SB 870
Enacts provisions relating to health care provider participation in health benefit plans
LR Number:
Last Action:
2/20/2020 - Second Read and Referred S Insurance and Banking Committee
Journal Page:
Calendar Position:
Effective Date:
August 28, 2020

Current Bill Summary

SB 870 - This act requires health carriers to maintain on a website page a list of participating providers for its health benefit plans. At the request of an enrollee, the list shall be provided by mail or email not less frequently than every 3 months. For enrollees who request to receive the list by mail or email, the most recent list they have received shall be deemed to be current. (Section 376.327.2)

The act requires the list of participating providers to contain, at any given time, at least 90% of the providers participating in the health benefit plan, and 10% or less of the list to consist of nonparticipating providers. Health carriers shall submit an audit to the Department of Commerce and Insurance confirming adherence to these requirements any time the list is modified. (Section 376.327.3)

A health care provider that is not a participating provider but is included on the list of participating providers shall be reimbursed by the health carrier at the lesser of the highest reimbursement rate paid under the health benefit plan to any participating provider for the health care services rendered, or the reimbursement rate agreed upon when the provider most recently became a participating provider for the health benefit plan. The health care provider shall not bill the enrollee for the difference between the reimbursement amount and the provider's billed charge. The enrollee shall be responsible for the cost-sharing applicable to services received from participating providers, which shall be counted by the health carrier toward the enrollee's deductible and out-of-pocket maximum. (Section 376.327.4)



No Amendments Found.