A carrier shall not enter into an agreement or contract with a health care provider
if the agreement or contract contains a provision that:
(a)(i) limits the ability of the carrier to introduce or modify a select network plan
or tiered network plan by granting the health care provider a guaranteed right of
participation; (ii) requires the carrier to place all members of a provider group,
whether local practice groups or facilities, in the same tier of a tiered network
plan; (iii) requires the carrier to include all members of a provider group, whether
local practice groups or facilities, in a select network plan on an all-or-nothing
basis; or (iv) requires a provider to participate in a new select network or tiered
network plan that the carrier introduces without granting the provider the right to
opt-out of the new plan at least 60 days before the new plan is submitted to the commissioner
for approval; or
(b) requires or permits the carrier or the health care provider to alter or terminate
a contract or agreement, in whole or in part, to affect parity with an agreement or
contract with other carriers or health care providers or based on a decision to introduce
or modify a select network plan or tiered network plan; or
(c) requires or permits the carrier to make any form of supplemental payment unless
each supplemental payment is publicly disclosed to the commissioner as a condition
of accreditation, including the amount and purpose of each payment and whether or
not each payment is included within the provider's reported relative prices and health
status adjusted total medical expenses under section 10 of chapter 12C; and
(d) limits the ability of either the carrier or the health care provider from disclosing
the allowed amount and fees of services to an insured or insured's treating health
(e) limits the ability of either the carrier or the health care provider from disclosing
out-of-pocket costs to an insured.
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature or via Westlaw before relying on it for your legal needs.
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