More than 350 stakeholders representing major employer, patient, provider, and payer groups are urging a lame-duck Congress to extend into 2023 a waiver allowing employers to cover telehealth services for their employees before they spend down their deductible.

The waiver, which loosens rules for employees’ pre-tax contributions to health savings accounts, was included in the 2020 Coronavirus Aid, Relief and Economic Security (CARES) Act, but will expire on December 31.  

Stakeholders have asked Congress to extend the waiver before the end of 2022, arguing in their letter to House and Senate leaders that the safe harbor improves care access for workers who otherwise would have avoided telehealth because of out-of-pocket expenses.

“Without Congressional action, employers will be required to charge employees more to access telehealth services, creating a barrier to care, including mental health treatment,” the letter states. “Unfortunately, more Americans need access to affordable mental and behavioral health services, not less.”

The letter urges Congressional leaders to expedite passage of the Telehealth Expansion Act of 2021, which has bicameral, bipartisan support.  

“The support for affordable telehealth and telemental health is strong. Allowing employers and health plans to continue offering these important services pre-deductible improves affordability and expands access,” the letter says.


The COVID-19 pandemic resulted in massive growth for telehealth with both government- and employer-sponsored health plans.

A U.S. Department of Health and Human Services study showed a 63-fold increase in Medicare fee-for-service telehealth use, vaulting from approximately 840,000 in 2019 to 52.7 million in 2020, and a 32-fold increase in telemental health during the pandemic.

An Employee Benefit Research Institute survey found that 96% of employer respondents had adopted pre-deductible coverage for telehealth services as a result of the CARES Act waiver, with more than three-quarters of employers hoping the waiver will become permanent.

The waiver expired on January 1, 2022, but Congress re-instated and extended it in late March under the Consolidated Appropriations Act, 2022. The Alliance for Connected Care, also a signatory, noted that the lapsed waiver between January 1, 2022 – March 31, 2022 “led to confusion and uncertainty for patients and employers.”

More than 67 million people have HSAs, according to the Alliance for Connected Care, a signatory of the letter, and 78% of them have annual household incomes below $100,000. America’s Health Insurance Plans, also a signatory, says that 40% of the 180 million Americans with employer-sponsored insurance are covered by an HDHP-HSA plan, with the vast majority of plans covering pre-deductible telehealth services.