Text: HSB00617                          Text: HSB00619
Text: HSB00600 - HSB00699               Text: HSB Index
Bills and Amendments: General Index     Bill History: General Index

House Study Bill 618

Bill Text

PAG LIN
  1  1    Section 1.  Section 509.19, Code 2001, is amended to read
  1  2 as follows:
  1  3    509.19  DISCLOSURE OF CLAIMS AND RELATED COSTS CLAIMS AND
  1  4 PREMIUM DISCLOSURE TO POLICYHOLDERS.
  1  5    1.  a.  A person issuing a policy or contract providing
  1  6 group health benefit coverages to a group of one hundred
  1  7 fifty-one or more persons eligible employees as defined in
  1  8 chapter 513B shall provide to the policyholder, contract
  1  9 holder, or sponsor of the group health benefit plan, upon
  1 10 request, once in a twelve-month period, all of the following
  1 11 information:
  1 12    a.  Number of claims submitted to date.
  1 13    b.  Costs of claims submitted to date.
  1 14    c.  Average cost per claim, and average annual cost per
  1 15 covered individual. annually, but not more than three months
  1 16 prior to the policy renewal date, the total amount of actual
  1 17 claims identified as paid or incurred and paid, and the total
  1 18 amount of premiums by line of coverage.
  1 19    b.  For purposes of this section, "line of coverage"
  1 20 includes medical, prescription drug card program, dental,
  1 21 vision, long-term disability, and short-term disability.
  1 22    c.  The information required by paragraph "a" shall be
  1 23 provided separately for the current policy year-to-date and
  1 24 for the prior policy year.
  1 25    d.  The information shall be presented in the aggregate,
  1 26 and required by paragraph "a" shall not disclose any
  1 27 confidential information or otherwise disclose the identity of
  1 28 an individual insured, subscriber, or enrollee, who has
  1 29 submitted a claim within the time frame of the report.
  1 30    2.  For purposes of this section, "person issuing a policy
  1 31 or contract providing group health benefit coverages" includes
  1 32 all of the following:
  1 33    a.  A person issuing a group policy of accident or health
  1 34 insurance pursuant to this chapter.
  1 35    b.  A person issuing a group contract of a nonprofit health
  2  1 service corporation pursuant to chapter 514.
  2  2    c.  A person issuing a group contract of a health
  2  3 maintenance organization pursuant to chapter 514B.
  2  4    d.  An organized delivery system authorized under 1993 Iowa
  2  5 Acts, chapter 158, licensed by the director of public health.
  2  6    e.  A  multiple employer welfare arrangement, as defined in
  2  7 section 3 of the federal Employee Retirement Income Security
  2  8 Act of 1974, 29 U.S.C. } 1002, paragraph 40, that meets the
  2  9 requirements of section 507A.4, subsection 9, paragraph "a".
  2 10    f.  A plan for public employees established pursuant to
  2 11 chapter 509A.
  2 12    g.  A person issuing or sponsoring an association group
  2 13 policy under section 509.14.  
  2 14                           EXPLANATION
  2 15    This bill amends Code section 509.19, regarding certain
  2 16 claim-related disclosures made to policyholders of group
  2 17 health insurance covering 100 persons or more.
  2 18    The bill lowers the coverage threshold to 51 persons or
  2 19 more, and changes the information to be provided, according to
  2 20 lines of coverage, to total amount of actual claims identified
  2 21 as paid or incurred and paid, and total amount of premiums.
  2 22 The information would be separate for current and prior policy
  2 23 years, and would be provided on request, on an annual basis,
  2 24 but not more than three months prior to the policy renewal
  2 25 date.
  2 26    The bill also provides four additional types of group
  2 27 health benefit coverages to which the disclosure requirement
  2 28 extends:  organized delivery systems, multiple employer
  2 29 welfare arrangements, group health insurance plans for public
  2 30 employees, and association group policies.  
  2 31 LSB 6206YC 79
  2 32 jj/pj/5
     

Text: HSB00617                          Text: HSB00619
Text: HSB00600 - HSB00699               Text: HSB Index
Bills and Amendments: General Index     Bill History: General Index

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