Provider Nondiscrimination
For plan years beginning on or after January 1, 2014, non-grandfathered plans may not discriminate against health care providers acting within the scope of their licenses. For example, this could prevent a plan from denying benefits solely because a doctor prescribed a drug for an off-label purpose or provided a service outside the doctor's typical specialty area (assuming both acts were within the scope of the doctor's license).
Note: The provider nondiscrimination rule only applies to certain types of health plans, such as major medical insurance. It does not apply to HIPAA excepted benefits, such as disability, cancer, or accident insurance. Click here for more information about the types of benefits that are exempt from the Health Care Reform plan design mandates.
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Additional Resource
American Fidelity Assurance Company does not provide tax or legal advice.
ESB-910(0111)
