Patient engagement strategies are critical in North Carolina’s healthcare system to ensure that patients are actively involved in their care, leading to better health outcomes and satisfaction. Under North Carolina law and regulations, healthcare providers are encouraged to adopt patient-centered approaches that promote communication, education, and shared decision-making. The North Carolina Department of Insurance emphasizes the importance of compliance with state-specific laws, such as the North Carolina Patients’ Bill of Rights, which ensures patients are informed about their treatment options and can participate in decisions about their care. Effective patient engagement strategies often include personalized communication plans, health literacy initiatives, and the use of technology to facilitate access to health information. These strategies must align with ethical standards and the code of conduct for healthcare professionals, which prioritize patient autonomy and confidentiality. By fostering a collaborative relationship between patients and providers, healthcare organizations can improve adherence to treatment plans and reduce disparities in care. Understanding these principles is essential for passing the North Carolina Healthcare Insurance Exam, as it tests the candidate’s ability to apply these strategies in real-world scenarios while adhering to state-specific regulations.

In North Carolina, healthcare insurance professionals are required to adhere to strict reporting mechanisms to ensure compliance with state laws and regulations. These mechanisms are designed to maintain transparency, protect consumer rights, and uphold ethical standards in the insurance industry. One critical aspect of reporting involves the timely and accurate submission of complaints or violations related to insurance practices. The North Carolina Department of Insurance (NCDOI) mandates that any suspected fraudulent activity, unethical behavior, or violations of the state’s insurance code must be reported promptly. This is in line with the state’s commitment to safeguarding public interest and ensuring that insurance providers operate within the legal framework. Additionally, the NCDOI emphasizes the importance of maintaining confidentiality and integrity throughout the reporting process to protect both the reporter and the parties involved. Understanding these reporting mechanisms is essential for healthcare insurance professionals, as failure to comply can result in severe penalties, including fines, license revocation, or legal action. The state’s regulations also require that all reports be documented thoroughly, with clear evidence and adherence to procedural guidelines, to ensure that investigations are conducted efficiently and fairly.

In North Carolina, healthcare insurance regulations are designed to protect consumers and ensure fair practices among insurance providers. One critical aspect of these regulations is the requirement for insurers to provide clear and accurate information about policy benefits, limitations, and exclusions. This is particularly important when dealing with pre-existing conditions, as North Carolina law mandates specific protections for individuals with such conditions. Insurers must adhere to the state’s guidelines on waiting periods and coverage limitations for pre-existing conditions, ensuring that consumers are not unfairly denied coverage. Additionally, North Carolina’s insurance laws emphasize the importance of transparency in policy documentation, requiring insurers to use language that is easily understandable by the average policyholder. This aligns with the broader principles of the Affordable Care Act (ACA), which prohibits insurers from denying coverage based on pre-existing conditions and mandates essential health benefits. Understanding these regulations is crucial for insurance professionals in North Carolina, as non-compliance can lead to significant legal and financial consequences for both the insurer and the policyholder.

In the context of North Carolina’s healthcare insurance regulations, understanding global healthcare insurance models is crucial for professionals to ensure compliance and effective policy implementation. The Bismarck Model, one of the prominent global healthcare models, is characterized by its reliance on insurance funds that are jointly financed by employers and employees through payroll deductions. This model emphasizes universal coverage without direct government provision of healthcare services, instead relying on private insurance plans that are tightly regulated. North Carolina, like many states, incorporates elements of this model into its healthcare policies, particularly in the regulation of employer-sponsored insurance plans. The state mandates specific coverage requirements and consumer protections, ensuring that insurance providers adhere to ethical standards and legal obligations. This model contrasts with the Beveridge Model, which is government-funded and operated, and the National Health Insurance Model, which combines government funding with private service provision. Understanding these distinctions helps professionals navigate the complexities of healthcare insurance in North Carolina, ensuring that they can effectively advocate for policies that align with state regulations and ethical standards.

Exclusive Provider Organizations (EPOs) are a type of managed care plan that restricts coverage to healthcare providers within a specific network, except in cases of emergency. Unlike Health Maintenance Organizations (HMOs), EPOs typically do not require referrals to see specialists, but they also do not provide coverage for out-of-network care unless it is an emergency. In North Carolina, EPOs must comply with state-specific regulations, including those outlined in the North Carolina Insurance Code, which governs the operation of health insurance plans. These regulations ensure that EPOs provide adequate access to care, maintain network adequacy, and adhere to consumer protection standards. Understanding the nuances of EPOs, including their limitations and compliance requirements, is crucial for healthcare insurance professionals in North Carolina, as it directly impacts how they advise clients and manage healthcare plans.

