TITLE 27
Insurance

CHAPTER 27-18.8
Health Care Accessibility and Quality Assurance Act [Effective January 1, 2018.]

SECTION 27-18.8-5


§ 27-18.8-5. Contracts with providers for optometric services. [Effective January 1, 2018.].

(a) No contract between an eye care provider and a health care entity or vision plan may require that an eye care provider provide services or materials to its beneficiaries 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 beneficiary. 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 a beneficiary's plan contract, or for which a reimbursement would be available but for the application of the beneficiary'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. 2017, ch. 302, art. 5, § 4.)