CT
Connecticut House Bill HB07173

Connecticut 2019 Regular Session

Connecticut House Bill HB07173 Compare Versions

OldNewDifferences
11
22
3-LCO \\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07173-R01-
4-HB.docx
5-1 of 3
3+LCO No. 4270 1 of 3
64
7-General Assembly Substitute Bill No. 7173
5+General Assembly Raised Bill No. 7173
86 January Session, 2019
7+LCO No. 4270
8+
9+
10+Referred to Committee on INSURANCE AND REAL ESTATE
11+
12+
13+Introduced by:
14+(INS)
915
1016
1117
1218
13-
14-AN ACT CONCERNING CO NTRACTS BETWEEN HEAL TH INSURERS,
15-OPTOMETRISTS AND OPHTHALMOLOGISTS.
19+AN ACT CONCERNING CO NTRACTS BETWEEN HEALTH INSUR ERS
20+AND OPTOMETRISTS.
1621 Be it enacted by the Senate and House of Representatives in General
1722 Assembly convened:
1823
1924 Section 1. Section 38a-472h of the general statutes is repealed and 1
2025 the following is substituted in lieu thereof (Effective January 1, 2020): 2
2126 (a) No insurer, health care center, fraternal benefit society, hospital 3
2227 service corporation, medical service corporation or other entity 4
2328 delivering, issuing for delivery, renewing, amending or continuing: 5
2429 (1) An individual or a group dental plan in this state shall include in 6
2530 any contract with a dentist licensed pursuant to chapter 379 that is 7
2631 entered into, renewed or amended on or after January 1, 2012, any 8
2732 provision that requires such dentist to accept as payment an amount 9
2833 set by such insurer, center, society, corporation or entity for services or 10
2934 procedures provided to an insured or enrollee that are not covered 11
3035 benefits under such insured's or enrollee's plan; or 12
3136 (2) An individual or a group vision plan in this state shall include in 13
32-any contract with an optometrist licensed pursuant to chapter 380 or 14
33-an ophthalmologist licensed pursuant to chapter 370 that is entered 15
34-into, renewed or amended on or after January 1, [2016] 2020, any 16
35-provision that requires such optometrist or ophthalmologist to accept 17
36-as payment an amount set by such insurer, center, society, corporation 18 Substitute Bill No. 7173
37+any contract with an optometrist licensed pursuant to chapter 380 that 14 Raised Bill No. 7173
3738
3839
39-LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07173-
40-R01-HB.docx }
41-2 of 3
4240
43-or entity for services, [or] procedures or products provided to an 19
44-insured or enrollee that are not covered benefits under such insured's 20
45-or enrollee's plan. 21
46-(b) No dentist [or optometrist] shall charge more for services or 22
47-procedures that are not covered benefits than such dentist's [or 23
48-optometrist's] usual and customary rate for such services or 24
49-procedures, and no optometrist or ophthalmologist shall charge more 25
50-for services, procedures or products that are not covered benefits than 26
51-such optometrist's or ophthalmologist's usual and customary rate for 27
52-such services, procedures or products. 28
53-(c) (1) Each evidence of coverage for an individual or a group dental 29
54-plan shall include the following statement: 30
55-"IMPORTANT: If you opt to receive dental services or procedures 31
56-that are not covered benefits under this plan, a participating dental 32
57-provider may charge you his or her usual and customary rate for such 33
58-services or procedures. Prior to providing you with dental services or 34
59-procedures that are not covered benefits, the dental provider should 35
60-provide you with a treatment plan that includes each anticipated 36
61-service or procedure to be provided and the estimated cost of each 37
62-such service or procedure. To fully understand your coverage, you 38
63-may wish to review your evidence of coverage document." 39
64-(2) Each evidence of coverage for an individual or a group vision 40
65-plan shall include the following statement: 41
66-"IMPORTANT: If you opt to receive optometric or ophthalmologic 42
67-services, [or] procedures or products that are not covered benefits 43
68-under this plan, a participating optometrist or ophthalmologist may 44
69-charge you his or her usual and customary rate for such services, [or] 45
70-procedures or products. Prior to providing you with optometric or 46
71-ophthalmologic services, [or] procedures or products that are not 47
72-covered benefits, the optometrist or ophthalmologist should provide 48
73-you with a treatment plan that includes each anticipated service, [or] 49 Substitute Bill No. 7173
41+LCO No. 4270 2 of 3
42+
43+is entered into, renewed or amended on or after January 1, [2016] 2020, 15
44+any provision that requires such optometrist to accept as payment an 16
45+amount set by such insurer, center, society, corporation or entity for 17
46+services, [or] procedures or products provided to an insured or 18
