Enacts new Article 66B, Health Insurance Claims Transparency, in GS Chapter 58. Makes the Article applicable to a governmental entity (defined as any State department, institution, agency, or any political subdivision of the State) that enters into a contract with a health insurance issuer (issuer) that results in the health insurance issuer delivering, issuing for delivery, or renewing a group health plan. Requires that health insurance issuers treat such a governmental entity as a plan sponsor or administrator. Specifies that a report of claim information provided to a governmental entity is confidential and not public record.
Requires the issuer to provide a request report no later than the thirtieth calendar day after the date a health insurance issuer receives a written request for a written report of claim information from a plan, plan sponsor, or plan administrator. Specifies that the issuer is not obligated to provide a report regarding a particular employer or group health plan more than twice in 12 months. Specifies the ways in which the report of claim information may be transmitted. Requires a report of claim information include all information available to the issuer that is responsive to the request. Specifies requirements that the report of claim must meet.
Prohibits an issuer from disclosing protected health information in a report of claim if disclosure if prohibited under another state or federal law that imposes more stringent privacy restrictions than those imposed under federal law under the Health Insurance Portability and Accountability Act of 1996. Specifies what action the issuer must take when withholding information. Entitles a plan sponsor to protected information only after an authorized representative of the sponsor makes to the issuer a certification about safeguarding the documents, in a form similar to the one specified in the act. Specifies what information can be made in a report when the request for information is made after the date of termination of coverage. Requires a plan, plan sponsor, or administrator to request a report of claim information on or before the second anniversary of the date of the termination of coverage under a group health plan issued by the issuer.
Sets out the process under wihich a plan, plan sponsor, or administrator may request information in addition to what is included in a received report.
Specifies that an issuer that releases information in accordance with the Article has not violated a standard of care and is not liable for civil damages or subject to criminal prosecution for that release.
Makes an issuer that does not comply with the Article subject to civil penalties under GS 58-2-70.
Applies to reports of claim information requested on or after October 1, 2017.
Bill Summaries: S543 HEALTH INSURANCE CLAIMS TRANSPARENCY ACT.
Bill S 543 (2017-2018)Summary date: Mar 30 2017 - View Summary