Bill > A1873

Introduced Session

This bill requires health insurance carriers to provide an adequate network of physicians. Under the bill, a carrier will ensure that a network have a sufficient number of physicians to ensure that 100 percent of covered persons reside no more than: (1) a 20 minute drive or 10 miles, whichever is less, from at least three primary care physicians within each type of primary care specialty as defined in the bill and within the geographic boundaries of the State; and (2) a 30 minute drive or 15 miles, whichever is less, from at least three office-based medical specialists within each specialty as defined in the bill and within the geographic boundaries of the State. Under the bill, a network will be required to have a sufficient number of physicians to: (1) meet the health needs of covered persons; (2) provide an appropriate choice of physicians sufficient to render services covered by the health benefits plan; and (3) reasonably ensure that covered persons have timely access to in-network facilities. The bill provides that a carrier will be required to submit a plain language description of the network to the commissioner with information sufficient to allow the commissioner to determine whether the network is in compliance with the provisions of the bill. The commissioner will investigate the information supplied in the description to ensure compliance. Annually thereafter, the carrier will be required to submit an updated, plain language description of the network to the commissioner and must certify that the network described remains compliant with the provisions of the bill. Additionally, the bill requires the Commissioner of Banking and Insurance and the Commissioner of Human Services to establish a system by which a covered person may file a formal complaint concerning network adequacy with the Department of Banking and Insurance or the Department of Human Services. The bill also requires a carrier to display the plain language description of each network available to the public in a conspicuous location within its internet website within 20 days of the submission of the description to the commissioner.

AI Summary

Committee Categories

Balvir Singh (D)*, 

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 01/09/2024)

Official Document