Exclusive Provider Organizations (EPOs) are a type of managed care plan that requires members to use healthcare providers within a specific network, except in cases of emergency. In North Carolina, EPOs are regulated under state insurance laws, which emphasize the importance of network adequacy and consumer protection. EPOs do not cover out-of-network care unless it is an emergency, making it crucial for members to understand the limitations of their coverage. Additionally, North Carolina law mandates that EPOs provide clear and transparent information about their network restrictions and coverage details to policyholders. This ensures that consumers are fully aware of their rights and responsibilities under the plan. The state also enforces strict compliance with the Affordable Care Act (ACA) provisions, which include protections for pre-existing conditions and essential health benefits. Understanding the nuances of EPOs, including their regulatory framework and operational requirements, is essential for healthcare insurance professionals in North Carolina to ensure compliance and provide accurate guidance to clients.

In North Carolina, the role of legal counsel in the healthcare insurance industry is critical to ensuring compliance with state-specific laws and regulations. Legal counsel provides guidance on interpreting and applying laws such as the North Carolina Insurance Act, which governs the operation of insurance companies within the state. They also assist in navigating complex regulatory frameworks, including those related to patient privacy under HIPAA and state-specific privacy laws. Legal counsel ensures that insurance policies and practices align with ethical standards and the North Carolina Department of Insurance (NCDOI) requirements. Additionally, they play a key role in advising on disputes, claims, and litigation, ensuring that the organization adheres to the state’s insurance code of conduct. Their involvement is essential in mitigating legal risks, maintaining compliance, and upholding the integrity of the healthcare insurance system in North Carolina.

In the context of North Carolina healthcare insurance, conflicts of interest are a critical area of focus, particularly for agents and brokers who must adhere to strict ethical standards and state regulations. A conflict of interest arises when an individual’s personal interests could potentially interfere with their professional responsibilities, leading to decisions that may not be in the best interest of the client. North Carolina law mandates that insurance professionals disclose any potential conflicts of interest to their clients to ensure transparency and maintain trust. This disclosure must be clear, timely, and in writing, allowing clients to make informed decisions. Failure to disclose conflicts of interest can result in disciplinary actions, including fines, suspension, or revocation of the agent’s license. Additionally, the North Carolina Department of Insurance enforces these regulations to protect consumers and uphold the integrity of the insurance industry. Understanding how to identify, manage, and disclose conflicts of interest is essential for maintaining compliance with state laws and ethical standards.

In North Carolina, healthcare providers and networks are governed by specific state laws and regulations that ensure patient access to quality care while maintaining ethical standards. The state mandates that healthcare providers must adhere to the North Carolina Insurance Code, which includes provisions for network adequacy, patient rights, and provider conduct. Network adequacy ensures that insurance plans offer a sufficient number of in-network providers to meet the healthcare needs of enrollees. Additionally, providers must comply with the North Carolina Medical Board’s Code of Conduct, which emphasizes patient confidentiality, informed consent, and non-discrimination. Understanding these regulations is crucial for healthcare providers and insurance professionals to ensure compliance and avoid legal repercussions. This question tests the candidate’s ability to apply these principles in a real-world scenario, focusing on the ethical and legal obligations of healthcare providers within the state’s regulatory framework.

Medical device coverage policies in North Carolina are governed by both state and federal regulations, ensuring that devices are safe, effective, and medically necessary for patient care. Under North Carolina law, insurers must adhere to specific guidelines when determining coverage for medical devices, including the requirement that devices meet FDA approval or clearance. Additionally, insurers must consider the medical necessity of the device as determined by a licensed healthcare provider. The state also mandates that insurers provide clear and transparent communication to policyholders regarding coverage decisions, including denials, and offer an appeals process for disputed claims. Ethical considerations, such as patient autonomy and equitable access to care, are also embedded in these policies. Understanding these regulations is critical for healthcare professionals and insurance providers to ensure compliance and advocate for patients effectively.

