SB2278 Summary

• Prohibits nonparticipating health care providers from billing patients ("balance billing" or "surprise billing") for amounts exceeding their copayment, coinsurance, or deductible obligations under their insurance plan.

• Requires health insurers, mutual benefit societies, and health maintenance organizations to reimburse nonparticipating providers at the "usual and customary rate" defined as the plan's average contracted rate for similar services.

• Mandates that insurers use transparent, third-party databases to calculate out-of-network reimbursement rates for emergency services and requires mandatory mediation overseen by the insurance division to resolve disputes between insurers and providers.

• Establishes binding arbitration procedures for disputes over emergency service reimbursements that cannot be resolved within 45 days, with cost allocation determined by arbitration outcome.

• Effective January 2, 2050 and repeals January 2, 2025 (note: these dates appear to be errors in the bill's codification).