Managed Care Kryptonite Evicerates PPO Contracts

The government prohibits group health plans and issuers offering group health insurance from entering into agreements with providers, third-party administrators (TPAs) or other service providers that include language that would constitute a gag clause……………..

“Plan sponsors and carriers of fully insured plans are both required to submit a [Gag Clause Prohibition Compliance Attestation (GCPCA)]. [FAQs Part 57] provide that if the insurance carrier submits the GCPCA on behalf of the plan, the Departments will consider the plan (and insurer) compliant. Sponsors of fully insured plans, however, should confirm that the carrier will be submitting the GCPCA on the plan’s behalf.” 

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