Document Type

Peach Sheet


The Act requires managed care plans and health maintenance organizations to disclose all pertinent information regarding healthcare services or benefits under the plan to consumers. Consumers are also entitled to information regarding limitations on services, potential liability for using out-of-network providers, and financial obligations of the enrollee. Enrollees in a plan will also be given a consumer choice option providing additional access to out-of-network providers. The Act prohibits plans and organizations from compensating a health provider for providing less than medically necessary treatment or punishing a provider for giving appropriate care; the Act also mandates that healthcare providers or hospitals shall fully and promptly be paid any payment or reimbursement. Healthcare providers cannot be penalized for discussing with their patients what medical care is actually necessary. The Act provides for penalties in the event of noncompliance.

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