Bill
S 4187
Limits patient co-pays/deductibles to one per 180 days for follow-up care from in-network providers, if medical-necessity preauthorization is followed.
Note: The bill’s title refers to early decision admissions data reporting by colleges, but the introduced text pertains to health benefits plan co-payments. The following summary reflects the introduced version’s content as provided.
1) Co-pay/deductible limit for follow-up care
- A health benefits plan carrier offering a managed care plan must ensure that for follow-up care provided by a participating provider, a covered person is responsible for only one co-payment or deductible during any 180-day period following the payment of that co-payment or deductible.
- The participating provider may not collect more than one such co-payment or deductible within the same 180-day period, regardless of the number of follow-up visits.
2) Conditions for applicability
- The above limits apply only if the covered person complies with the plan’s preauthorization or review requirements related to determining medical necessity to access in-network inpatient benefits, as written in accordance with the Health Care Quality Act.
3) Effective date
- The act would take effect on the first day of the fourth month after enactment.
- It would apply to all contracts and policies issued or renewed on or after that effective date.
If you need, I can compare this bill’s text to the companion bills or outline potential fiscal/administrative implications in more detail.
Compiled from official sources — confirm details with the bill’s official record.
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