TITLE 23
Health and Safety

CHAPTER 23-17.13
Health Care Accessibility and Quality Assurance Act

SECTION 23-17.13-7


§ 23-17.13-7 Contracts with providers and optometric services.

(a) No contract between an eye care provider and a company offering accident and sickness insurance as defined in chapter 18 of title 27; a nonprofit medical service corporation as defined in chapter 20 of title 27; or a health maintenance organization as defined in chapter 41 of title 27; or a vision plan, may require that an eye care provider provide services or materials to its subscribers at a fee set by the insurer or vision plan unless the insurer or vision plan compensates the eye care provider for the provision of such services or materials to the patient. Reimbursement paid by the insurer or vision plan for covered services and materials shall not provide nominal reimbursement in order to claim that services and materials are covered services.

(b)(1) "Services" means services and materials for which reimbursement from the vision plan is provided for by an enrollee's plan contract, or for which a reimbursement would be available but for the application of the enrollee's contractual limitations of deductibles, copayments, or coinsurance.

(2) "Materials" means and includes, but is not limited to, lenses, devices containing lenses, prisms, lens treatments and coatings, contact lenses, orthoptics, vision training, and prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human eye or its adnexa.

(3) "Eye care provider" means an optometrist, optician, or ophthalmologist.

History of Section.
(P.L. 2014, ch. 411, § 1; P.L. 2014, ch. 443, § 1.)