If you are a small or midsize business HR lead or benefits administrator evaluating telemedicine options to add to your group health benefits package, you have likely received employee requests for more flexible, lower-cost access to non-emergency care. Many employers add telemedicine to reduce barriers to care for employees who work non-standard hours, live in rural areas with limited in-person provider access, or need quick prescription refills for routine conditions. This resource outlines the key details to confirm before you sign a contract, plus an actionable checklist to evaluate all potential options.
Direct answer
Before you add a telemedicine benefit—either as an embedded feature of your existing group health plan or a standalone third-party add-on—you need to confirm alignment with your current coverage, employee needs, internal policies, and federal and state compliance rules. The following Telemedicine Add-On Checklist covers all core requirements to verify during your evaluation:
Telemedicine Add-On Checklist
☐ Existing plan coordination rules: Confirm if in-network telehealth visits count toward the deductible the same as in-person primary care visits, and if your carrier will reimburse for visits from a third-party telemedicine vendor if you select a separate add-on.
☐ Covered service categories: Verify that the telemedicine offering includes the service types your employees have requested (e.g. urgent care for minor ailments, psychiatric talk therapy, prescription refills for maintenance medications, dermatology screenings, pediatric care).
☐ Provider network requirements: Confirm that all telemedicine providers are licensed to practice in every state where your employees reside, and that you can share a real-time provider directory with staff before open enrollment.
☐ Cost sharing for employees: Confirm flat copay amounts, if any, for each visit type, and whether there are any hidden fees for after-hours visits, prescription delivery, or specialist referrals sent via telehealth. Illustrative example: A telemedicine plan with a $15 copay for urgent care visits would mean an employee pays $15 out of pocket for a visit to treat a cold, compared to a $30 copay for an in-person urgent care visit and a $150 copay for an emergency room visit for the same symptom.
☐ Waiting period rules: Confirm if telemedicine access is active on the first day of coverage, or if there is a separate waiting period that applies only to telehealth services.
☐ HIPAA and privacy compliance: Confirm that the telemedicine platform meets all federal HIPAA requirements for protecting patient health information, including end-to-end encryption for video calls and secure messaging.
☐ Internal policy alignment: Confirm if your existing paid time off (PTO) policy will allow employees to take 15-30 minute telehealth visits during work hours without using PTO, if you choose to offer that flexibility to drive usage.
☐ Reporting access: Confirm that you will receive anonymized, aggregate usage data to measure how many employees are using the benefit, without accessing individual patient health records that are protected under HIPAA.
☐ Dependent eligibility: Confirm if spouses, domestic partners, and dependent children covered under your group plan are eligible for the same telemedicine benefits as primary employees.
☐ Termination terms: Confirm if you can drop the telemedicine add-on outside of open enrollment if usage is extremely low, or if you are locked into a 12-month contract regardless of usage.
Completing this checklist will eliminate most common post-implementation surprises, such as employees discovering mental health visits are not covered, or that they have to pay full price for visits because the vendor’s providers are not licensed in their state of residence.
Common questions
Below are answers to the most frequent questions employers ask when evaluating telemedicine add-ons:
Can I offer telemedicine as a voluntary benefit, or does it have to be part of core coverage?
You can offer telemedicine either as part of your core group health benefits (with the business covering all or part of the premium) or as a voluntary benefit where employees pay the full premium via payroll deduction. Confirm with your carrier or broker if voluntary telemedicine add-ons qualify for pre-tax treatment under your company’s cafeteria plan.
Do telemedicine visits count toward the Affordable Care Act’s (ACA) essential health benefit requirements?
This depends on the service type and your specific plan design. For example, a telehealth visit for a minor sinus infection counts the same as an in-person urgent care visit for essential health benefit tracking, but an elective cosmetic telehealth consultation likely does not. Confirm all coverage classifications in your official Summary of Benefits and Coverage (SBC) before adding the benefit.
Can employees use telemedicine to get prescriptions for controlled substances?
Rules for controlled substance prescriptions via telehealth vary by state and current federal guidance. Most telemedicine vendors will only prescribe controlled substances if the patient has an existing established in-person relationship with a provider, or if specific emergency exceptions apply. Ask your vendor for a full list of prescription limitations that apply to their offering.
Will adding telemedicine reduce our overall group health premiums?
There is no guaranteed impact on group health premiums when you add a telemedicine benefit. Some carriers may offer minor adjustments to rates if telemedicine is shown to reduce emergency room usage for minor ailments over time, but you should not assume a premium reduction will apply. Confirm any potential rate impacts directly with your carrier before signing a contract.
What this page cannot settle
This resource is for educational purposes only, and cannot resolve highly specific questions that depend on your unique business, plan design, or location:
- This page cannot confirm if a specific telemedicine vendor is compliant with your state’s unique insurance regulations, as telehealth coverage mandates vary widely by state.
- This page cannot advise you on how to structure cost sharing to meet minimum value requirements for your ACA-compliant group plan, as that depends on your specific plan design and employee population.
- This page cannot give you guidance on tax treatment of telemedicine premium contributions for your specific business, as that depends on your cafeteria plan structure and current federal and state tax rules.
- This page cannot predict how many of your employees will use the telemedicine benefit, as usage depends on factors including employee awareness, cost sharing levels, and access to in-person care in their local area.
Next verification step
Once you have completed the Telemedicine Add-On Checklist and narrowed down 2-3 top telemedicine options, schedule a 30-minute call with your licensed group health insurance broker to review your selections. Ask your broker to provide a side-by-side comparison of each option’s covered services, cost sharing, contract terms, and alignment with your existing group health plan. You should also ask your broker to share sample SBC language for each option so you can review exactly what will be disclosed to employees during open enrollment. If you do not work with a broker, reach out directly to your group health carrier’s account manager to request this comparison information. You may also choose to run a short anonymous survey of a small sample of your employees to confirm that the covered services in your top choice match the services they are most likely to use, for example, if most employees request mental health telehealth visits, confirm your top option has a large network of licensed mental health providers in your service area.
Bottom line
This is not insurance, tax, legal, or medical advice. All telemedicine benefit selections should be verified against your official plan documents and reviewed by a licensed insurance broker or legal advisor specializing in employee benefits before you sign a contract. Adding a telemedicine benefit can make your health benefits package more competitive and give employees more flexible, affordable access to care, but it is important to confirm all terms upfront to avoid gaps in coverage or unexpected costs. Taking the time to work through the checklist and verify details with your carrier or broker will help you select an option that aligns with both your budget and your employees’ needs.
Important note: This page is educational and is not insurance, tax, legal, or medical advice. Confirm current rules in your plan documents or with a licensed professional.