2014 Regular Session
By: Representative Chism
AN ACT TO PROHIBIT PROVIDER CONTRACTS FOR VISION SERVICES IN HEALTH AND VISION INSURANCE PLANS FROM ESTABLISHING OR LIMITING FEES FOR NONCOVERED SERVICES; TO PROHIBIT A PROVIDER FROM CHARGING MORE FOR SERVICES AND MATERIALS THAT ARE NONCOVERED SERVICES UNDER A VISION PLAN THAN HIS USUAL AND CUSTOMARY RATE FOR THOSE SERVICES AND MATERIALS; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. (1) No agreement between an insurer or an entity that writes vision insurance and an optometrist for the provision of vision services on a preferred or in-network basis to plan members or insurance subscribers in connection with coverage under a stand-alone vision plan, a medical plan, or health insurance policy may require that an optometrist or ophthalmologist provide services or materials at a fee limited or set by the plan or insurer unless the services or materials are reimbursed as covered services under the contract.
(2) A provider shall not charge more for services and materials that are noncovered services under a vision plan than his or her usual and customary rate for those services and materials.
(3) The amount of a contractual discount shall not result in a fee less than the health or vision plan would pay for covered services and materials but for the application of an enrollee's contractual limitations of deductibles, copayments and coinsurance.
(4) Reimbursement paid by the vision plan for covered services and materials shall be reasonable and shall not provide nominal reimbursement in order to claim that services and materials are covered services.
(5) For purposes of this section:
(a) "Contractual discount" means a percentage reduction from a provider's usual and customary rate for covered services and materials required under a participating provider agreement.
(b) "Covered services" means services and materials for which reimbursement from the vision plan is provided for by an enrollee's plan contract, or for which a reimbursement would be available but for the application of the enrollee's contractual limitations of deductibles, copayments, and coinsurance.
(c) "Materials" includes, but is not limited to, lenses, devices containing lenses, prisms, lens treatments and coatings, contact lenses, orthoptics, vision training, and prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human eye or its adnexa.
(d) "Vision plan" means any policy of insurance that is issued by a health care entity that provides coverage of vision services not in connection with a medical plan.
SECTION 2. This act shall take effect and be in force from and after July 1, 2014.