SB3233 Summary

• Amends the Health Maintenance Organization Act to define "basic health care services" as including emergency care, inpatient hospital and physician care, outpatient medical services, mental health services, and alcohol and drug abuse treatment, subject to reasonable deductibles and copayments as described in new Section 4-20.

• Creates new Section 4-20 establishing that HMOs may require deductibles and copayments for specific health care services, but these are the only allowable charges to enrollees beyond premiums (excluding reasonable administrative fees).

• Limits combined deductibles and copayments for basic health care services to the annual maximum out-of-pocket expenses of a high deductible health plan as defined in 26 U.S.C. 223.

• Exempts deductibles and copayments for supplemental health care services, catastrophic-only plans under the Affordable Care Act, and pre-existing condition coverage from the annual out-of-pocket limitation.

• Applies deductible and copayment limitations to enrollees only and does not limit HMO plan payments for services provided by non-participating providers.