General Assembly Raised Bill No. 6736
January Session, 2015 LCO No. 3305
*03305_______INS*
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
General Assembly
Raised Bill No. 6736
January Session, 2015
LCO No. 3305
*03305_______INS*
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT PROHIBITING THE SETTING OF PAYMENTS BY HEALTH INSURERS AND OTHER ENTITIES FOR NONCOVERED BENEFITS.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. Section 38a-472h of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
(a) No insurer, health care center, fraternal benefit society, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, amending or continuing an individual or group [dental] health insurance or health benefits plan in this state shall include in any contract with a [dentist licensed pursuant to chapter 379] health care provider that is entered into, renewed or amended on or after January 1, [2012] 2016, any provision that requires such [dentist] health care provider to accept as payment an amount set by such insurer, center, society, corporation or entity for services or procedures provided to an insured or enrollee that are not covered benefits under such insured's or enrollee's plan.
(b) A [dentist] health care provider shall not charge more for services or procedures that are not covered benefits than such [dentist's] health care provider's usual and customary rate for such services or procedures.
(c) Each evidence of coverage for an individual or group [dental] health insurance or health benefits plan shall include the following statement:
"IMPORTANT: If you opt to receive [dental] services or procedures that are not covered benefits under this plan, a participating [dental] health care provider may charge you his or her usual and customary rate for such services or procedures. Prior to providing you with [dental] services or procedures that are not covered benefits, the [dental] health care provider should provide you with a treatment plan that includes each anticipated service or procedure to be provided and the estimated cost of each such service or procedure. To fully understand your coverage, you may wish to review your evidence of coverage document."
(d) Each [dentist] health care provider shall post, in a conspicuous place, a notice stating that services or procedures that are not covered benefits under [an] a health insurance policy or health benefits plan might not be offered at a discounted rate.
(e) The provisions of this section shall not apply to (1) a self-insured plan, [that covers dental services,] or (2) a contract that is incorporated in or derived from a collective bargaining agreement or in which some or all of the material terms are subject to a collective bargaining process.
This act shall take effect as follows and shall amend the following sections:
Section 1 January 1, 2016 38a-472h
This act shall take effect as follows and shall amend the following sections:
Section 1
January 1, 2016
38a-472h
Statement of Purpose:
To extend to other health care providers besides dentists the prohibition on insurers and other entities setting payment for services or procedures that are not covered benefits under a health insurance or health benefits plan.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]