Telemedicine Benefit – 2017

The Affordable Care Act (ACA, aka Obamacare) contains reforms that go beyond how health insurance is paid and what benefits must be covered. The law also has an impact on the way our medical needs are delivered. Effective January 1st, 2017 all fully insured health plans are required to include some form of Telemedicine. Telemedicine is not a new product or idea, but has been evolving into a very practical way of offering medical care for non-life threatening needs. And, as an added benefit, it saves both time and money for the consumer (employer/employee/covered individual) and the insurance carrier.

Most carriers have partnered with a third-party vendor to deliver this service. Included in your fully insured 2017 health plan will be the ability to call or video chat (i.e., FaceTime, Skype, Facebook Live, etc.) a provider in the Telemedicine vendors network. This service can be used for common issues like allergies, pink eye, rashes, insect bites, cold and flu. Basic ailments that don’t necessarily require sitting in a waiting room (and exposing yourself to more illnesses).

Doctors are able to diagnose illness and prescribe medication and the outcome of the interaction is immediately sent to the patients primary care doctor. Most services will also provide a printout after the visit with follow up care instructions.

The cost of this service, depending on the vendor, is approximately $40 per call and will be treated like an office visit in your health plan. Payment is often confirmed prior to the visit by entering insurance and credit card information and going through the “on-boarding” process. The goal of this service is to provide high level care for common ailments in a more cost effective manner than office or facility visits.

Telemedicine is a mandated benefit in all fully insured plans, but self-funded employer groups have the option of including the service for a per-member per-month fee.

An emergency room visit will easily cost the insured plan a minimum of $500. Urgent care $150 per occurrence. If telemedicine can reduce that cost to $40 for an easily diagnosed and treatable condition, then we’re using technology to push us in the right direction. If you have any questions about how this will be implemented in your health plan, call your KBM Account Manager today.