SB1273 - Exclusive Provider Benefit Plan Act

• Creates new regulatory framework for Exclusive Provider Organization (EPO) plans, allowing insurers to offer health plans that require use of exclusive providers except for emergency services.

• Requires insurers to provide enrollees with comprehensive written disclosures including provider lists, covered benefits, cost-sharing details, appeals procedures, and continuity of care provisions.

• Mandates that EPO plans cover emergency services at the same benefit level regardless of whether provider is in-network, without prior authorization, and allows retrospective denial only in limited circumstances such as services never performed or patient not being an enrollee.

• Establishes appeals procedures with 24-hour decision timeframes for urgent health matters and 15 business day timeframes for non-urgent appeals, with clinical peer review required for medical determinations.

• Amends Freedom of Information Act to exempt identified or deidentified health information held by the Department of Insurance in administering the EPO plan law.