Bill > S4251

Introduced Session

This bill establishes certain procedures that are required to be followed if a carrier removes a health care facility network from its provider network or a health care facility network leaves a carrier's provider network. Prior to any removal or departure, a carrier or a health care facility network is to provide electronic notice of the potential removal or departure to the other party and electronic notice to the Department of Banking and Insurance, as prescribed by the department. The carrier is to require continued coverage of claims provided by the health care facility network for a period of no less than 15 business days after the notice of potential removal has been sent to the health care facility network and the department. During the 15-business day period of continued coverage, the carrier and the health care facility network are required to negotiate in good faith to come to an agreement. Notice to subscribers and patients residing in the county or counties where a health care facility network is located is to be issued on the first day of the 15 business day period to disclose that: (1) the negotiation is taking place; and (2) the potential impact if a negotiation fails. Conspicuous notice of the potential removal is to also be displayed on each party's Internet website and applications used by their respective subscribers and patients. Upon conclusion of the 15-business day period, if negotiations to reach an agreement between a carrier and health care facility network have failed, a special enrollment period of 30 days is to open to individuals who 1) belong to a small employer health benefits plan or an individual health benefits plan and 2) are residing in the county or counties where a health care facility network is located. The carrier is to provide coverage of claims provided by the health care facility network for the entirety of the special enrollment. The special enrollment period is to allow a policyholder of a small employer health benefits plan or an insured of an individual health benefits plan to select a new health benefits plan, including, but not limited to, through enrollment in the State-based exchange or in an employer-based plan of a spouse. Upon conclusion of the 15-day period of continued coverage, if the carrier and the health care facility network have not reached an agreement for the health care facility network to remain in the carrier network, the carrier is to provide coverage of claims provided by the health care facility network as an out-of-network charge with the insured party only responsible for payment of any portion of claims provided by the health care facility network in the same manner as provided for prior to the removal of the health care facility network from the carrier's network. The carrier network is responsible for the remaining charges until: (1) the next open enrollment period for that carrier; or (2) the carrier and the health care facility network reach a new agreement for the health care facility network to remain in the carrier network.

Committee Categories

Holly Schepisi (R)*,  Patrick Diegnan (D), 

Introduced in the Senate, Referred to Senate Commerce Committee (on 03/03/2025)

Official Document