Legislation


H 620 (replaced by H 4605) – Massachusetts

Status: Inactive / Dead
Year Introduced: 2017
Link: https://malegislature.gov/Bills/190/H620

AN ACT RELATING TO HEALTH CARE COST TRANSPARENCY: The connector shall ensure that the following information about each health benefit plan offered for sale to consumers in the commonwealth shall be available to consumers in a clear and understandable form for use in comparing plans, plan coverage, and plan premiums: (a) The ability to determine whether specific types of specialists are in network and to determine whether a named physician, hospital or other health care provider is in network; (b) Any exclusions from coverage and any restrictions on use or quantity of covered items and services in each category of benefits; (c) A description of how medications will specifically be included in or excluded from the deductible, including a description of out-of-pocket costs that may not apply to the deductible for a medication; (d) The specific dollar amount of any co-pay or percentage coinsurance for each item or service; (e) The ability to determine whether a specific drug is available on formulary, the applicable cost-sharing requirement, whether a specific drug is covered when furnished by a physician or clinic, and any clinical prerequisites or authorization requirements for coverage of a drug; (f) The process for a patient to obtain reversal of a health plan decision where an item or service prescribed or ordered by the treating physician has been denied; and (g) An explanation of the amount of coverage for out of network providers or non- covered services, and any rights of appeal that exist when out of network providers or non-covered services are medically necessary.


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