PA 15-122—sHB 6736

Insurance and Real Estate Committee

AN ACT EXTENDING TO OPTOMETRISTS THE PROHIBITION ON THE SETTING OF PAYMENTS BY HEALTH INSURERS AND OTHER ENTITIES FOR NONCOVERED BENEFITS

SUMMARY: This act prohibits a provider contract between an insurer and a licensed optometrist entered into, renewed, or amended on or after January 1, 2016 from requiring the optometrist to accept as payment an amount the insurer sets for services or procedures that are not covered benefits under an insurance policy or benefit plan.

Under the act, an “insurer” includes a health insurer, HMO, fraternal benefit society, hospital or medical service corporation, or other entity that delivers, issues, renews, amends, or continues an individual or group vision plan in Connecticut.

The act prohibits an optometrist from charging patients more than his or her usual and customary rate for services or procedures not covered by an insurance policy or benefit plan. It (1) requires an insurer to include a statement regarding noncovered services on each evidence of coverage document issued for individual or group vision plans and (2) specifies the language that must be included in the statement.

The act also requires optometrists to post, in a conspicuous place, a notice stating that services or procedures that are not covered benefits under an insurance policy or plan might not be offered at a discounted rate.

The act does not apply to self-insured plans or collectively bargained agreements.

EFFECTIVE DATE: January 1, 2016

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