AZ SB1471

Health insurers offering individual or small group market plans must establish an interactive website mechanism by January 1, 2019 that enables enrollees to compare allowed amounts and out-of-pocket costs among network providers for nonemergency procedures.

The interactive mechanism must provide good faith estimates of enrollee out-of-pocket responsibility including copayments, deductibles, coinsurance, and other cost-sharing for covered benefits, with notice that actual costs may differ.

Health insurers must notify enrollees annually about the availability of the cost comparison tool at enrollment or renewal and attest annually to the Department that cost information remains current.

Beginning with the next rate filing after the effective date, health insurers must establish shared savings programs in individual and small group plans that incentivize enrollees to select lower-cost, high-quality providers through cash payments, gift cards, premium credits, or reduced cost-sharing.

Comparable health care services include physical and occupational therapy, obstetrical and gynecological services, radiology and imaging, laboratory services, infusion therapy, and inpatient and outpatient surgical procedures, with the Department authorized to expand this list beginning January 1, 2020.