Here are five things to note:
1. The bill would allow payers to sell “exclusive provider organization” plans, meaning they wouldn’t reimburse for out-of-network care.
2. Supporters of the legislation claim it would create more affordable healthcare.
3. Aetna, UnitedHealth Group and Blue Cross and Blue Shield favor the proposed legislation.
4. House Bill 2454 permits payers to require referrals for specialty care. Typical EPO plans don’t require referrals as long as the care is in-network. This caveat would make the EPO plans more like HMOs, but the payers would be exempt from the privilege fee.
5. Some legislators ask that payers be required to tell consumers about the limited networks, if the legislation passes.
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