Senate Bill 228 Summary

• Creates new exclusive provider benefit plans (EPOs) that allow insureds to receive covered services only from contracted providers, with limited out-of-network coverage for emergencies and medically necessary services when in-network providers are unavailable.

• Prohibits providers from being restricted in their ability to contract with multiple insurers and requires EPO networks to provide participating providers with information about plan designs and incentives.

• Establishes continuity of care protections allowing insureds undergoing treatment for ongoing special conditions (acute illness, chronic disease, pregnancy from second trimester, terminal illness) to continue seeing their provider for up to 90 days after plan termination or changes.

• Extends continuity of care beyond 90 days for scheduled surgeries, organ transplants, inpatient care, pregnancy through 60 days postpartum, and terminal illness care through end of life.

• Applies all existing preferred provider organization rules regarding provider accessibility, adequacy, and financial solvency to exclusive provider organizations, effective October 1, 2021.