4.__Limitation.__Standards of care required by subsections 1 and 2 do not require a carrier to provide to an enrollee treatment that is not covered by the managed care plan provided by the carrier.

5.__Law not a defense.__The laws of the State prohibiting a person from practicing medicine may not be asserted by a carrier as a defense in any action.

6.__Proof of relationship.__In an action against a carrier, a finding that a physician or other health care provider is an employee, agent, ostensible agent or representative of the carrier may not be based solely on proof that the person's name appears in a listing of approved physicians or health care providers made available to enrollees under a managed care plan.

7.__Workers' compensation.__This section does not apply to workers' compensation insurance coverage.

SUMMARY

This bill establishes a duty and standard of ordinary care that must be provided by an insurance company, health maintenance organization, preferred provider organization or nonprofit hospital or medical service organization under a managed health care plan. It also authorizes a person enrolled in a managed health care plan to bring a legal action for damages against a carrier if the person is harmed by a carrier's failure to exercise ordinary care.