Prohibition on denial of claim based on out of network provider referral

Sec. 10. (a) This section applies to an individual contract and a group contract that is entered into, delivered, amended, or renewed after June 30, 2025. (b) A health maintenance organization may not deny a claim for reimbursement for a covered service or item provided to an enrollee on the sole basis that the referring provider is an out of network provider. As added by P.L.144-2025, SEC.38 and P.L.215-2025, SEC.65.