Other Prohibited Clauses

Anti-Steering Clauses

Used to prevent health plans from encouraging their members to utilize more cost-effective or higher quality providers.
Example of beneficial activity prevented by these clauses:
Employer to employee: Hospital A is in our network, but we prefer that you visit hospital B, which has higher quality scores and lower copays.

Anti-Tiering Clauses

Used to prevent employers from developing benefit plans that encourage their employees to incentivize the use of especially high-quality/low-cost providers by providing employees with lower cost-sharing or out-of-pocket expenses if they use that subset.
Example of anti-tiering clause:
If you visit hospital A, we will waive your deductible and any other out-of-pocket expenses. If you visit any other hospital in our network, your normal $1,000 deductible applies.

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