47+enrollee that are not covered benefits under such insured's or enrollee's 19
48+plan. 20
49+(b) No dentist [or optometrist] shall charge more for services or 21
50+procedures that are not covered benefits than such dentist's [or 22
51+optometrist's] usual and customary rate for such serv ices or 23
52+procedures, and no optometrist shall charge more for services, 24
53+procedures or products that are not covered benefits than such 25
54+optometrist's usual and customary rate for such services, procedures 26
55+or products. 27
56+(c) (1) Each evidence of coverage for an individual or a group dental 28
57+plan shall include the following statement: 29
58+"IMPORTANT: If you opt to receive dental services or procedures 30
59+that are not covered benefits under this plan, a participating dental 31
60+provider may charge you his or her usual and customary rate for such 32
61+services or procedures. Prior to providing you with dental services or 33
62+procedures that are not covered benefits, the dental provider should 34
63+provide you with a treatment plan that includes each anticipated 35
64+service or procedure to be provided and the estimated cost of each 36
65+such service or procedure. To fully understand your coverage, you 37
66+may wish to review your evidence of coverage document." 38
67+(2) Each evidence of coverage for an individual or a group vision 39
68+plan shall include the following statement: 40
69+"IMPORTANT: If you opt to receive optometric services, [or] 41
70+procedures or products that are not covered benefits under this plan, a 42
71+participating optometrist may charge you his or her usual and 43
72+customary rate for such services, [or] procedures or products. Prior to 44
73+providing you with optometric services, [or] procedures or products 45
74+that are not covered benefits, the optometrist should provide you with 46 Raised Bill No. 7173
7475
7576
76-LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07173-
77-R01-HB.docx }
78-3 of 3
7977
80-procedure or product to be provided and the estimated cost of each 50
81-such service, [or] procedure or product. To fully understand your 51
82-coverage, you may wish to review your evidence of coverage 52
83-document." 53
84-(d) Each dentist, [and] optometrist and ophthalmologist shall post, 54
85-in a conspicuous place, a notice stating that services, [or] procedures or 55
86-products, as applicable, that are not covered benefits under an 56
87-insurance policy or plan might not be offered at a discounted rate. 57
88-(e) The provisions of this section shall not apply to: 58
89-(1) [a] A self-insured plan that covers (A) dental services or 59
90-procedures, or (B) optometric or ophthalmologic services, procedures 60
91-or products; or 61
92-(2) [a] A contract that is incorporated in or derived from a collective 62
93-bargaining agreement or in which some or all of the material terms are 63
94-subject to a collective bargaining process. 64
78+LCO No. 4270 3 of 3
79+
80+a treatment plan that includes each anticipated service, [or] procedure 47
81+or product to be provided and the estimated cost of each such service, 48
82+[or] procedure or product. To fully understand your coverage, you 49
83+may wish to review your evidence of coverage document." 50
84+(d) Each dentist and optometrist shall post, in a conspicuous place, a 51
85+notice stating that services, [or] procedures or products, as applicable, 52
86+that are not covered benefits under an insurance policy or plan might 53
87+not be offered at a discounted rate. 54
88+(e) The provisions of this section shall not apply to (1) a self-insured 55
89+plan that covers dental services or procedures or optometric services, 56
90+procedures or products, or (2) a contract that is incorporated in or 57
91+derived from a collective bargaining agreement or in which some or all 58
92+of the material terms are subject to a collective bargaining process. 59
9593 This act shall take effect as follows and shall amend the following
9694 sections:
9795
9896 Section 1 January 1, 2020 38a-472h
9997
100-INS Joint Favorable Subst.
98+Statement of Purpose:
99+To provide that no insurer, health care center, fraternal benefit society,
100+hospital service corporation, medical service corporation or other
101+entity delivering, issuing for delivery, renewing, amending or
102+continuing an individual or group vision plan in this state shall
103+include in any contract with an optometrist any provision that requires
104+the optometrist to accept as payment an amount set by such insurer,
105+center, society, corporation or entity for products provided to an
106+insured or enrollee that are not covered benefits under such insured's
107+or enrollee's plan.
108+[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
109+except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
110+not underlined.]
101111