Restricts eligibility for individual coverage through the Health Connector to individuals who are not seeking to replace employer-sponsored coverage that complies with minimum creditable coverage standards.

Requires insurance carriers, including third party administrators of insurance plans, to report information to the Division of Insurance (DOI) on premiums earned, membership, medical loss ratio, and other detailed financial information associated with business operations. Carriers must annually report this information to DOI each April 1st to avoid a late penalty and may subsequently be subject to an audit. Information collected under this provision will be available to the public, and DOI must issue an annual report of information collected under this provision to the legislature. Any carrier that reports a risk-based capital ratio over 700% must participate in a public hearing to determine what portion of excess funds will go toward reducing the costs of health benefit plans or for health care quality improvement.

DOI may develop procedures to carry out the requirements of this section, including requiring the registration of third party administrators and standardizing reporting criteria, after consulting with state and federal agencies and affected carriers to ensure that regulations are not duplicative.

Adds new definition of "wellness program" to the Group Insurance Commission statute.

Prohibits certain contracting practices between insurance carriers and health care providers including the following: provisions that guarantee a health care provider the right to participate in a select network or tiered network plan; requirements that all members of a provider group be included in the same tier in a tiered network plan or all be included in a select network plan; requiring provider participation in a new select or tiered network plan without granting providers the right to opt out of the new plans; requiring or permitting carriers or providers to alter contracts based on agreements with other carriers and providers; and requiring or permitting carriers to make supplemental payments without first publicly disclosing the amount and purpose of each such supplemental payment to the Insurance Commissioner.

Adds to the information insurers must provide to consumers to include the location, specialty, and methods of compensation or reimbursement for each provider in a plan’s network, a provider’s price relativity, health status adjusted total medical expense, and quality performance based on measures from the Standard Quality Measure Set standards developed by the Department of Public Health. The information specific to each provider in a carrier’s network must be provided on a health insurance carrier’s website, to at least one plan member per subscriber household, and to each prospective insured upon request.

The Bureau of Managed Care within the Division of Insurance (DOI) is directed to require, as a condition of accreditation, that carriers adopt uniform standards and methodologies for credentialing health care providers. Also, any carrier that contracts with a third party administrator must ensure that the third party complies with the standards. By way of background, the Bureau of Managed Care within DOI determines standards and procedures for accreditation of health insurance carriers. The Bureau must consult with the Division of Health Care Finance and Policy, the Department of Public Health, the Group Insurance Commission, the Centers for Medicare and Medicaid Services, and each health insurance carrier to develop the standards.

Amended to allow a carrier to seek approval from the Commissioner of the Division of Insurance (DOI) to discontinue a closed guarantee issue health plan pursuant to DOI regulations. Prior to this amendment, a carrier could only discontinue a closed guarantee issue health plan if the number of subscribers in the plan was less than 25% of the plan’s 2004 subscriber total. Furthermore, no carrier may deny coverage to, impose any pre-existing condition exclusion, or impose any waiting period on an individual or dependent who is eligible for a guaranteed issue health plan.

Amended to clarify that carriers offering coverage to individuals, including those who renew through the Connector, are considered to be participating in the nongroup health insurance market.

By way of background, any carrier that offers health plans in the small business market to more than 5,000 employees and dependents, and offers eligible individuals a guaranteed issue managed care plan, a guaranteed issue medical plan, or a guaranteed issue preferred provider plan will be included in the nongroup health insurance market.

Creates a market for up to six small business group purchasing cooperatives to operate in the state. The purpose of creating the cooperatives is to allow small businesses to combine purchasing power and to seek lower premiums as a larger group. Division of Insurance (DOI) must establish an application and certification process for the cooperatives and must certify up to six applications that meet DOI requirements. Approved group purchasing cooperatives may cover up to a combined number of 85,000 covered lives at any given time.

Plan benefits must include those mandated by the state as well as access to a wellness program. At least 33% of covered employees of each cooperative must commit to enrolling in the health management programs the cooperative must provide. A cooperative may not deny coverage to any employee or dependent of association members based on health condition, age, race, or sex. Premiums for a particular plan offered to a member of a cooperative must be equal to or less than premiums an insurer would charge that small business if it was seeking benefits outside of the cooperative.

Products may be sold through brokers, licensed agents and the Connector.

Within 2 years of the first small business group purchasing cooperative certification, DOI must report to the legislature on the cost savings to members of the cooperatives, any impact the cooperatives have on the state risk pool and premium costs in the merged market, and whether DOI should continue certifying cooperatives.

Requires any insurance carrier that has a combined total of at least 5,000 eligible individuals, employees, and dependents, and wishes to continue offering health plans in the individual and small group market, to file a plan with each group purchasing cooperative if the group purchasing cooperative requests such health plan proposal for its next plan year. Any health plan option offered to a cooperative must include all state mandated benefits, and must apply the same preexisting coverage limitations, waiting periods, open enrollment periods and rating rules as applied to small groups outside the cooperative.