SB 433 Summary

• Establishes comprehensive network adequacy standards requiring health carriers to maintain a sufficient number and appropriate types of participating providers to ensure covered persons have accessible health care services without unreasonable travel or delay, effective January 1, 2017.

• Requires health carriers to establish processes allowing covered persons to receive covered benefits at in-network cost-sharing levels from nonparticipating providers when the carrier lacks sufficient network providers or providers with necessary expertise, with timely review procedures.

• Mandates 60-day written notice before health carriers remove or providers leave networks; requires good faith efforts to notify affected covered persons within 30 days and establish continuity of care procedures for patients in active treatment.

• Requires all health carrier-provider contracts to include hold harmless provisions protecting covered persons from balance billing, survive contract termination, and include provisions for continuity of care in case of health carrier insolvency.

• Establishes participating provider directory requirements including monthly updates posted online with searchable information on provider names, specialties, languages, hospital affiliations, and whether providers accept new patients; requires print copies upon request.