§ 4-20 — Deductibles and copayments

(a) A Health Maintenance Organization may require deductibles and copayments of enrollees as a condition for the receipt of specific health care services, including basic health care services. Deductibles and copayments shall be the only allowable charges, other than premiums, assessed enrollees. Nothing within this subsection (a) shall preclude the provider from charging reasonable administrative fees, such as service fees for checks returned for non-sufficient funds and missed appointments. (b) Deductibles and copayments shall be for specific dollar amounts or for specific percentages of the cost of the health care services. (c) No combination of deductibles and copayments paid for the receipt of basic health care services may exceed the annual maximum out-of-pocket expenses of a high deductible health plan as defined in 26 U.S.C. 223. (d) Deductibles and copayments applicable to supplemental health care services, catastrophic-only plans as defined under the federal Affordable Care Act, or pre-existing conditions are not subject to the annual limitations described in this Section. (e) This Section applies to enrollees and does not limit the health care plan payment for services provided by non-participating providers. (f) This Section applies to enrollees and does not limit the health care plan payment for services provided by non-participating providers.

Legislative History

(Source: P.A. 97-1148, eff. 1-24-13.)