Substitute for S.B. No. 10
Session Year 2025


AN ACT CONCERNING HEALTH INSURANCE AND PATIENT PROTECTION.

To: (1) Establish (A) certain reporting requirements and enforcement provisions concerning compliance with mental health and substance use disorder benefit laws, and (B) the parity advancement account; (2) require health carriers to bear the burden of proving that certain health care services under adverse determination or utilization review are not medically necessary; (3) establish certain prohibitions on the use of step therapy for prescription drugs; (4) require health carriers to include certain provisions in contracts with health care providers regarding reimbursement for certain covered health benefits; (5) establish certain requirements concerning stop loss insurance policies for health care or medical benefits under any self-funded employee health benefit plan; (6) establish certain health insurance rate filing requirements and require that the Insurance Commissioner adopt regulations concerning affordability in rate filing; (7) prohibit the use of artificial intelligence to make an adverse determination based on medical necessity; and (8) prohibit any individual or group health insurance policy from imposing (A) arbitrary time limits on reimbursement for general anesthesia services, or (B) unilateral arbitrary limitations on reimbursement for medically necessary ancillary services.


Other Bills with Similar Topics

  Alcoholism 

  Certificates and certification 

 

  Children 

 

  Consumer protection 

 

  Drug abuse treatment 

 

  Drugs 

 

  Electronic government information 

 

  Fines (Penalties) 

 

  Health care centers 

  Health care providers 

 

  Health insurance 

 

  Health insurance rates 

  Hospital service corporations 

  Insurance companies 

  Insurance Fund 

  Insurance rates 

  Insurance Department 

 

  Medical service corporations 

  Mental health services 

 

  Patients 

 

  Patients' rights 

  Public hearings 

 

  Reports 

 

  Utilization review 

  Anesthesia 

  Developmental disabilities, persons with 

 

  Adverse events (medical) 

  Artificial intelligence