Like more and more companies, you probably offer a stand-alone telemedicine program to your employees. You already know you must list your medical, dental, vision, Health Flexible Spending Account plan, your Health Reimbursement Account plan and your Employee Assistance Plan on a COBRA notice but what about your telemedicine benefit? Do you list it on a COBRA notice when someone terminates employment? This article dives deeper into why the answer is YES, you must list it on the COBRA notice because it is, in fact, a group health plan.
What programs are considered a “group medical plan?”
ERISA’s definition of a group health plan essentially has three elements that it must be:
- Either a plan, fund or program. To determine whether there is a plan, fund or program, courts look to whether a reasonable person could ascertain:
- Can the intended benefits be identified?
- Is a class of beneficiaries identified?
- Is the source of financing identifiable?
- Is the procedure for receiving benefits explained?
- Established or maintained by an employer. A plan “maintained by an employer or employee organization is any plan of, or contributed to (directly or indirectly) by, an employer or employee organization.” Even if the employer does not contribute to the plan, if coverage under the plan is not be available at the same cost to an individual but for the individual’s employment-related connection to the employer then the employer is deemed to maintain the plan.
- For the purpose of providing medical care. Medical care and health care are synonymous for COBRA purposes because the IRS final regulations clarify that health care has the same meaning as medical care under IRS Code 213(d).
Does a telemedicine program meet the standards of a group health plan?
Let’s take a closer look at a popular stand-alone telemedicine provider called Teladoc. According to their website, “We provide access to on-demand 24/7 phone, video and mobile access to US Board Certified doctors who can diagnose your problem and prescribe medication when needed” (https://www.teladoc.com). To me, this definition qualifies this program as a COBRA-eligible benefit. I decided to get a second opinion by calling Teladoc itself. After several attempts to reach a representative to ask if they consider their program a COBRA eligible benefit or not, I decided to go straight to the top and called the Department of Labor. They agreed that Teladoc is indeed a “medical plan” subject to COBRA. That means it must meet the ERISA requirements of having a Summary Plan Description (SPD) and be included on a Form 5500. (My inquiring mind wonders if it is considered an excepted benefit under PPACA, but that is not the purpose of this article and there are experts in that field more qualified than me to ask and answer this tough question!)
I came across an article dated June 2017 on this topic called, “Is our Telemedicine program subject to ERISA, COBRA or PPACA?” I found it extremely helpful. If you would like more depth information on this topic, I recommend reading it.
So folks, if you have a stand-alone telemedicine plan in place, put it on a COBRA notice, ask your provider for a Summary Plan Description so you can include it in your ERISA wrap document and be sure to include it in your Form 5500 filing. This is a great employee benefit, let’s make sure we treat it like a “medical plan” and keep compliant!