S.F. No. 3620 Summary

• Defines "unauthorized provider services" as services received from nonparticipating providers at participating facilities when the participating provider is unavailable, services rendered without enrollee knowledge, unforeseen services needed at time of rendering, or services sent to nonparticipating labs or facilities, excluding emergency services.

• Prohibits health plans from imposing more restrictive coverage limitations on unauthorized provider services than those applied to participating provider services, with identical cost-sharing requirements including copayments, deductibles, and coinsurance.

• Allows enrollees to consent in advance in writing to use nonparticipating providers or receive uncovered services, which exempts those services from the unauthorized provider definition and its protections.

• Prohibits participating providers from balance billing enrollees for amounts exceeding the contracted allowable amount, while permitting billing for approved copayments, deductibles, or coinsurance.

• Effective January 1, 2017 for health plans offered, issued, or renewed to Minnesota residents on or after that date; repeals Minnesota Statutes 2014, section 62K.11.