Tex. Ins. Code §§ 1273.001 through 1273.005: Point-of-Service Plans– Blended Contracts – Texas
Status: Enacted Year Enacted: 2003
Allows managed care organizations to offer point of service plans and charge separate fees. Provides that an insurer may allow the cost-sharing provisions for indemnity benefits may be higher than the cost-sharing provisions for in-network …
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Tex. Ins. Code §§ 1273.051 through 1273.057: Point-of-Service Plans– Availability of Health Benefit Coverage Options – Texas
Status: Enacted Year Enacted: 2003
If the only health benefit coverage offered under an employer’s health benefit plan is a network-based delivery system of coverage offered by one or more health maintenance organizations, each health maintenance organization offering coverage must …
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Tex. Ins. Code §§ 1453.001 through 1453.003: Disclosure of Reimbursement Guidelines Under Managed Care Plans – Texas
Status: Enacted Year Enacted: 2003
On the written request of an out-of-network health care provider, a managed care entity shall furnish to the provider a written description of the factors considered by the entity in determining the amount of reimbursement …
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Tex. Ins. Code §§ 1456.001 through 1456.007: Physicians and Health Care Providers –Disclosure of Provider Status – Texas
Status: Enacted Year Enacted: 2007
A health benefit plan must include notice when a facility based physician is not included in network and such a physician may not bill the enrollee for amounts not paid by the benefit plan. A …
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Utah Code § 31A-22-618. Nondiscrimination among health care professionals: Accident and Health Insurance – Utah
Status: Enacted Year Enacted: 1985
No insurer may unfairly discriminate against any licensed class of health care providers by structuring contract exclusions which exclude payment of benefits for the treatment of any illness, injury, or condition by any licensed class …
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Utah Code § 31A-22-649. Coverage of telepsychiatric consultations: Accident and Health Insurance – Utah
Status: Enacted Year Enacted: 2018
Provisions related to the overage of telepsychiatric consutations for health benefit plans.
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Va. Code Ann. § 8.01-27.5. Duty of in-network providers to submit claims to health insurers; liability of covered patients for unbilled health care services: Actions on Contracts Generally – Virginia
Status: Enacted Year Enacted: 2013
An in-network provider that provides health care services to a covered patient shall submit its claim to the health insurer for the health care services in accordance with the terms of the applicable provider agreement …
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Va. Code Ann. §§ 38.2-3400 through 3407.19: Provisions Relating to Accident and Sickness Insurance – Virginia
Status: Enacted Year Enacted: 1950
Virginia’s provisions relating to accident and sickness insurance.
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Va. Code Ann. §§ 38.2-3438 through 3454.1: Federal Market Reforms – Virginia
Status: Enacted Year Enacted: 2011
Virginia’s implementation of the ACA.
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Va. Code Ann. §§ 38.2-4300 through 4323: Health Maintenance Organizations – Virginia
Status: Enacted Year Enacted: 1980
Describes prohibited practices of health maintenance organizations.
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Vt. Stat. Ann. tit. 33, § 1905a. Medicaid reimbursements to certain outpatient providers: Medical Assistance – Vermont
Status: Enacted Year Enacted: 2015
To the extent permitted under federal law, the Department of Vermont Health Access shall not use provider-based billing for outpatient medical services provided at an off-campus outpatient department of a hospital as a result of …
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Vt. Stat. Ann. tit. 8, § 4062. Filing and approval of policy forms and premiums: Health Insurance — Generally – Vermont
Status: Enacted Year Enacted: 1983
The Green Mountain Care Board shall review rate requests and shall approve, modify, or disapprove a rate request within 90 calendar days after receipt of an initial rate filing from an insurer. If an insurer …
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W. Va. Code §§ 33-55-1 through 33-55-10: Health Benefit Plan Network Access and Adequacy Act – West Virginia
Status: Enacted
A health carrier providing a network plan shall maintain a network that is sufficient in numbers and appropriate types of providers, including those that serve predominantly low-income, medically underserved individuals, to assure that all covered …
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Wash. Rev. Code § 41.05.074. Public employees—Prior authorization standards and criteria—Health plan requirements—Definitions: State Health Care Authority – Washington
Status: Enacted Year Enacted: 2015
A health plan offered to public employees and their covered dependents under this chapter that imposes different prior authorization standards and criteria for a covered service among tiers of contracting providers of the same licensed …
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Wash. Rev. Code § 48.43.016. Prior authorization standards and criteria—Health carrier requirements—Definitions: Insurance Reform – Washington
Status: Enacted Year Enacted: 2015
Definitions of relevant health care providers and network elements.
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Wash. Rev. Code § 48.43.093. Health carrier coverage of emergency medical services–Requirements–Conditions: Insurance Reform – Washington
Status: Enacted Year Enacted: 1997
When conducting a review of the necessity and appropriateness of emergency services or making a benefit determination for emergency services a health carrier must cover the following.
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