Section 19: Defines Unfair Competition Among Insurers Seeking Provider Contracts

The following shall be unfair methods of competition and unfair or deceptive acts or practices in the business of insurance by entities organized under chapters 176A, 176B, 176G and 176I or licensed under chapter 175:

(i) entering into any agreement to commit or by any concerted action committing any act of, boycott, coercion, intimidation resulting in or tending to result in unreasonable restraint of, or monopoly in, the business of insurance;

(ii) refusal to enter into a contract with a health care facility on the basis of the facility's religious affiliation;

(iii) seeking to set the price to be paid to any health care facility or provider by reference to the price paid, or the average of prices paid, to that health care facility or provider under a contract or contracts with any other nonprofit hospital service corporation, medical service corporation, insurance company, health maintenance organization or preferred provider arrangement;

(iv) refusal to contract or affiliate with a health care facility solely because the facility does not provide a specific service or range of services;

(v) selecting or contracting with a health care facility or provider not based primarily on cost, availability and quality of covered services;

(vi) refusal to enter into a contract with a health care facility solely on the basis of the facility's governmental affiliation; and

(vii) arranging for an individual employee to apply for individual health insurance coverage, as defined in chapter 176J, for the purpose of separating that employee from group health insurance coverage to reduce costs for an employer sponsored health plan provided in connection with the employee's employment.

Summary

Modifies the definition of unfair or deceptive insurance practices by including insurers that arrange for an employee to apply for individual health insurance coverage for the purpose of then excluding that employee from an employer-sponsored health plan, for which the employee is eligible, to reduce costs for other individuals in the employer-sponsored health plan.