PA 11-38—sHB 6310

Insurance and Real Estate Committee


SUMMARY: This act requires an HMO or preferred provider network (PPN) that provides benefits for ophthalmologic and optometric services to provide opthalmologists (licensed physicians specializing in ophthalmology) and optometrists equal access to all health plans and policies it offers. It prohibits an HMO or health insurer contracting with a PPN from restricting participation in a plan or policy based on the service limitations of individual optometrists or opthalmologists. It also specifies that providing equal access to all health plans and policies does not permit any such provider to perform or provide services outside of his or her scope of practice.

Existing law requires an HMO or PPN providing ophthalmologic care benefits to also provide optometric care. If ophthalmologic care can be legally provided by an optometrist, then the HMO or PPN must provide the same eye care coverage and benefits for services they perform. HMOs and PPNs must contract with both types of specialists in a fair and sufficient manner and equally inform enrollees of the availability of opthalmologic and optometric services.

EFFECTIVE DATE: January 1, 2012

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