Bill > H1018

This bill requires the Commonwealth Health Insurance Connector, a state entity that helps residents find health insurance, to make detailed information about health benefit plans easily accessible and understandable to consumers. This includes providing clarity on whether specific doctors and specialists are "in network" (meaning they have a contract with the insurance plan), outlining any coverage exclusions or limitations on services and items, explaining how prescription drug costs are handled in relation to deductibles (the amount a patient pays before insurance kicks in), specifying co-pay (a fixed amount paid for a service) and coinsurance (a percentage of the cost paid by the patient) amounts, detailing drug formulary status (whether a drug is covered and at what tier), and explaining the process for appealing denied services. The bill also addresses coverage for out-of-network providers and non-covered services, including appeal rights for medically necessary treatments. Furthermore, it establishes penalties, including fines of $50,000 to $250,000, for insurance carriers that knowingly provide false information or fail to submit required data to the Connector.