Relating to: transparency and regulation of prior authorization requirements under health insurance plans. (FE)

SB 434 regulates prior authorization processes for health insurance plans by requiring greater transparency and standardizing procedures. It directly affects health insurers, self-insured employer plans, and utilization review entities (like insurance companies) that manage pre-approval for medical services. Key provisions include defining "prior authorization" and "adverse determination," mandating that adverse decisions be made by qualified healthcare providers (physicians, physician assistants, or nurse practitioners), and setting timeframes for non-urgent cases. The bill also establishes new requirements for notifying enrollees about coverage decisions. This focuses on clarifying the process for patients seeking covered treatments, not altering coverage benefits.