Bill > S1045

Introduced Session

This bill places certain requirements on carriers offering health benefits plans with a tiered network. A tiered network is a managed care plan provider network with more than one level or tier of in-network benefits, based on different levels of cost sharing accepted by the health care providers in that network. Carriers include an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State, the State Health Benefits Commission and the School Employees' Health Benefits Commission. The bill requires a carrier that offers a health benefits plan with a tiered network to clearly and conspicuously state on the carrier's website and in plan documents supplied to the subscriber the cost sharing differences for covered persons in various tiers. The bill also requires a carrier, in the case of a health benefits plan with a tiered network, to ensure that variations in cost sharing among provider tiers are reasonable in relation to the premium charged. With respect to this requirement, the bill specifies that: (1) a carrier may offer more than two levels or tiers of providers within the tiered network; and (2) variations among each of the levels or tiers must be reasonable in relation to the premium charged.

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Joe Vitale (D)*, 

Introduced in the Senate, Referred to Senate Commerce Committee (on 01/22/2018)