TRANSPARENCY IN THE COST OF HEALTH CARE.

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View NCGA Bill Details2011-2012 Session
Senate Bill 744 (Public) Filed Tuesday, April 19, 2011
TO ALLOW EMPLOYERS ACCESS TO INFORMATION ABOUT THEIR GROUP HEALTH PLANS.
Intro. by Goolsby.

Status: Ref To Com On Insurance (House Action) (Jun 13 2011)

Bill History:

S 744

Bill Summaries:

  • Summary date: Jun 9 2011 - View Summary

    Senate committee substitute makes the following changes to 1st edition. Amends proposed GS 58-50-300 to include insurer as a defined term. Amends proposed GS 58-50-305 by clarifying the report of claim information must include certain information for the 36 months prior to the employer’s request, if the request is made to the employer’s current insurer or for the 12 months prior to the employer’s request if the request is made to the employer’s prior insurer. Removes the requirement that such report contain the following information: (1) the total dollar amount of claims pending as of the date of the report and (2) for certain claims, a statement describing precertification requests for hospital stays of five days or longer that were made during the 30-day period preceding the date of the report. Makes other clarifying changes to the information required in the report.
    Amends proposed GS 58-50-310, GS 58-50-315, GS 58-50-320, and GS 58-50-325 by removing the term health care benefits provider issuer and replacing it with the term insurer throughout. Clarifies that an insurer is not required to provide a report to an employer more than once (was, twice) in a 12-month period. Makes other conforming and clarifying changes. Deletes provision concerning requests for additional information after receipt of report.


  • Summary date: Jun 9 2011 - View Summary

    Senate amendment makes the following changes to 2nd edition. Amends proposed GS 58-50-305(a) to clarify the statute applies only to an employer with 51 or more covered employees. Requires the report of claim information from the insurer include certain information for the 24 months prior to the employer’s request (previously 36 months).
    Rewrites proposed GS 58-50-305(b) to add that an insurer may use its own certification document so long as the document references the requirements of 45 C.F.R Section 164.504(f)(2).
    Makes act effective January 1, 2012 (previously October 1, 2011).
    Makes other clarifying changes.


  • Summary date: Apr 20 2011 - View Summary

    Enacts new Part 8, Reporting of Group Claims Information to Employers, to Article 50 of GS Chapter 58. Provides that an employer is entitled to claim information for its employee group health plan from its health benefits provider, including information covering the 36 months prior to the employer’s request, as specified in six provisions. Provides additional details concerning certain information requested by the employer. Specifies that an employer is entitled to request and receive information under Part 8 up to two years after termination of the contract with the health care benefits provider. Defines “protected health information” as the term is defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Directs a health care benefits provider to provide the required information within 30 days of the employer’s request, as detailed. Prohibits a health care benefits provider from disclosing protected health information if the health insurance issuer is prohibited from disclosing the information under any state or federal law that imposes more stringent privacy restrictions than HIPAA. Requires that the issuer notify the plan, plan sponsor, or plan administrator that the information is being withheld, and provide the plan, plan sponsor, or plan administrator categories of claim information that the issuer determined are subject to more stringent privacy restrictions, if the issuer withholds information. Specifies that a health care benefits provider is not required to provide a report more than twice in a 12 month period. Allows employers to request additional information from the health care benefits provider, as specified. Authorizes governmental entities to request reports from health care benefits providers; states that these reports are confidential and not a public record. Clarifies that a health care benefits provider issuer that releases information, including protected health information, under Part 8 does not violate a standard of care and is not civilly or criminally liable. Specifies the penalty for failure to comply with Part 8. Effective October 1, 2011.