Bill Text: HI HB1707 | 2016 | Regular Session | Introduced
Bill Title: Rate Filings; Disclosure
Spectrum: Partisan Bill (Democrat 10-0)
Status: (Introduced - Dead) 2016-02-12 - Passed Second Reading as amended in HD 1 and referred to the committee(s) on CPC with none voting aye with reservations; none voting no (0) and Representative(s) Tokioka excused (1). [HB1707 Detail]
Download: Hawaii-2016-HB1707-Introduced.html
|
HOUSE OF REPRESENTATIVES |
H.B. NO. |
1707 |
|
TWENTY-EIGHTH LEGISLATURE, 2016 |
|
|
|
STATE OF HAWAII |
|
|
|
|
|
|
|
|
||
|
|
||
A BILL FOR AN ACT
relating to Health insurance.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Chapter 431, article 10A, Hawaii Revised Statutes, is amended by adding two new sections to part VI to be appropriately designated and to read as follows:
"§431:10A- Rate increases; public disclosures. For sixty days prior to the implementation of any rate increase, the commissioner and the insurer shall, at a minimum, make the following information readily available to the public on their respective internet websites, in plain language and in a manner and format specified by the commissioner:
(1) Justifications for any rate increases, including all information and supporting documentation as to why the rate increase is justified;
(2) The insurer's overall annual medical trend factor assumptions in each rate filing for all benefits;
(3) The insurer's actual costs, by aggregate benefit category to include hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology; and
(4) The amount of the projected trend attributable to the use of services, price inflation, or fees and risk for annual policy trends by aggregate benefit category, such as hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology. An insurer that exclusively contracts with no more than two medical groups in the State to provide or arrange for professional medical services for the enrollees of the policy shall instead disclose the amount of its actual trend experience for the prior contract year by aggregate benefit category, using benefit categories that are, to the maximum extent possible, the same or similar to those used by other policies.
§431:10A- Claims data to group purchasers. (a) An insurer shall annually provide claims data at no charge to a group purchaser if the group purchaser requests the claims data.
(b) The insurer shall provide claims data in an aggregated form so that the claims data do not identify or do not provide a reasonable basis from which to identify an individual.
(c) Nothing in this section shall be construed to prohibit an insurer and a group purchaser from negotiating the release of additional information not described in this section.
(d) All disclosures of data to the group purchaser made pursuant to this section shall be in compliance with applicable federal law."
SECTION 2. Chapter 432, article 1, Hawaii Revised Statutes, is amended by adding two new sections to part I to be appropriately designated and to read as follows:
"§432:1- Rate increases; public disclosures. For sixty days prior to the implementation of any rate increase, the commissioner and the mutual benefit society shall, at a minimum, make the following information readily available to the public on their respective internet websites, in plain language and in a manner and format specified by the commissioner:
(1) Justifications for any rate increases, including all information and supporting documentation as to why the rate increase is justified;
(2) The mutual benefit society's overall annual medical trend factor assumptions in each rate filing for all benefits;
(3) The mutual benefit society's actual costs, by aggregate benefit category to include hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology; and
(4) The amount of the projected trend attributable to the use of services, price inflation, or fees and risk for annual plan contract trends by aggregate benefit category, such as hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology. A mutual benefit society that exclusively contracts with no more than two medical groups in the State to provide or arrange for professional medical services for the enrollees of the policy shall instead disclose the amount of its actual trend experience for the prior contract year by aggregate benefit category, using benefit categories that are, to the maximum extent possible, the same or similar to those used by other plan contracts.
§432:1- Claims data to group purchasers. (a) A mutual benefit society shall annually provide claims data at no charge to a group purchaser if the group purchaser requests the claims data.
(b) The mutual benefit society shall provide claims data in an aggregated form so that the claims data do not identify or do not provide a reasonable basis from which to identify an individual.
(c) Nothing in this section shall be construed to prohibit a mutual benefit society and a group purchaser from negotiating the release of additional information not described in this section.
(d) All disclosures of data to the group purchaser made pursuant to this section shall be in compliance with applicable federal law."
SECTION 3. Chapter 432D, Hawaii Revised Statutes, is amended by adding two new sections to be appropriately designated and to read as follows:
"§432D- