Bill Text: CT HB05579 | 2014 | General Assembly | Introduced

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Bill Title: An Act Extending The Grace Period For Nonpayment Of Premium For Certain Health Plans And Concerning Disclosure By Health Carriers To Health Care Providers Of Enrollees' Paid-up Status.

Spectrum: Committee Bill

Status: (Introduced - Dead) 2014-03-14 - Public Hearing 03/18 [HB05579 Detail]

Download: Connecticut-2014-HB05579-Introduced.html

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General Assembly		Raised Bill No. 5579
February Session, 2014		LCO No. 2302
		*02302_______INS*
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)

AN ACT EXTENDING THE GRACE PERIOD FOR NONPAYMENT OF PREMIUM FOR CERTAIN HEALTH PLANS AND CONCERNING DISCLOSURE BY HEALTH CARRIERS TO HEALTH CARE PROVIDERS OF ENROLLEES' PAID-UP STATUS.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective October 1, 2014) (a) As used in this section, "exchange", "health carrier", "qualified employer", "qualified health plan" and "qualified individual" have the same meanings as provided in section 38a-1080 of the general statutes, and "grace period" means a continuous three-month period during which a qualified individual or qualified employer has not paid the required premiums.

(b) (1) Each health carrier that offers a qualified health plan through the exchange shall provide a grace period for qualified individuals and qualified employers that enroll in such health plan on or after January 1, 2015, that shall be in addition to any period for nonpayment of premium allowed in such health plan or required under title 38a of the general statutes.

(2) (A) Each health carrier shall establish a telephone number for enrollees and health care providers to call regarding (i) the notice provided under subsection (c) of this section, (ii) requests and information as set forth in subsection (d) of this section, or (iii) any other questions related to qualified individuals and qualified employers enrolled in qualified health plans through the exchange.

(B) No health carrier may, more than twelve months after the date of receipt of a clean claim, seek to recoup full or partial payment from any health care provider for services provided to an enrollee during a grace period.

(c) (1) Each health carrier that offers a qualified health plan through the exchange shall notify the following, on the first day of the second month of the grace period, or if such first day falls on a Saturday, Sunday or legal holiday, the next business day thereafter, of any qualified individual or qualified employer enrolled in a qualified health plan through the exchange that has failed to pay the premium: (A) The enrollee; (B) the enrollee's primary health care provider of record and any other health care providers on record from whom such enrollee has sought treatment; and (C) the exchange.

(2) Such notice shall include the following:

(A) The name of the enrollee, the name of the qualified health plan in which such enrollee is enrolled, the purpose of the notice and a notice-unique identification number;

(B) The first and last dates of the enrollee's grace period and a statement that the enrollee's enrollment will terminate upon the expiration of the grace period if the enrollee fails to pay the outstanding premium or premiums by such date;

(C) An explanation of any action the health carrier intends to take, with respect to the enrollee and the health care provider, during the grace period and upon the expiration of the grace period. Such explanation shall include (i) whether the health carrier will suspend any or all payment of claims to such provider for services provided to such enrollee during the grace period until such time as the enrollee pays the outstanding premium or premiums, and (ii) whether the health carrier, if it paid or will pay claims during the grace period, will seek to recoup any payment made to such provider;

(D) An explanation of the health carrier's appeals process for the enrollee in the event such enrollee believes the health carrier has mistakenly placed the enrollee in a grace period; and

(E) The customer service telephone number for such enrollee or provider to call regarding such notice.

(d) (1) If a health care provider or an authorized representative or agent of a health care provider (A) requests information from such health carrier regarding the eligibility of, (B) performs a benefit inquiry for, or (C) submits a request for a related claim status for one or more claims in a remittance advice related to, an enrollee of a qualified health plan and such enrollee is in a grace period, such health carrier shall clearly inform such provider, representative or agent that the enrollee is in a grace period and payment by the health carrier is questionable.

(2) Notwithstanding subparagraph (B) of subdivision (2) of subsection (b) of this section, a health carrier shall be liable to pay claims for services provided to an enrollee during a grace period and may not seek to recoup full or partial payment from any health care provider if such health carrier informed the provider, representative or agent under subdivision (1) of this subsection that the enrollee is eligible for services and failed to inform such provider, representative or agent that the enrollee is in a grace period.

(e) If an enrollee's coverage has been terminated for nonpayment of premium after the expiration of the grace period, the health carrier shall notify the enrollee, the enrollee's primary health care provider of record, any other health care providers on record from whom such enrollee has sought treatment and the exchange.

(f) Any health carrier that offers a qualified health plan through the exchange that violates any provision of this section shall be fined five thousand dollars for each offense.

This act shall take effect as follows and shall amend the following sections:
Section 1	October 1, 2014	New section

Statement of Purpose:

To establish an additional grace period for enrollees in qualified health plans through the exchange and require health carriers to provide notice to health care providers when such enrollees enter such grace periods.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]