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Text: SF00189                           Text: SF00191
Text: SF00100 - SF00199                 Text: SF Index
Bills and Amendments: General Index     Bill History: General Index

Senate File 190

Partial Bill History

Bill Text

PAG LIN
  1  1    Section 1.  NEW SECTION.  514F.4  REIMBURSEMENT FOR HEALTH
  1  2 CARE SERVICES.
  1  3    1.  Nothing contained in Title XIII, subtitle 1, shall be
  1  4 construed to authorize a carrier to deny a claim and refuse to
  1  5 pay benefits under a plan or contract for services provided by
  1  6 a licensed health care provider not approved under the plan or
  1  7 contract if the cost of such services would be paid if
  1  8 performed by a licensed health care provider approved under
  1  9 the plan or contract.  Notwithstanding section 514C.6, each
  1 10 policy or contract of a carrier shall include a provision
  1 11 providing for the payment or prepayment of health or medical
  1 12 expenses provided by health care providers not approved under
  1 13 the plan or contract if such services would be paid if
  1 14 performed by a licensed health care provider approved under
  1 15 the plan or contract.
  1 16    2.  Any copayment required under the plan or contract for a
  1 17 covered service provided by a licensed health care provider
  1 18 not approved under the plan or contract shall remain the same
  1 19 as if the covered service had been provided by an approved
  1 20 licensed health care provider.
  1 21    3.  Payment for covered services under a plan or contract
  1 22 provided by a licensed health care provider not approved under
  1 23 the plan or contract shall be for no less than eighty-five
  1 24 percent of the amount which would be paid for such covered
  1 25 services if the services were provided by an approved licensed
  1 26 health care provider.
  1 27    4.  A carrier shall provide to a prospective insured,
  1 28 subscriber, or enrollee, written information concerning the
  1 29 policy or contract provisions relating to the payment or
  1 30 prepayment of covered services by a licensed health care
  1 31 provider not approved under the plan or contract.
  1 32    5.  For purposes of this section, "carrier" means any
  1 33 entity that provides individual or group health benefit plans
  1 34 in this state.  For purposes of this section, "carrier"
  1 35 includes an insurance company, a group hospital or medical
  2  1 service corporation, a fraternal benefit society, a health
  2  2 maintenance organization, an organized delivery system
  2  3 licensed by the director of public health, and any other
  2  4 entity providing a plan of health insurance or health benefits
  2  5 subject to state insurance regulation.  
  2  6                           EXPLANATION
  2  7    This bill provides that a carrier providing individual or
  2  8 group health benefit plans in this state must provide a
  2  9 provision for the payment or prepayment of health or medical
  2 10 expenses provided by licensed health care providers not
  2 11 approved under a plan or contract if such services would be
  2 12 paid if performed by a licensed health care provider approved
  2 13 under the plan or contract.  Payment for covered services
  2 14 under a plan or contract provided by a licensed health care
  2 15 provider not approved under the plan or contract must be for
  2 16 no less than 85 percent of the amount which would be paid for
  2 17 such covered services if the services were provided by an
  2 18 approved licensed health care provider.  
  2 19 LSB 1943SS 76
  2 20 mj/jj/8
     

Text: SF00189                           Text: SF00191
Text: SF00100 - SF00199                 Text: SF Index
Bills and Amendments: General Index     Bill History: General Index

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