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Advocacy - 10.07.16
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On September 1, 2016, Senator LaRose introduced legislation (SB 351) that will add significant requirements for insurance companies to disclose claims data to group policyholders. While it is still not clear how the bill will move through the legislature, there are some important points to highlight. First, the bill would require a health plan issuer, upon request, to release to each group policy holder claims data within fourteen days of receipt of the request. The data released will include the net claims paid by month, and, if the group policyholder is an employer, the monthly enrollment by employee only, employee and spouse, and employee and family. The release will also need to include a complete listing of all potential catastrophic diagnoses and prognoses involving persons covered under the policy. The health plan issuer does not need to include the name and date of occurrence, amount paid toward each claim, which claims are unpaid or outstanding, and claimant health condition or diagnosis.


A health plan issuer that provides this data may condition the disclosure upon execution of an agreement with the policyholder absolving the issuer from civil liability, and the issuer will be immune from civil liability for any acts or omissions of any person’s subsequent use of such data or information. A group policyholder may only receive protected health information after an appropriately authorized representative of the group policyholder makes to the health plan issuer a certification substantially similar to the following: "I hereby certify and have demonstrated that the plan documents comply with the requirements of 45 C.F.R. 164.504 (f) (2) and that the group policyholder will safeguard and limit the use and disclosure of protected health information that the policyholder may receive from the group health plan to perform plan administration functions." A health plan issuer that does not comply with the new requirements will be deemed to have engaged in an unfair and deceptive act or practice in the business of insurance. Again, this legislation is very early in the process and our legal team will continue to monitor any changes that may occur.

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