Ky. Rev. Stat. § 304.17A-728. Contract disclosures of discounted fees; violation is unfair claims settlement practice: Health Benefit Plans – Kentucky
Status: Enacted Year Enacted: 2000
All contracts shall have a provision that identifies the products and markets that have an applicable discount as provided in the contract.
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La. Rev. Stat. Ann. § 22:263. Requirements of provider contracts; prohibited incentives; definitions: Health Maintenance Organization Act – Louisiana
Status: Enacted Year Enacted: 1986
Contracts between a health maintenance organization and a provider of health care services will include language exempting the enrollee from owing money that the HMO is responsible for covering. Providers who do not contract with …
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LD 1197 – Maine
Introduced: 2019 Status: Enacted
This bill provides that the law that prohibits carriers from denying payment for covered health care services solely on the basis that the referral for services was made by an out-of-network provider applies only to …
Mass. Gen. Laws ch. 176J, § 11. Reduced or selective network plans; tiered network plans; smart tiering plans: Small Group Health Insurance – Massachusetts
Status: Enacted Year Enacted: 2010
Describes requirements for tiered network plan, including those related to cost-sharing.
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Mass. Gen. Laws ch. 176J, § 11A. Continuing coverage for active course of treatment for serious disease begun prior to enrollment in reduced or selective network plan or tiered network plan: Small Group Health Insurance – Massachusetts
Status: Enacted Year Enacted: 2012
For an insured member who is receiving an active course of medical treatment from a health care provider for a serious disease, that if disrupted in the course of medical treatment would pose an undue …
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Mass. Gen. Laws ch. 176J, § 15. Display by insurer offering tiered network plan of cost-sharing differences for enrollees in various tiers in promotional and agreement material: Small Group Health Insurance – Massachusetts
Status: Enacted Year Enacted: 2012
An insurer offering a tiered network plan shall clearly and conspicuously indicate, in all promotional and agreement materials, the cost-sharing differences for enrollees in the various tiers. The commissioner shall adopt regulations to carry out …
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Mass. Gen. Laws ch. 176J, § 17. Disclosure of patient-level data and contracted prices of individual health care services by carriers to providers: Small Group Health Insurance – Massachusetts
Status: Enacted Year Enacted: 2012
Every carrier shall disclose patient-level data to providers in their network solely for the purpose of carrying out treatment, coordinating care among providers and managing the care of their own patient panel; provided, that an …
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Mass. Gen. Laws ch. 32B, § 22. Copayments, deductibles, tiered provider network copayments and other cost-sharing plan design features; increases: Contributory Group General or Blanket Insurance for Persons in the Service of Counties, Cities, Towns and Districts, and Their Dependents – Massachusetts
Status: Enacted Year Enacted: 2011
Governments offering this insurance may generally include copayments, deductibles, tiered provider network copayments and other cost-sharing plan design features that are no greater in dollar amount than the copayments, deductibles, tiered provider network copayments and …
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Mass. Gen. Laws ch. 32B, § 29. Annual report on non-Medicare and Medicare plans with largest subscriber enrollments: Contributory Group General or Blanket Insurance for Persons in the Service of Counties, Cities, Towns and Districts, and Their Dependents – Massachusetts
Status: Enacted Year Enacted: 2011
Each fiscal year, the commission shall prepare and place on its website a report delineating the dollar amount of the copayments, deductibles, tiered provider network co-payments and other design features offered by the commission in …
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Md. Code, Ins. § 14-205. Benefits for health care services; payments and rates for providers: Preferred Provider Organizations – Maryland
Status: Enacted Year Enacted: 1997
Services rendered by preferred providers may be compensated either through direct payments to the health care provider or through reimbursement to the insured. PPOs must also pay a reasonable amount of compensation as determined by …
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Md. Code, Ins. § 14-205.1. Policies which condition payment on the use of preferred providers: Preferred Provider Organizations – Maryland
Status: Enacted Year Enacted: 2007
The Commissioner may authorize an insurer or nonprofit health service plan to offer a preferred provider insurance policy that conditions the payment of benefits on the use of preferred providers if the insurer or nonprofit …
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Md. Code, Ins. § 14-205.2. Payments to on-call physicians and hospital-based physicians: Preferred Provider Organizations – Maryland
Status: Enacted Year Enacted: 2010
Except as provided in subsection (3), an insured may not be liable to an on-call physician or a hospital-based physician subject to this section for covered services rendered by the on- call physician or hospital-based …
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Md. Code, Ins. § 14-205.3. Assignment of benefits and reimbursement of nonpreferred providers: Preferred Provider Organizations – Maryland
Status: Enacted Year Enacted: 2010
An insurer may not prohibit the assignment of benefits to a provider who is a physician by an insured or refuse to directly reimburse a nonpreferred provider who is a physician under an assignment of …
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Md. Code, Ins. § 15-852. Prorated daily copayment or coinsurance amount for partial supply of prescription drug: Required Health Insurance Benefits – Maryland
Status: Enacted Year Enacted: 2017
An entity subject to this section shall allow and apply a prorated daily copayment or coinsurance amount for a partial supply of a prescription drug dispensed by an in-network pharmacy if the prescriber or the …
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Md. Code, Ins. §§ 14-201 through 14-206: Preferred Provider Organizations – Maryland
Status: Enacted Year Enacted: 1997
Insurers may an insurer may offer preferred provider insurance policies that limit, through the use of provider service contracts, the numbers and types of providers of health care services eligible for payment as preferred providers, …
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Md. Code, Ins. §§ 14-601 through 14-612: Discount Medical Plan Organizations and Discount Drug Plan Organizations – Maryland
Status: Enacted Year Enacted: 2007
An entity shall register with the Commissioner as a discount medical plan or drug plan organization before a discount medical plan or drug plan established by that entity is sold, marketed, or solicited in the …
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