In North Carolina, ethical considerations in healthcare insurance coverage decisions are governed by both state regulations and professional codes of conduct. These ethical considerations ensure that decisions are made fairly, transparently, and in the best interest of the patient. One key principle is the avoidance of conflicts of interest, where personal or financial interests could influence coverage decisions. Additionally, North Carolina law mandates that insurers provide clear and accurate information to policyholders about their coverage options, benefits, and limitations. Ethical decision-making also involves respecting patient autonomy, ensuring that patients have the necessary information to make informed choices about their healthcare. Furthermore, insurers must adhere to the principle of non-discrimination, ensuring that coverage decisions are not based on race, gender, age, or other protected characteristics. These ethical guidelines are critical in maintaining trust between insurers, healthcare providers, and patients, and are essential for the integrity of the healthcare system in North Carolina.

Health Information Exchanges (HIEs) are critical components of the healthcare system, particularly in North Carolina, where they facilitate the secure sharing of patient information among healthcare providers, insurers, and other stakeholders. HIEs are governed by state-specific laws and regulations, including the North Carolina Health Information Exchange Act, which ensures that patient data is handled in compliance with privacy and security standards such as HIPAA. The primary purpose of HIEs is to improve healthcare outcomes by enabling timely access to patient records, reducing redundant tests, and enhancing care coordination. However, the implementation of HIEs also raises ethical and legal concerns, particularly regarding patient consent, data ownership, and the potential for misuse of sensitive information. In North Carolina, HIEs must adhere to strict protocols for obtaining patient consent before sharing their data, and they are required to implement robust cybersecurity measures to protect against data breaches. Understanding these nuances is essential for healthcare professionals and insurance providers operating in the state, as non-compliance can result in significant legal and financial penalties.

In North Carolina, healthcare quality and outcomes measurement are critical components of ensuring that patients receive effective and efficient care. The state adheres to federal regulations such as the Affordable Care Act (ACA), which emphasizes the importance of quality improvement initiatives and patient-centered outcomes. North Carolina also has specific state laws and regulations that mandate healthcare providers to report on quality metrics, such as patient satisfaction, readmission rates, and infection control. These metrics are used to evaluate the performance of healthcare facilities and ensure compliance with state and federal standards. Additionally, the North Carolina Department of Health and Human Services (NCDHHS) plays a pivotal role in overseeing these quality measures and implementing programs like Medicaid Managed Care, which requires providers to meet specific quality benchmarks. Understanding these regulations and how they apply to real-world scenarios is essential for healthcare professionals to ensure compliance and improve patient outcomes. This question tests the candidate’s ability to apply these principles in a practical context, focusing on the regulatory framework and its implications for healthcare quality measurement in North Carolina.

Risk management in healthcare insurance involves identifying, assessing, and mitigating risks that could negatively impact the financial stability and operational efficiency of insurance providers. In North Carolina, healthcare insurance companies must adhere to state-specific regulations and laws designed to protect consumers and ensure fair practices. One critical aspect of risk management is the implementation of robust fraud detection and prevention mechanisms. Fraudulent activities, such as false claims or misrepresentation of services, can lead to significant financial losses and erode trust in the healthcare system. North Carolina law mandates that insurance providers establish comprehensive anti-fraud programs, which include regular audits, employee training, and the use of advanced analytics to detect suspicious activities. Additionally, the state requires insurers to report suspected fraud to the appropriate regulatory bodies promptly. Effective risk management also involves maintaining adequate reserves to cover potential claims and ensuring compliance with state-mandated solvency requirements. By adhering to these principles, healthcare insurance providers in North Carolina can mitigate risks, protect policyholders, and maintain the integrity of the insurance market.

In North Carolina, catastrophic risk coverage is a critical component of healthcare insurance, particularly for individuals facing severe or high-cost medical conditions. This type of coverage is designed to protect policyholders from financial ruin due to exceptionally high medical expenses. Under North Carolina law, catastrophic plans must comply with specific state and federal regulations, including the Affordable Care Act (ACA), which mandates that such plans cover essential health benefits and limit out-of-pocket costs. Additionally, North Carolina’s insurance regulations require that catastrophic plans be available to individuals under 30 or those who qualify for a hardship exemption. These plans typically have lower premiums but higher deductibles, making them suitable for individuals who are generally healthy but want protection against worst-case scenarios. Understanding the nuances of catastrophic risk coverage, including eligibility requirements, coverage limitations, and regulatory compliance, is essential for insurance professionals operating in North Carolina. This ensures they can provide accurate guidance to clients and adhere to the state’s legal and ethical standards.

