Uses most favored nation (MFN) clauses in physician managed-care contracts. Dominant health insurers can force physicians to give discounts to the dominant insurer that the physician may have given to other insurers or payers. This model bill prohibits health insurers from putting MFN clauses in physician contracts.

Patient and health care provider protection

Definitions

Prohibition-Most favored nation clause

No overpayment request solely because of contract with another health care service plan

Limitation on most favored nation clauses

Material changes to fee schedules. Return of payment by provider. Appeals. Filing of claim by provider under other applicable insurance coverage. Certain clauses, covenants and agreements prohibited. Exception

Health care providers–Participation by any qualified, willing provider–Contracts–Grievance procedure

Best price–Most favored nations clause prohibited