PA 07-18—sSB 229

Insurance and Real Estate Committee

AN ACT CONCERNING LISTS OF PROVIDERS AND NOTIFICATION OF TERMINATION OR WITHDRAWAL OF PRIMARY CARE PHYSICIANS

SUMMARY: By law, managed care organizations (MCOs) must annually provide people enrolled in a health plan a list of health care providers participating in the plan. This act specifies that the list must be provided in writing or through the Internet at the enrollee's option.

Prior law required an MCO to notify an enrollee as soon as possible when his or her primary care physician left the MCO's provider network. The act limits this requirement to managed care plans that require an enrollee to select a primary care physician.

EFFECTIVE DATE: October 1, 2007

BACKGROUND

MCO

An MCO is an insurer, HMO, hospital or medical service corporation, or other organization delivering, issuing for delivery, renewing, or amending an individual or group managed care plan in Connecticut.

Managed Care Plan

A managed care plan is a product an MCO offers that finances or delivers health care services to plan enrollees through a panel of health care providers selected based on explicit standards. The plan offers incentives to encourage enrollees to use these providers (e. g. , lower copayments).

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