Risk management in healthcare insurance involves identifying, assessing, and mitigating risks that could impact the financial stability and operational efficiency of insurance providers. In North Carolina, healthcare insurance companies must adhere to state-specific regulations and laws designed to protect consumers and ensure fair practices. One critical aspect of risk management is the implementation of robust compliance programs to adhere to the North Carolina Insurance Act, which governs the conduct of insurance providers. This includes ensuring transparency in policy terms, avoiding deceptive practices, and maintaining adequate reserves to cover potential claims. Additionally, North Carolina law requires insurers to have a formal risk management framework that includes regular audits, employee training, and contingency planning. A key principle in risk management is the concept of “duty of care,” which mandates that insurers act in the best interest of their policyholders. This includes providing clear and accurate information about coverage, promptly addressing claims, and avoiding conflicts of interest. Understanding these principles is essential for anyone preparing for the North Carolina Healthcare Insurance Exam, as they form the foundation of ethical and effective risk management practices in the state.

In North Carolina, Medicare and Medicaid regulations are critical to ensuring compliance with federal and state laws, particularly when it comes to patient eligibility, coverage, and provider responsibilities. Medicare is a federal program primarily for individuals aged 65 and older or those with certain disabilities, while Medicaid is a joint federal and state program designed to assist low-income individuals and families. North Carolina has specific Medicaid guidelines under the North Carolina Department of Health and Human Services (NCDHHS), which align with federal requirements but also include state-specific provisions. For example, North Carolina has expanded Medicaid eligibility under the Affordable Care Act, which impacts how providers and insurers must handle enrollment and claims. Additionally, providers in North Carolina must adhere to strict documentation and billing practices to avoid fraud, waste, and abuse, as outlined in both federal and state regulations. Understanding these nuances is essential for healthcare professionals to ensure compliance and avoid penalties.

In North Carolina, prescription drug coverage is a critical component of healthcare insurance, governed by both state and federal regulations. The state adheres to the Affordable Care Act (ACA) guidelines, which mandate that all health insurance plans cover a minimum set of prescription drugs, including those listed in the essential health benefits. North Carolina also has specific regulations that ensure transparency and fairness in drug pricing and coverage. For instance, insurers are required to provide a formulary, which is a list of covered drugs, and must clearly communicate any changes to this list to policyholders. Additionally, North Carolina law prohibits insurers from imposing excessive waiting periods or prior authorization requirements that could delay access to necessary medications. Understanding these regulations is crucial for healthcare insurance professionals to ensure compliance and to advocate for patients’ rights to accessible and affordable prescription drugs.

Capitation is a payment model used in healthcare where a set amount of money is paid to a healthcare provider for each enrolled patient assigned to them, regardless of whether the patient seeks care or not. In North Carolina, this model is often used in managed care plans, such as Health Maintenance Organizations (HMOs), to control costs and encourage preventive care. The capitation model shifts the financial risk from the insurer to the provider, incentivizing providers to manage resources efficiently and focus on preventive measures to avoid costly treatments. However, it also raises ethical and legal concerns, such as the potential for under-treatment of patients to save costs. North Carolina’s healthcare regulations require providers to adhere to strict standards of care and ethical practices, ensuring that patient welfare is not compromised under capitation agreements. Providers must also comply with state-specific laws, such as the North Carolina Insurance Code, which governs the terms and conditions of capitation contracts, including transparency and fairness in payment structures. Understanding the nuances of capitation is crucial for healthcare professionals in North Carolina to navigate the balance between cost control and quality care.

Exclusive Provider Organizations (EPOs) are a type of managed care plan that requires members to use healthcare providers within a specific network, except in cases of emergency. In North Carolina, EPOs are regulated under state insurance laws, which mandate that these plans must provide clear disclosures about network restrictions and coverage limitations. One key aspect of EPOs is that they do not cover out-of-network care, unlike Preferred Provider Organizations (PPOs), which offer partial coverage for such services. This makes EPOs more cost-effective for insurers but places a greater responsibility on the insured to ensure they seek care within the designated network. Additionally, North Carolina law requires EPOs to maintain an adequate network of providers to ensure accessibility for members. Violations of these regulations can result in penalties for the insurer. Understanding the nuances of EPOs, including their regulatory requirements and the implications for policyholders, is critical for anyone preparing for the North Carolina Healthcare Insurance Exam.

