"ANY WILLING PROVIDER" LAWS NOT PREEMPTED BY EMPLOYEE RETIREMENT INCOME SECURITY ACT (ERISA). KENTUCKY ASSOCIATION OF HEALTH PLANS, INC. ET. AL. V. MILLER, COMMISSIONER, KENTUCKY DEPARTMENT OF INSURANCE.

2004-09-29 / Date completed: 2004-11-02 / Date revised:

Print / Benefits Q; 2004; Publication 8756-1263:20:69-70

Journal Article | Legal Cases

15453199 [MEDLINE]

"Any Willing Provider" laws are not preempted by ERISA because they are state laws regulating insurance if they are (1) specifically directed toward entities engaged in insurance and (2) substantially affect the risk-pooling arrangement between the insurer and the insured. Thus, a state may prohibit health maintenance organizations (HMOs) from creating exclusive "provider networks" of doctors, hospitals and other health care providers by excluding other providers who are "willing and able" to comply with all the HMO's contractual terms if the law meets the new two-prong test established by the Supreme Court in this case. The Court made a "clean break" from using the McCarran-Ferguson Act factors for determining whether certain practices constitute "the business of insurance," when deciding when they regulate insurance for purposes of ERISA preemption.