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General Assembly Raised Bill No. 7173
January Session, 2019
LCO No. 4270
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING CO NTRACTS BETWEEN HEALTH INSUR ERS
AND OPTOMETRISTS.
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 Section 38a-472h of the general statutes is repealed and 1
the following is substituted in lieu thereof (Effective January 1, 2020): 2
(a) No insurer, health care center, fraternal benefit society, hospital 3
service corporation, medical service corporation or other entity 4
delivering, issuing for delivery, renewing, amending or continuing: 5
(1) An individual or a group dental plan in this state shall include in 6
any contract with a dentist licensed pursuant to chapter 379 that is 7
entered into, renewed or amended on or after January 1, 2012, any 8
provision that requires such dentist to accept as payment an amount 9
set by such insurer, center, society, corporation or entity for services or 10
procedures provided to an insured or enrollee that are not covered 11
benefits under such insured's or enrollee's plan; or 12
(2) An individual or a group vision plan in this state shall include in 13
any contract with an optometrist licensed pursuant to chapter 380 that 14 Raised Bill No. 7173
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is entered into, renewed or amended on or after January 1, [2016] 2020, 15
any provision that requires such optometrist to accept as payment an 16
amount set by such insurer, center, society, corporation or entity for 17
services, [or] procedures or products provided to an insured or 18
enrollee that are not covered benefits under such insured's or enrollee's 19
plan. 20
(b) No dentist [or optometrist] shall charge more for services or 21
procedures that are not covered benefits than such dentist's [or 22
optometrist's] usual and customary rate for such serv ices or 23
procedures, and no optometrist shall charge more for services, 24
procedures or products that are not covered benefits than such 25
optometrist's usual and customary rate for such services, procedures 26
or products. 27
(c) (1) Each evidence of coverage for an individual or a group dental 28
plan shall include the following statement: 29
"IMPORTANT: If you opt to receive dental services or procedures 30
that are not covered benefits under this plan, a participating dental 31
provider may charge you his or her usual and customary rate for such 32
services or procedures. Prior to providing you with dental services or 33
procedures that are not covered benefits, the dental provider should 34
provide you with a treatment plan that includes each anticipated 35
service or procedure to be provided and the estimated cost of each 36
such service or procedure. To fully understand your coverage, you 37
may wish to review your evidence of coverage document." 38
(2) Each evidence of coverage for an individual or a group vision 39
plan shall include the following statement: 40
"IMPORTANT: If you opt to receive optometric services, [or] 41
procedures or products that are not covered benefits under this plan, a 42
participating optometrist may charge you his or her usual and 43
customary rate for such services, [or] procedures or products. Prior to 44
providing you with optometric services, [or] procedures or products 45
that are not covered benefits, the optometrist should provide you with 46 Raised Bill No. 7173
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a treatment plan that includes each anticipated service, [or] procedure 47
or product to be provided and the estimated cost of each such service, 48
[or] procedure or product. To fully understand your coverage, you 49
may wish to review your evidence of coverage document." 50
(d) Each dentist and optometrist shall post, in a conspicuous place, a 51
notice stating that services, [or] procedures or products, as applicable, 52
that are not covered benefits under an insurance policy or plan might 53
not be offered at a discounted rate. 54
(e) The provisions of this section shall not apply to (1) a self-insured 55
plan that covers dental services or procedures or optometric services, 56
procedures or products, or (2) a contract that is incorporated in or 57
derived from a collective bargaining agreement or in which some or all 58
of the material terms are subject to a collective bargaining process. 59
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2020 38a-472h
Statement of Purpose:
To provide that 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 vision plan in this state shall
include in any contract with an optometrist any provision that requires
the optometrist to accept as payment an amount set by such insurer,
center, society, corporation or entity for products provided to an
insured or enrollee that are not covered benefits under such insured's
or enrollee's 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.]