HB 1251 Summary

• Requires state employee plans, accident and sickness insurers, and health maintenance organizations to provide covered individuals with annual directories of participating providers including name, address, telephone number, and specialty.

• Mandates that insurers provide annually updated information on websites and in writing allowing individuals to estimate out-of-pocket costs for services from nonparticipating providers in specific geographic areas.

• Requires participating providers and insurers to refer covered individuals to appropriate nonparticipating providers within reasonable time and geographic proximity when needed services are not available from participating providers; referred individuals pay only their normal cost-sharing amounts.

• Establishes that emergency care must be covered without prior authorization regardless of provider status, with payment at usual and customary rates or agreed amounts; nonparticipating emergency providers may not bill patients beyond applicable copayments or deductibles.

• Expands independent external grievance procedures for insurers and health maintenance organizations to include determinations about whether services were provided by contracted or noncontracted providers.