No. SB 114
Filed under Insurance.
Continuity of Care in Health Insurance Contracts; Requiring that contracts between a health insurer and a contracted health care practitioner require a specified notice; requiring a health insurer and a health care practitioner to allow certain policyholders to continue coverage and care for a specified timeframe; requiring that certain health maintenance organization contracts require a specified notice; requiring a health maintenance organization and a treating provider to allow certain subscribers to continue coverage and care for a specified timeframe, etc.
Plain English Summary
AI-GENERATEDWhen a health insurer or HMO ends its contract with a doctor, both sides must now give patients 60 days' written notice explaining their rights to continued care and coverage.
Patients already being treated can keep seeing that provider, under the old contract's terms, until they pick a new one or the next enrollment period, up to 6 months.
For health maintenance organizations specifically, this continuation duty now applies even when a provider is terminated for cause, and providers lose their express right to cut off care to abusive, noncompliant, or non-paying patients.
AIRequires a health insurer and a contracted practitioner to jointly notify each affected policyholder at least 60 days before ending their contract, explaining the policyholder's continuation-of-care rights, transition timelines, and where to direct questions or complaints. The office may fine either side up to $5,000 per violation for failing to comply.
AIRequires the insurer and practitioner to let a policyholder already in active treatment keep that care and coverage through completion of the condition being treated, until the policyholder picks a new practitioner or the next open enrollment period, whichever is longer, capped at 6 months after termination.
AIWhile a policyholder's care continues after termination, the insurer and practitioner remain bound by the terminated contract's own terms, including presumably its payment rates, rather than new terms either side might prefer.
AIRequires an HMO and its contracted provider to jointly notify each affected subscriber at least 60 days before ending their contract, on the same terms as the new insurer-side notice, backed by the same up-to-$5,000 per-violation fine.
AIStrikes the exception that let an HMO and provider skip continuation of care when the provider's contract was terminated for cause, so the duty to let patients finish treatment now applies regardless of why the contract ended.
AIDeletes the sentence that let a provider refuse to keep treating a subscriber who was abusive, noncompliant, or behind on payments, removing that express exception to the continuation-of-care duty.
AIA policyholder who has started prenatal care, in any trimester, keeps coverage and care with the terminated practitioner through completion of postpartum care, a separate rule from the 6-month cap that governs other conditions.
AIRemoves the qualifier that had limited the HMO continuation-of-care duty to care that was medically necessary, so the duty as written no longer carries that express condition.