The Health Insurance Portability and Accountability Act (HIPAA) is a federal regulation that sets national standards for protecting sensitive patient health information. In North Carolina, healthcare providers and insurance companies must comply with HIPAA regulations to ensure the privacy and security of patient data. HIPAA’s Privacy Rule governs how protected health information (PHI) can be used and disclosed, while the Security Rule establishes standards for safeguarding electronic PHI (ePHI). Non-compliance with HIPAA can result in significant penalties, including fines and legal action. Additionally, North Carolina has its own state-specific laws, such as the North Carolina Identity Theft Protection Act, which complements HIPAA by providing additional protections for personal information. Understanding the interplay between federal and state regulations is critical for healthcare professionals in North Carolina to ensure compliance and avoid legal repercussions.

Value-Based Care (VBC) is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Under this model, providers are incentivized to deliver high-quality care efficiently, focusing on preventive care and chronic disease management rather than the volume of services provided. In North Carolina, the implementation of VBC aligns with state and federal regulations aimed at improving healthcare quality and reducing costs. The state has adopted various initiatives, such as the North Carolina Medicaid Transformation, which emphasizes value-based payment models to enhance patient outcomes. Additionally, North Carolina’s healthcare laws require providers to adhere to ethical standards and patient-centered care principles, ensuring that VBC aligns with the state’s regulatory framework. Understanding the nuances of VBC, including its alignment with state-specific regulations and ethical considerations, is critical for healthcare professionals preparing for the North Carolina Healthcare Insurance Exam.

In North Carolina, healthcare providers and networks are governed by specific laws and regulations that ensure the quality and accessibility of healthcare services. One critical aspect is the requirement for healthcare providers to maintain transparency in their network participation and to adhere to ethical standards outlined in the state’s code of conduct. This includes ensuring that patients are informed about which providers are in-network and which are out-of-network, as well as the implications of choosing out-of-network care. Additionally, North Carolina law mandates that healthcare providers must not engage in practices that could be considered discriminatory or that could limit a patient’s access to necessary care. Understanding these regulations is crucial for healthcare professionals to ensure compliance and to provide the best possible care to their patients. The state also emphasizes the importance of maintaining accurate and up-to-date provider directories to prevent any misunderstandings or miscommunications that could affect patient care.

Compliance programs play a critical role in ensuring that healthcare organizations adhere to state and federal laws, regulations, and ethical standards. In North Carolina, healthcare insurance providers are required to implement robust compliance programs to prevent fraud, waste, and abuse, as well as to ensure patient privacy and data security under laws such as HIPAA and the North Carolina Identity Theft Protection Act. These programs are designed to identify and mitigate risks, promote ethical behavior, and ensure that the organization operates within the legal framework. A key component of an effective compliance program is the establishment of clear policies and procedures, regular training for employees, and a mechanism for reporting and addressing violations. Additionally, compliance programs must be tailored to the specific needs of the organization and regularly updated to reflect changes in laws and regulations. Failure to maintain an effective compliance program can result in significant penalties, legal action, and damage to the organization’s reputation. Therefore, understanding the role and structure of compliance programs is essential for healthcare insurance professionals in North Carolina.

In North Carolina, healthcare insurance regulations are designed to ensure that consumers are protected while maintaining the integrity of the insurance market. One critical aspect of these regulations is the requirement for insurers to provide clear and accurate information about policy benefits, exclusions, and limitations. This is particularly important in scenarios where a policyholder may need to make a claim. The North Carolina Department of Insurance enforces strict guidelines to ensure that insurers do not engage in deceptive practices, such as misrepresenting the terms of a policy or failing to disclose important details. Additionally, North Carolina law mandates that insurers must act in good faith when handling claims, which includes conducting thorough investigations and providing timely responses. Failure to comply with these regulations can result in penalties for the insurer, including fines and potential loss of licensure. Understanding these principles is crucial for anyone preparing for the North Carolina Healthcare Insurance Exam, as they form the foundation of ethical and legal practices in the state’s insurance industry.

