Definitions

For purposes of this Act: (1) All-or-nothing clause The term all-or-nothing clause means a provision of a health care contract that requires— (A) a health insurance carrier or health plan administrator to include all members of a health care provider in a network plan; or (B) a health insurance carrier or health plan administrator to enter into an additional contract with an affiliate of the health care provider as a condition of entering into a contract with such health care provider. (2) Anti-steering clause The term anti-steering clause means a provision of a health care contract that restricts the ability of a health insurance carrier or a health plan administrator from encouraging an enrollee to obtain a health care service from a competitor of the hospital or health system, including offering incentives to encourage enrollees to utilize specific health care providers. (3) Anti-tiering clause The term anti-tiering clause means a provision in a health care contract that— (A) restricts the ability of a health insurance carrier or a health plan administrator to introduce or modify a tiered network plan or assign health care providers into tiers; or (B) requires the health insurance carrier or health plan administrator to place all members of a health care provider in the same tier of a tiered network plan. (4) Gag clause The term gag clause means a provision of a health care contract that— (A) restricts the ability of a health insurance carrier, a health plan administrator, or a health care provider to disclose a price or quality information, including the allowed amount, negotiated rates or discounts, fees for services, or any other claim-related financial obligations included in the provider contract to— (i) a governmental entity as authorized by law, (ii) its contractors or agents, (iii) an enrollee, (iv) a treating health care provider of an enrollee, (v) a plan sponsor, or (vi) potential eligible enrollees and plan sponsors; or (B) restricts the ability of a health insurance carrier, a health plan administrator, or a health care provider to disclose out-of-pocket costs to an enrollee. (5) Tiered network plan The term tiered network plan means a health benefit plan that sorts some or all types of health care providers into specific groups to which different provider reimbursement, enrollee cost sharing, health care provider access requirements, or a combination thereof, are applied for the same services.