Coverage for continued medical treatment.
1. The provisions of this section apply to a policy of health insurance offered or issued by an insurer if an insured covered by the policy receives health care through a defined set of providers of health care who are under contract with the insurer.
2. Except as otherwise provided in this section, if an insured who is covered by a policy described in subsection 1 is receiving medical treatment for a medical condition from a provider of health care whose contract with the insurer is terminated during the course of the medical treatment, the policy must provide that:
(a) The insured may continue to obtain medical treatment for the medical condition from the provider of health care pursuant to this section, if:
(1) The insured is actively undergoing a medically necessary course of treatment; and
(2) The provider of health care and the insured agree that the continuity of care is desirable.
(b) The provider of health care is entitled to receive reimbursement from the insurer for the medical treatment he provides to the insured pursuant to this section, if the provider of health care agrees:
(1) To provide medical treatment under the terms of the contract between the provider of health care and the insurer with regard to the insured, including, without limitation, the rates of payment for providing medical service, as those terms existed before the termination of the contract between the provider of health care and the insurer; and
(2) Not to seek payment from the insured for any medical service provided by the provider of health care that the provider of health care could not have received from the insured were the provider of health care still under contract with the insurer.
3. The coverage required by subsection 2 must be provided until the later of:
(a) The 120th day after the date the contract is terminated; or
(b) If the medical condition is pregnancy, the 45th day after:
(1) The date of delivery; or
(2) If the pregnancy does not end in delivery, the date of the end of the pregnancy.
4. The requirements of this section do not apply to a provider of health care if:
(a) The provider of health care was under contract with the insurer and the insurer terminated that contract because of the medical incompetence or professional misconduct of the provider of health care; and
(b) The insurer did not enter into another contract with the provider of health care after the contract was terminated pursuant to paragraph (a).
5. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2003, has the legal effect of including the coverage required by this section, and any provision of the policy or renewal thereof that is in conflict with this section is void.
6. The Commissioner shall adopt regulations to carry out the provisions of this section.
Last modified: February 27, 2006