Health Plan Provisions

The WSMA believes health plans should: 1) Provide adequate, comparable and understandable information to their beneficiaries about the content and cost containment policies of their plans, prior to and during enrollment; 2) Ensure that patients have a broad choice of physicians and protection from loss of continuity for at least six months, if their employer changes health plans; 3) Have dispute resolution processes that are timely, independent, and fair, such as the right of patients to use court action or other alternative external dispute resolution processes against health plans if necessary to uphold the terms of the patient’s contract; and, 4) Provide access to covered services and specialty care which are medically needed and appropriate. (Res C-2, A-99) (Reaffirmed A-23)

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Abbreviations for House of Delegates report origination:

EC – Executive Committee; BT – Board of Trustees; CPA – Council on Professional Affairs; JC – Judicial Council; CHS – Community and Health Services