Reference is to Printer's Date 4/10/13-S.
Amend the bill, as and if amended, by deleting all after the enacting words and inserting:
/ SECTION 1. Section 38-71-1730(A) of the 1976 Code is amended to read:
"(A) For purposes
of health plans offered pursuant to this section:
(1)
An employer who employs more than fifty eligible
employees and who offers to employees major medical,
hospitalization, and surgical health insurance coverage only
under a closed panel health plan, also shall offer to employees
at the time of their eligibility as major medical,
hospitalization, and surgical health insurance coverage a
point-of-service option. An employee of an employer offering
only a closed panel health plan has the right to choose whether
to remain in the closed panel health plan or to choose a
point-of-service option.
(2) An employer may
require an employee who chooses a point-of-service option to be
responsible for payment of premiums, deductibles, copayments, or
other payments in excess of the benefits provided by the closed
panel health plan.
(32)
Differences between coinsurance percentages for in-network
and out-of-network covered health care services or supplies in a
point-of-service option may not exceed a maximum differential of
twenty thirty percent. The coinsurance
percentage for in-network and out-of-network covered health care
services or supplies provided by dentists may not exceed a
maximum difference of five percent.
(43) An
employee, a spouse, or a dependent receiving treatment for an
illness covered under a closed panel health plan may continue to
receive services from a provider who elects to discontinue
participation as a closed panel plan provider, subject to the
terms of the contract between the provider and the health plan.
This right of continuation is limited to a period of ninety days
or the anniversary date of the plan, whichever occurs first.
(54) A
point-of-service option or closed panel health plan
offered pursuant to this article may not
discriminate against a physician, a podiatrist, an optometrist,
an oral surgeon, a physical therapist, an occupational
therapist, or a chiropractor by excluding the provider from
participating in the plan on the basis of the profession. A
health care plan may not exclude these providers from providing
health care services which they are licensed to provide and
which are covered by the plan and as determined by medical
necessity under utilization review guidelines. Nothing in this
section interferes in any way with the medical decision of the
primary health care provider to use or not use any health care
professional on a case-by-case basis.
(65) A
pharmacist may provide professional services under the
pharmacist's scope of practice so long as the services are
provided pursuant to a prescription written by a medical doctor
or dentist with whom the patient has an established
physician-patient relationship. Nothing in this subsection
requires a managed care plan to provide reimbursement to a
pharmacist. An advanced practice nurse functioning as
authorized by the State Board of Nursing Regulation 91-6 may
provide professional services under the advanced practice
nurse's scope of practice so long as the services provided are
pursuant to protocols by a medical doctor with whom the patient
has an established physician-patient relationship. A
point-of-service option offered pursuant to this section may not
discriminate against an advanced practice nurse. Nothing in
this subsection requires a managed care plan to provide
reimbursement to an advanced practice nurse.
(76) Nothing
contained in this article affects in any way a plan exempted by
the federal Employee Retirement Income Security Act of 1974 or
any South Carolina law in existence before January 1, 1999, and
state employee health insurance programs or any political
subdivision self-funded health insurance program; and this
article does not affect the right of an employer to specify plan
design or affect the right of a plan to credential or
re-credential a provider. Nothing contained in this article
affects accident-only, blanket accident and sickness, specified
disease, credit, Medicare supplement, long-term care, or
disability income insurance, coverage issued as a supplement to
liability or other insurance coverage designed solely to provide
payments on a per diem, fixed-indemnity, or nonexpense incurred
basis, coverage for Medicare or Medicaid services pursuant to a
contract with state or federal government, worker's compensation
or similar insurance, or automobile medical payment
insurance."
SECTION 2. This act takes effect forty-five days after approval by the Governor. /
Renumber sections to conform.
Amend title to conform.