4.__Construction.__This section may not be construed as:

A.__Creating coverage for any health care service that is not otherwise covered under the terms of a health plan or managed care plan;

B.__Requiring a health plan or managed care plan to include as a participating provider every willing provider or health professional who meets the terms and conditions of the health plan or managed care plan;

C.__Preventing a covered person from seeking eye care services from the plan sponsor or enrollee's primary care provider in accordance with the terms of the plan sponsor or enrollee's health plan or managed care plan;

D.__Increasing or decreasing the scope of practice of optometry or ophthalmologist as defined in Title 32;

E.__Requiring eye care services to be provided in a hospital or similar medical facility; or

F.__Prohibiting a health plan or managed care plan from requiring a plan sponsor or enrollee to receive a referral or prior authorization from a primary care provider for any subsequent surgical procedures.

SUMMARY

This bill specifies that health plans and managed care plans offered by a carrier that provide coverage for eye care services must provide direct access to eye care providers and may not impose deductible or coinsurance costs for eye care services that are greater than a deductible or coinsurance for other medical services.