Bill > S528

This bill mandates that health insurance carriers doing business in the state must offer an "Affordable Health Plan" to all eligible individuals and small businesses, both within and outside of the state's health insurance marketplace, known as the connector. These plans must provide benefits that are financially equivalent to the lowest level of standard health plans available to the public, excluding a specific young adult plan. The bill defines a "statutory reimbursement rate" for healthcare providers as 110% of the Medicare reimbursement rate for services, or a comparable rate determined by the commissioner of the center for health information and analysis for services not covered by Medicare, in consultation with the commissioner of insurance. Healthcare providers are required to accept payment at the lowest of this statutory rate, its actuarial equivalent, or their existing contract rate with the carrier for their lowest-tier plan, and cannot charge patients more than their co-payments, co-insurance, or deductibles. Providers are also prohibited from recouping these amounts by increasing charges to other plans, and the center for health information and analysis will monitor compliance and report any violations to the attorney general. Existing contracts must comply with these reimbursement requirements, and providers cannot refuse to participate in a carrier's network for the Affordable Health Plan. Additionally, the bill repeals a section of existing law (Section 16 of Chapter 176J) and specifies that the repeal of Section 16 will take effect on January 1, 2016.