Title 31, Chapter 1, Section 22
( 31-1-22)
(a) A health care insurer providing a health benefit plan which
includes eye care benefits shall: (1) Not set professional fees or reimbursement for the same eye
care services as defined by established current procedural
terminology codes in a manner that discriminates against an
individual eye care provider or a class of eye care providers; (1.1) Not preclude a covered person who seeks eye care from
obtaining such service directly from a provider on the health
benefit plan provider panel who is licensed to provide eye care; (2) Not promote or recommend any class of providers to the
detriment of any other class of providers for the same eye care
service; (3) Ensure that all eye care providers on a health benefit plan
provider panel are included on any publicly accessible list of
participating providers for the plan; (4) Allow each eye care provider on a health benefit plan provider
panel, without discrimination between classes of eye care
providers, to furnish covered eye care services to covered persons
to the extent permitted by such provider's licensure; (5) Not require any eye care provider to hold hospital privileges
or impose any other condition or restriction for initial
admittance to a provider panel not necessary for the delivery of
eye care upon such providers which would have the effect of
excluding an individual eye care provider or class of eye care
providers from participation on the health benefit plan; and (6) Include optometrists and ophthalmologists on the health
benefit plan provider panel in a manner that ensures plan
enrollees timely access and geographic access. (b) Nothing in this Code section shall preclude a covered person
from receiving eye care or other covered services from the covered
person's personal physician in accordance with the terms of the
health benefit plan. (c) A person adversely affected by a violation of this Code section
by a health care insurer may bring an action in a court of competent
jurisdiction for injunctive relief against such insurer and, upon
prevailing, in addition to any injunctive relief that may be
granted, shall recover from such insurer damages of not more than
$100.00 and attorney's fees and costs. (d) Nothing in this Code section requires a health benefit plan to
include eye care benefits. |