In North Carolina, healthcare insurance regulations are designed to ensure that consumers are protected and that insurance providers operate within the bounds of the law. One critical aspect of these regulations is the concept of “guaranteed renewability,” which ensures that policyholders cannot be denied renewal of their health insurance policy as long as they continue to pay their premiums and have not committed fraud. This principle is particularly important in the context of the Affordable Care Act (ACA), which mandates that health insurance policies in the individual and small group markets must be guaranteed renewable. Additionally, North Carolina law requires that insurers provide a clear explanation of benefits and coverage to policyholders, ensuring transparency and understanding. The state also enforces strict guidelines on how insurers can modify premiums, prohibiting arbitrary increases and requiring that any changes be based on specific, justified factors such as age, geographic location, or tobacco use. Understanding these regulations is crucial for anyone involved in the healthcare insurance industry in North Carolina, as non-compliance can lead to significant penalties and loss of licensure.

In North Carolina, healthcare insurance referral processes are governed by specific laws and regulations designed to ensure patient care is managed efficiently and ethically. The state mandates that healthcare providers and insurance companies adhere to strict guidelines when referring patients to specialists or other healthcare services. These guidelines are in place to prevent conflicts of interest, ensure patient autonomy, and maintain the integrity of the healthcare system. For instance, North Carolina law prohibits healthcare providers from receiving kickbacks or any form of compensation for referrals, as this could compromise patient care. Additionally, the referral process must be transparent, with patients being fully informed about their options and the reasons for the referral. This ensures that patients can make informed decisions about their healthcare. The state also requires that all referrals be documented thoroughly to maintain accountability and facilitate continuity of care. Understanding these regulations is crucial for healthcare professionals and insurance agents in North Carolina, as non-compliance can result in severe penalties, including fines and loss of licensure.

Telemedicine has become an integral part of healthcare delivery, especially in North Carolina, where state laws and insurance regulations play a significant role in determining coverage and reimbursement policies. North Carolina law requires that health insurance plans provide coverage for telemedicine services if the same services would be covered when delivered in person. This parity law ensures that patients have access to remote healthcare services without facing additional financial burdens. However, the specifics of coverage, such as the types of telemedicine services covered, the technology platforms allowed, and the healthcare providers eligible to deliver these services, can vary between insurance plans. Additionally, North Carolina adheres to federal regulations, such as HIPAA, which mandate the secure transmission of patient data during telemedicine consultations. Understanding these nuances is critical for healthcare professionals and insurance providers to ensure compliance and deliver effective care.

In North Carolina, healthcare insurance providers are required to adhere to strict reporting mechanisms to ensure compliance with state laws and regulations. These mechanisms are designed to maintain transparency, protect consumer rights, and uphold the integrity of the healthcare system. Reporting mechanisms include the submission of detailed reports on claims, grievances, and any fraudulent activities. The North Carolina Department of Insurance (NCDOI) oversees these reporting requirements and ensures that all healthcare insurance providers comply with the state’s regulations. Failure to comply with these reporting requirements can result in severe penalties, including fines and revocation of licenses. Understanding these mechanisms is crucial for healthcare insurance professionals to ensure they are operating within the legal framework and providing the best service to their clients. The reporting mechanisms also play a vital role in identifying and addressing any issues that may arise within the healthcare system, ensuring that consumers are protected and that the system operates efficiently.

In North Carolina, healthcare insurance policies often include premiums, deductibles, and copayments as key components of their cost-sharing structure. Premiums are the regular payments made by the policyholder to maintain coverage, regardless of whether healthcare services are used. Deductibles are the amounts the insured must pay out-of-pocket before the insurance company begins to cover expenses. Copayments are fixed amounts paid by the insured for specific services, such as doctor visits or prescription medications, after the deductible has been met. North Carolina law mandates that insurers clearly disclose these cost-sharing elements in policy documents to ensure transparency and compliance with state regulations. Understanding how these components interact is crucial for policyholders to make informed decisions about their healthcare coverage. For example, a policy with a lower premium might have a higher deductible, which could be more cost-effective for individuals who rarely use medical services. Conversely, a higher premium with a lower deductible might be better for those who frequently access healthcare. The state also enforces regulations to prevent insurers from imposing unreasonable cost-sharing requirements that could hinder access to necessary care.