HB 7173 — AN ACT CONCERNING CONTRACTS BETWEEN HEALTH INSURERS, OPTOMETRISTS AND OPHTHALMOLOGISTS.

General Assembly SubstituteRaised Bill No.

7173 January Session, 2019 ANLCO ACTNo. CONCERNING CONTRACTS BETWEEN HEALTH INSURERS, OPTOMETRISTS AND OPHTHALMOLOGISTS.

4270 Referred to Committee on INSURANCE AND REAL ESTATE Introduced by:

(INS) AN ACT CONCERNING CONTRACTS BETWEEN HEALTH INSURERS AND OPTOMETRISTS.

or (2) An individual or a group vision plan in this state shall include in any contract with an optometrist licensed pursuant to chapter 380 or an ophthalmologist licensed pursuant to chapter 370 that is entered into, renewed or amended on or after January 1, [2016] 2020, any provision that requires such optometrist or ophthalmologist to accept as payment an amount set by such insurer, center, society, corporation LCO \\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07173-R011 of 3 HB.docx Substitute Bill No.

71734270 1 of 3 Raised Bill No.7173 is entered into, renewed or amended on or after January 1, [2016] 2020, any provision that requires such optometrist to accept as payment an amount set by such insurer, center, society, corporation or entity for services, [or] procedures or products provided to an insured or enrollee that are not covered benefits under such insured's or enrollee's plan.

(b) No dentist [or optometrist] shall charge more for services or procedures that are not covered benefits than such dentist's [or optometrist's] usual and customary rate for such services or procedures, and no optometrist or ophthalmologist shall charge more for services, procedures or products that are not covered benefits than such optometrist's or ophthalmologist's usual and customary rate for such services, procedures or products.

If you opt to receive optometric or ophthalmologic services, [or] procedures or products that are not covered benefits under this plan, a participating optometrist or ophthalmologist may charge you his or her usual and customary rate for such services, [or] procedures or products.

Prior to providing you with optometric or ophthalmologic services, [or] procedures or products that are not covered benefits, the optometrist or ophthalmologist should provide you with a treatment plan that includes each anticipated service, [or] LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07173-2 of 3 R01-HB.docx } Substitute Bill No.

71734270 procedure2 or product to be provided and the estimated cost of each3 suchRaised service,Bill [or]No. procedure or product.

To7173 fullya understandtreatment yourplan coverage,that youincludes mayeach wishanticipated toservice, review[or] yourprocedure evidenceor ofproduct coverageto document."be (d)provided Each dentist, [and] optometrist and ophthalmologistthe shallestimated post,cost inof aeach conspicuoussuch place,service, a notice stating that services, [or] proceduresprocedure or products,product. as applicable, that are not covered benefits under an insurance policy or plan might not be offered at a discounted rate.

(e)To Thefully provisionsunderstand your coverage, you may wish to review your evidence of thiscoverage sectiondocument." (d) Each dentist and optometrist shall post, in a conspicuous place, a notice stating that services, [or] procedures or products, as applicable, that are not applycovered to:benefits under an insurance policy or plan might not be offered at a discounted rate.

(1)(e) [a]The Aprovisions of this section shall not apply to (1) a self-insured plan that covers (A) dental services or procedures,procedures or (B) optometric services, procedures or ophthalmologicproducts, services,or procedures(2) a contract that is incorporated in or products;derived from a collective bargaining agreement or in which some or all of the material terms are subject to a collective bargaining process.

or (2) [a] A contract that is incorporated in or derived from a collective bargaining agreement or in which some or all of the material terms are subject to a collective bargaining process.

Section 1 January 1, 2020 38a-472h INSStatement Jointof FavorablePurpose: Subst.

LCOTo {\\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07173-3provide ofthat 3no R01-HB.docxinsurer, }health care center, fraternal benefit society, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, amending or continuing an individual or group vision plan in this state shall include in any contract with an optometrist any provision that requires the optometrist to accept as payment an amount set by such insurer, center, society, corporation or entity for products provided to an insured or enrollee that are not covered benefits under such insured's or enrollee's plan.

[Proposed deletions are enclosed in brackets.

Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.] LCO No.

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