Sec. 20-138b. Interference with choice of physician or optometrist for vision
care prohibited. Offer by health care center or preferred provider network of ophthalmologic care to include optometric care and equal access to plans and policies.
Regulations. (a) No person shall interfere with the exercise by any other person of the
person's free choice in the selection of a licensee under either chapter 370 or this chapter
for vision training or care.
(b) If any health care center, as defined in section 38a-175, or preferred provider network, as defined in section 38a-479aa, offers health care benefits that provide ophthalmologic care for any person, partnership, corporation, association or group, however organized, such health care center or preferred provider network shall provide optometric care. If the ophthalmologic care provided may be lawfully rendered by an optometrist, such health care center or preferred provider network shall provide the identical eye care coverage and benefits for its members when such care is rendered by an optometrist under contract with such health care center or preferred provider network.
(1) Such health care center or preferred provider network shall (A) contract with ophthalmologists and optometrists in a manner that will provide fair and sufficient representation of such providers in relation to the benefits provided by the health care center plan or preferred provider network, and (B) equally inform its members of the availability of ophthalmologic and optometric services.
(2) Such health care center or preferred provider network (A) shall provide ophthalmologists and optometrists equal access to all health plans offered by such health care center or health insurance policies offered by a health insurer with which such preferred provider network has entered into a contractual relationship, and (B) shall not restrict participation in such plans or policies based on limitations in services provided by individual ophthalmologists or optometrists. Nothing in this subsection shall be construed as permitting any ophthalmologist or optometrist to perform or provide services beyond their scopes of practice permitted in chapter 370 and this chapter, respectively.
(c) The Insurance Commissioner may adopt regulations, in accordance with chapter 54, to carry out the provisions of subsection (b) of this section.
(1967, P.A. 598; P.A. 79-315; P.A. 80-482, S. 3, 345, 348; P.A. 87-126; P.A. 89-194; P.A. 93-358, S. 2; P.A. 99-284, S. 49; June Sp. Sess. P.A. 01-4, S. 22, 58; P.A. 11-38, S. 1.)
History: P.A. 79-315 added Subsecs. (b) and (c) re medical foundations; P.A. 80-482 reinstated insurance commissioner as department head of independent insurance department rather than as head of division of insurance within the department of business regulation (successor agency to previously independent insurance department), created by P.A. 77-614; P.A. 87-126 amended Subsec. (b) to require health care centers which provide ophthalmologic care to also provide optometric care, and deleted Subsec. (c) which had defined "medical foundation"; P.A. 89-194 amended Subsec. (b) to require health care centers to provide coverage and benefits for eye care lawfully rendered by an optometrist identical to the coverage and benefits provided for eye care when rendered by an ophthalmologist, to require fair representation of optometrists in relation to benefits under health care center plan, to require members be equally informed of availability of ophthalmologic and optometric services and added Subsec. (c) permitting the commissioner to adopt regulations to carry out the provisions of Subsec. (b); P.A. 93-358 amended Subsec. (b) to include preferred provider networks under the provisions of the Subsec.; (Revisor's note: In 1997 a reference in Subsec. (c) to "Commissioner of Insurance" was changed editorially by the Revisors to "Insurance Commissioner" for consistency with customary statutory usage); P.A. 99-284 made technical changes; June Sp. Sess. P.A. 01-4 amended Subsec. (b) by replacing reference to Sec. 19a-647b with reference to Sec. 38a-479aa and making technical changes; P.A. 11-38 amended Subsec. (b) by designating existing provisions re contracts and information as new Subdiv. (1), changing existing Subdiv. (1) and (2) designators to Subparas. (A) and (B) designators therein, adding new Subdiv. (2) requiring equal access to plans and policies, and making technical changes, effective January 1, 2012.
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