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2001 SESSION

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HB 2768 Managed care health insurance plans; freedom of choice.

Introduced by: C. Richard Cranwell | all patrons    ...    notes | add to my profiles

SUMMARY AS INTRODUCED:

Managed care health insurance plans; freedom of choice. Requires any operator of a managed care health insurance plan (MCHIP), whether a carrier offering preferred provider contracts, a corporation offering subscription contracts, or a health maintenance organization, to allow covered persons to choose their health care services provider. This right of choice extends to any provider that is not a member of the MCHIP's provider panel if the provider has previously notified the carrier of its agreement to accept, as payment in full, the reimbursement for health care services at the rates applicable to providers that are members of the MCHIP's provider panel. In addition, if the carrier requests in writing, an outside provider must execute the form of contract or agreement that the carrier requires all of the members of its provider panel to execute. Such agreement or contract must be signed by the outside provider within 30 days of the provider's receipt of the carrier's request. The bill prohibits reduced or disparate coverage and the imposition of monetary penalties if individuals receive their health care services from an outside provider. The bill also bars carriers from (i) denying immediate access to electronic claims filing to an outside provider that has executed the carrier's provider panel contract or agreement and (ii) requiring a covered person to make payment at point of service unless members of the MCHIP's provider panel are subject to the same requirement. A similar freedom to choose provision is added to the state employee's health insurance plan. The existing provision requiring HMO plans to offer optional point of service coverage is repealed.


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