The bill amends existing legislation regarding vision insurance, specifically focusing on reimbursement practices for licensed optometric physicians. It mandates that reimbursements for covered services must be at least at the sixtieth percentile of the usual charges for similar services in the same geographic area, as determined by a recognized independent nonprofit. Additionally, the bill prohibits any increase in reimbursement for covered services from being offset by a decrease in reimbursement for ophthalmic materials, unless such changes are uniformly applied to all providers. It also ensures that providers are not penalized for using nonaffiliated labs or frame vendors if they meet the necessary credentialing standards.
Furthermore, the bill requires vision benefit plans and insurers to disclose average reimbursements to both affiliated and independent providers for services and materials. It also includes provisions to prevent prepaid vision plans from impacting the pricing of noncovered services and materials, and from using extrapolation in audits of vision care providers. The effective date for this legislation is set for November 1, 2026.