Bill > H920

This bill aims to ensure consumer choice and fair treatment within vision and eyecare services by requiring health insurance plans, referred to as "carriers" which include various types of insurers and government programs, to cover vision and eyecare services and materials equally regardless of whether they are provided by a licensed optometrist or ophthalmologist, as long as the provider is within their authorized scope of practice and participates in the plan's network. It prohibits plans from imposing greater cost-sharing amounts (like co-payments or coinsurance) for services provided by one type of professional compared to the other, and mandates that providers receive the same level of reimbursement for services within the lawful scope of both professions. Furthermore, the bill ensures that licensed optometrists have the same participation opportunities as ophthalmologists in vision and health insurance plans, prevents plans from requiring providers to offer discounted materials or participate in other plans as a condition of joining, and prohibits plans from refusing to allow providers to continue offering services if they opt out of a specific product line. It also clarifies that agreements between plans and providers cannot set fees for services unless they are reimbursed as covered services, and providers cannot charge more than their usual rate for non-covered services, with reimbursement for covered services needing to be reasonable and not nominal. Finally, the bill states that for commercially insured plans, patients' choice of suppliers for materials should not be limited, and plans cannot change the terms of agreements without provider concurrence, with provisions for how claims are handled when a patient has multiple insurance plans.