Prevents patients from being financially penalized for receiving unanticipated out-of-network care in an emergency situation or when the patient did not have the ability or control to select services from an in-network health care professional.  It also would reduce patient exposure to unanticipated out-of-network care in the first place through measurable network adequacy requirements and incentives for insurers to offer fair contracts to providers.

Bans the use of all products clauses and gives physicians termination rights with respect to such clauses, e.g., a health insurer cannot terminate a physician’s contract because the physician refuses to participate in a new product.

Ensures that health insurer provider directors are accurate, timely updated, and contain information sufficient to enable patients to make informed decisions concerning physicians and health care providers.

Addresses the burden of prior authorizations on patients and physicians by increasing the transparency in prior authorization requirements, ensuring that payers respond to requests in a timely manner and preventing retroactive denials of authorizations.

Restricts managed care organizations’ ability to sell physician discounts and services to third parties, e.g., payers, network brokers, repricers, etc.

A red-lined version of the NAIC’s model bill to assist medical societies in states where the NAIC model has been introduced or where the medical society would like to propose network adequacy legislation.