SECTION 1. Chapter 176Q of the Massachusetts General Laws, as appearing in the 2012 Official Edition, is hereby amended by adding after section 18 the following new section:-
Section 18. The connector shall ensure that the following information about each health benefit plan offered for sale to consumers in the commonwealth shall be available to consumers in a clear and understandable form for use in comparing plans, plan coverage, and plan premiums:
(a) The ability to determine whether specific types of specialists are in network and to determine whether a named physician, hospital or other health care provider is in network;
(b) Any exclusions from coverage and any restrictions on use or quantity of covered items and services in each category of benefits;
(c) A description of how medications will specifically be included in or excluded from the deductible, including a description of out-of-pocket costs that may not apply to the deductible for a medication;
(d) The specific dollar amount of any co-pay or percentage coinsurance for each item or service;
(e) The ability to determine whether a specific drug is available on formulary, the applicable cost-sharing requirement, whether a specific drug is covered when furnished by a physician or clinic, and any clinical prerequisites or authorization requirements for coverage of a drug;
(f) The process for a patient to obtain reversal of a health plan decision where an item or service prescribed or ordered by the treating physician has been denied; and
(g) An explanation of the amount of coverage for out of network providers or non- covered services, and any rights of appeal that exist when out of network providers or non-covered services are medically necessary
(h) A carrier offering health benefit plans who knowingly falsifies or fails to file with the connector any information required by this section or any regulation promulgated by the connector related to this section shall be punished by a fine of not less than $50,000 and not more than $250,000.
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