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SB 1346

MANAGED CARE & INSURANCE CARDS

104th Regular Session Introduced by Christopher Belt and 9 co-sponsors

Requires health plans to disclose annually and on request complete provider networks, coverage terms, costs, and provider data to enrollees, boosting plan transparency.

Public Act . . . . . . . . . 104-0375
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Bill Summary · SB 1346

Summary — SB 1346 (Public Act 104-0375)

Status: Enacted (Public Act 104-0375) — Signed by the Governor in 2025. Effective date reported as September 1, 2025 (verify official source for final effective date).

Purpose

Amends the Managed Care Reform and Patient Rights Act to increase transparency about health plan benefits, provider networks, and financial/administrative practices for enrollees and prospective enrollees. Also amends related disclosure requirements for health benefit information cards.

Key provisions

  • Annual and on‑request disclosures by health plans (amends Sec. 15)
    • Health plans must provide, annually and upon request, a complete list of participating providers in the plan’s service area and a clear description of coverage terms including:
    • service area; covered benefits with exclusions/limitations; pre‑certification and utilization review rules; primary care selection and specialist access/referral policy;
    • emergency and out‑of‑area coverage and restrictions;
    • enrollee financial responsibility (copayments, deductibles, premiums, other out‑of‑pocket costs);
    • continuity-of‑care provisions if a provider leaves the network;
    • appeals processes, forms, and timeframes (with a phone number for more information).
    • Plans must include “a statement of all basic health care services and all specific benefits and services mandated to be provided to enrollees by any State law or administrative rule,” and highlight newly enacted State laws or rules. This disclosure requirement may be satisfied by providing the Department’s accident & health checklist. (A committee amendment specifies the highlighting requirement does not apply to Medicaid plans.)
  • Marketplace plan-specific disclosures
    • Qualified health plans offered through the state marketplace must also make available at time of comparison: the most recent prescription drug formulary (with tiering and cost‑sharing info) and the most recent provider directory (with contact, specialty, affiliations, accepting‑new‑patients status).
  • Financial transparency (upon written request)
    • Plans must describe financial relationships with providers and, if requested, report percentages of copayments/deductibles/premiums spent on healthcare vs. other (including administrative) expenses. Plans are not required to disclose specific provider reimbursement rates.
  • Provider obligations
    • Participating providers must make available upon request: education/training/board certification info; the licensed facilities where they have privileges relevant to the request; and information on continuing education/licensure compliance.
  • Format, delivery, and accessibility
    • Disclosures must be legible, understandable, provided at enrollment and annually; the Department of Insurance will establish standardized formats and web availability. Disclosure to one household member may satisfy the requirement for the household.
  • Office of Consumer Health Insurance reporting (amends Sec. 90)
    • The Office must post an annual report summarizing federal, State, and local actions affecting plan adequacy and a summary of State health insurance benefit legislation enacted in the prior calendar year (including links, citations, subjects, summaries, and effective dates). (A later amendment requires additional content beginning Jan. 31, 2027.)
  • Changes to Health Care Benefit Information Card requirements
    • Adds dental plans to the list of plans required to issue a benefit information card; cards may be electronic or physical.
    • Requires the card to indicate whether the plan is self‑insured or fully insured and whether it is regulated by the Department of Insurance.

Who is affected

  • Health insurers and issuers of qualified health plans (obligated to produce and post expanded disclosures)
  • Participating health care providers (required to supply credential and privilege information on request)
  • Enrollees and prospective enrollees (greater access to coverage, network, cost, and legislative-change information)
  • Department of Insurance / Office of Consumer Health Insurance (rulemaking, website postings, and reporting duties)

Potential impacts and considerations

  • Increased transparency for consumers when comparing plans and navigating care.
  • Administrative and operational costs for insurers and plans to compile, maintain, and publish updated formularies, directories, and mandated disclosures; some fiscal impacts expected though not quantified in the bill text.
  • The law prohibits forced disclosure of specific provider reimbursement amounts, limiting commercial exposure.
  • Timing and exact scope of some reporting/format requirements may depend on Department rulemaking; stakeholders should watch implementing rules.

Note: This summary is based on the enrolled/Public Act text and legislative summaries. Verify the official Public Act text and the Department of Insurance rulemaking for final requirements, deadlines, and the confirmed effective date.

Compiled from official sources — confirm details with the bill’s official record.

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