HB540 Alabama 2015 Session

Summary

Primary Sponsor

Matt Fridy

Republican

Session

Regular Session 2015

Title

Vision care, services provided by optometrists and ophthalmologists, contracts with insurers, restrictions on

Summary

HB540 would regulate vision care contracts to prevent insurers from unfairly limiting provider fees or supplier choices and to require reasonable reimbursements.

What This Bill Does

If passed, the bill would prevent insurers or vision care plans from forcing providers to set fees, join specific plans, or limit where they source services and materials. It would also bar providers from charging insurers more than their usual rates for non-covered items. The bill requires reasonable reimbursements for covered services and materials, and it provides exemptions for some health care service plans while giving the Department of Insurance authority to implement the rules. It also sets contract and disclosure rules, including a two-year maximum contract length and notification requirements for changes to provider manuals, with immediate effectiveness after governor approval and allowance for voluntary discount cards under certain conditions.

Who It Affects

• Vision care providers (licensed optometrists and ophthalmologists) would gain protections against insurers limiting their fees, participation, or supplier choices and would be ensured reasonable reimbursements.
• Insurers and vision care plans would be constrained in how they set fees, require participation, or limit supplier sources, and would need to provide reasonable reimbursements and follow contract terms; enrollees would be affected by clearer pricing and capped non-covered charges.

Key Provisions

• Insurers cannot limit a provider's ability to set fees, participate in specific plans, or choose suppliers for covered services or materials.
• Providers cannot charge more to insurers or enrollees for non-covered services or materials than their usual and customary rate.
• Reimbursements for covered services and materials must be reasonable and not nominal.
• Some health care service plans may be exempt from these provisions.
• The Department of Insurance may adopt rules to implement the act.
• Definitions are established for contractual discount, covered services/materials, insurer, materials, services, vision care plan, and vision care provider.
• Vision care plan contracts are limited to two years and require notification to providers before changes to provider manuals.
• This act applies to contracts executed in Alabama and becomes effective immediately after governor approval.
• Discount cards may be used voluntarily by enrollees if not tied to coverage or payments to providers.

AI-generated summary using openai/gpt-5-nano on Feb 24, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Optometrists