This bill amends the Insurance Company Law of 1921 to enhance continuity of care for individuals enrolled in managed care plans, specifically those under MA (Medical Assistance) and CHIP (Children's Health Insurance Program). Key provisions include extending the transitional period for ongoing treatment with a health care provider from 60 days to 120 days when a contract is terminated, expired, or nonrenewed by either the insurer or the provider. Additionally, it mandates that insurers notify covered individuals of changes in their provider's network status and allows for the extension of the transitional period if deemed clinically appropriate, particularly for pregnant individuals.

Furthermore, the bill introduces a new provision that prohibits nonparticipating health care providers from billing covered individuals directly for services rendered during the transitional period if they have been reimbursed at the same rate as participating providers. This aims to protect patients from unexpected costs while ensuring they receive necessary care during transitions in their health insurance coverage. The act will take effect 60 days after its passage, with specific applicability timelines for health insurance policies based on filing requirements.

Statutes/Laws affected:
Printer's No. 869 (Mar 10, 2025): P.L.682, No.284
Printer's No. 0869: P.L.682, No.284