This bill adds that, beginning in the 2022 plan year, the basic health plan must establish an alternate allowable charges schedule that allows an enrollee to utilize the services of any licensed medical provider in the United States without being penalized with out-of-network cost sharing charges except as provided in the alternate allowable charges schedule. The maximum allowable charges schedule must be the Medicare payment schedule plus 60 percent of the Medicare reimbursement rate for the service provided for facility fees, and the Medicare payment schedule plus 25 percent of the Medicare reimbursement rate for the service provided for medical provider charges. If there is no Medicare payment rate for a particular service, then the maximum allowable charges schedule for that particular service will be 40 percent of the billed charges.

This bill requires that, beginning in the 2022 plan year, the basic health plan be modified to have a preferred tier and a non-preferred tier. Providers who agree to accept charges below the maximum allowable charges must be in the preferred tier, and that tier must have lower cost sharing for the employee. Providers in the non-preferred tier are providers who have not agreed to accept charges below the maximum allowable charges, and that tier must have higher cost sharing for the employees utilizing those providers.