CT SB00323

Expands the definition of "surprise bill" to include emergency and non-emergency health care services provided by out-of-network providers at in-network facilities, or by out-of-network clinical laboratories upon referral from in-network providers.

Prohibits health carriers from requiring prior authorization for emergency services and from imposing higher cost-sharing (coinsurance, copayments, deductibles) for emergency services rendered by out-of-network providers than would be charged for in-network providers.

Requires health carriers to reimburse out-of-network providers for emergency services at the greatest of: the in-network plan rate, the eightieth percentile of charges in the same specialty and geographic area ("usual, customary and reasonable rate"), or the Medicare reimbursement rate.

Mandates that insureds pay only the applicable in-network cost-sharing amounts for surprise bills, with health carriers reimbursing out-of-network providers at in-network rates unless the carrier and provider agree to a different amount.

Requires health carriers to charge in-network cost-sharing rates when they fail to inform insureds of a provider's out-of-network status as required by law.

Effective January 1, 2021.