MS HB519

Effective July 1, 2019, health benefit plans must reimburse insureds for services performed by duly licensed physicians or podiatrists if the plan covers those services, and such providers are entitled to participate in the plan.

Health benefit plans cannot discriminate against physicians located within their geographic coverage area who meet the plan's terms and conditions, with notification of acceptance required within 60 days of completed application.

Health benefit plans may maintain different reimbursement rates for different types of physicians based on their specialty practice scope and may implement quality control and cost-control measures (including gatekeeper systems) as long as applied equally to all providers in the same class.

The article applies to all health benefit plans regardless of type, multiple employer welfare arrangements, and multiple employer trusts; providers may be excluded only for fraud or illegal activity.

The Commissioner of Insurance is empowered to enforce the article using powers granted under the Mississippi Insurance Code and may seek injunctions against violating health insurers.