509.19  Disclosure of claims and related costs.

1.  A person issuing a policy or contract providing group health benefit coverages to a group of one hundred or more persons shall provide to the policyholder, contract holder, or sponsor of the group health benefit plan, upon request, once in a twelve-month period, all of the following information:

a.  Number of claims submitted to date.

b.  Costs of claims submitted to date.

c.  Average cost per claim, and average annual cost per covered individual.

The information shall be presented in the aggregate, and shall not disclose any confidential information or otherwise disclose the identity of an individual insured, subscriber, or enrollee, who has submitted a claim within the time frame of the report.

2.  For purposes of this section, "person issuing a policy or contract providing group health benefit coverages" includes all of the following:

a.  A person issuing a group policy of accident or health insurance pursuant to this chapter.

b.  A person issuing a group contract of a nonprofit health service corporation pursuant to chapter 514.

c.  A person issuing a group contract of a health maintenance organization pursuant to chapter 514B.

Section History: Recent form

  90 Acts, ch 1159, §1


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