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2004 SESSION

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HB 1408 Health insurance; requirements when providing insured with claims experience or med. costs record.

Introduced by: Charles W. Carrico, Sr. | all patrons    ...    notes | add to my profiles

SUMMARY AS PASSED HOUSE: (all summaries)

Accident and sickness insurance; claims experience. Requires health maintenance organizations to provide, upon request, to those health care plan policyholders that employed an average of at least 100 insured, subscribers or enrollees in the preceding 12-month period, as part of the insured's claims experience record, (i) a summary of claims charges incurred and the amount paid for each claim for the most recent available 24-month period; (ii) a listing of the number of insured or subscribers for whom combined medical costs or claims exceeded $100,000 in the most recently available 12-month period; and (iii) total enrollment in each membership category. The existing disclosure requirements applicable to group accident and sickness insurance policies and subscription contracts are amended to incorporate the new provisions regarding the size of the group policyholder that may request the information and to increase the threshold enrollees for whom information must be disclosed from those with payments or costs in excess of $50,000 to those in excess of $100,000. The measure becomes effective on January 1, 2005.


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