-network provider without cost sharing. Therefore, if you have a network-based plan and cannot access an in-network provider for telehealth services, you should consult your health insurer to determine your options for out-of-network services without cost sharing. If you have a plan with out-of-network benefits and wish to see an out-of-network provider and do not request an in-plan exception, your plan should cover out-of-network telehealth services as if those services were provided in-person and out-of-network cost sharing will apply.
Does the expansion of telehealth and telemedicine include services offered by mental health and behavioral health providers, physical therapists, occupational therapists, and speech therapists?
Yes. All services for which physical contact between the provider and patient is not essential can be rendered via telehealth and telemedicine. Such services include, but are not limited to, physical, speech and occupational therapy, applied behavioral analysis, and mental health services. And although certain services rendered by a provider may require physical contact, other services by the same provider that do not require physical contact can be rendered by telehealth and telemedicine. Telehealth and telemedicine services, including those provided by in-network mental health and behavioral health providers, physical, occupational and speech therapists must be covered without cost-sharing. Carriers must also grant any requested in-plan exceptions for individuals to access out-of-network telehealth providers if network telehealth providers are not available.
Who can I contact if I am not able to resolve an issue with my health insurer related to telehealth and telemedicine, or if I have a complaint about an insurance company?
For inquiries and complaints related to coverage in the individual, small and large group fully insured markets, consumers may call the Department of Banking and Insurance at 1-800-446-7467 (8:30 am to 5:00 pm EST Monday through Friday), or visit the department website at www.dobi.nj.gov – and click on Consumer Assistance – Inquiries and Complaints.
Telehealth or telemedicine allows you to have a live telephone or video consultation with your doctor without visiting their office in person. During the COVID-19 emergency, telehealth is quickly becoming a widely used option for patients across New Jersey to receive care.
Did the state expand access to telehealth and telemedicine?
Yes. Legislation (A3860 and A3862) signed on March 19, 2020 expands access to telehealth services in response to COVID-19 and allows professional and occupational licensing boards to expedite licensure of out-of-state professionals during the state of emergency and public health emergency.
Telehealth allows you to access care for many conditions without leaving your home and risking COVID-19 exposure. It also protects health care workers by reducing their exposure.
Telehealth visits with various types of providers are now covered by most insurance plans. Additional information is available in this press release.
Will my insurance cover telehealth visits?
Your coverage will depend on your specific health insurance plan. For the duration of the state of emergency and public health emergency declared by Governor Murphy, fully insured health plans issued in New Jersey must cover, without cost-sharing (i.e., copayments, deductibles, or coinsurance), any healthcare services or supplies delivered or obtained via telemedicine or telehealth as required by a recently enacted law, P.L. 2020, c.7. The Department of Banking and Insurance is requiring that rates of payment by insurers to in-network providers for services delivered via telemedicine or telehealth are not lower than the rates of payment established by the carrier for the same services when delivered in-person.
Other types of coverage, such as Medicare, the State Health Benefits Plan and the School Employees Health Benefits Plans, and other self-funded health benefits plans may have different rules.
Will services be covered the same if I visit an in-network or an out-of-network provider?
For fully insured health plans, telehealth and telemedicine services are covered without cost sharing to the consumer for services by in-network providers. Additionally, if an in-network provider is not available, carriers must grant an in-plan exception and allow the consumer to see an out-of-network provider without cost sharing. Therefore, if you have a network-based plan and cannot access an in-network provider for telehealth services, you should consult your health insurer to determine your options for out-of-network services without cost sharing. If you have a plan with out-of-network benefits and wish to see an out-of-network provider and do not request an in-plan exception, your plan should cover out-of-network telehealth services as if those services were provided in-person and out-of-network cost sharing will apply.
Does the expansion of telehealth and telemedicine include services offered by mental health and behavioral health providers, physical therapists, occupational therapists, and speech therapists?
Yes. All services for which physical contact between the provider and patient is not essential can be rendered via telehealth and telemedicine. Such services include, but are not limited to, physical, speech and occupational therapy, applied behavioral analysis, and mental health services. And although certain services rendered by a provider may require physical contact, other services by the same provider that do not require physical contact can be rendered by telehealth and telemedicine. Telehealth and telemedicine services, including those provided by in-network mental health and behavioral health providers, physical, occupational and speech therapists must be covered without cost-sharing. Carriers must also grant any requested in-plan exceptions for individuals to access out-of-network telehealth providers if network telehealth providers are not available.
Who can I contact if I am not able to resolve an issue with my health insurer related to telehealth and telemedicine, or if I have a complaint about an insurance company?
For inquiries and complaints related to coverage in the individual, small and large group fully insured markets, consumers may call the Department of Banking and Insurance at 1-800-446-7467 (8:30 am to 5:00 pm EST Monday through Friday), or visit the department website at www.dobi.nj.gov – and click on Consumer Assistance – Inquiries and Complaints.
Insurance coverage
Telehealth and telemedicine have also been expanded for consumers covered by the following programs. Consumers with questions or complaints regarding the below programs may contact our partner agencies using the information below.
For inquiries related to public employee health benefits coverage, the Department of the Treasury recommends employees contact their appropriate carrier or contact the Division of Pensions and Benefits with any questions:
For inquiries related to Medicaid, consumers may visit NJFamilyCare.org contact the NJ FamilyCare hotline: 1-800-701-0710.
SOURCE: New Jersey Department of Banking & Insurance (https://www.state.nj.us/dobi/covid/telehealth.html)
For inquiries related to public employee health benefits coverage, the Department of the Treasury recommends employees contact their appropriate carrier or contact the Division of Pensions and Benefits with any questions:
- Horizon BCBSNJ, as administrator of SHBP/SEHBP: 1-800-414-SHBP (7427)
- Aetna, as administrator of SHBP/SEHBP: 1-866-234-3129
- Division of Pensions and Benefits Call Center: 609-292-7524
For inquiries related to Medicaid, consumers may visit NJFamilyCare.org contact the NJ FamilyCare hotline: 1-800-701-0710.
SOURCE: New Jersey Department of Banking & Insurance (https://www.state.nj.us/dobi/covid/telehealth.html)
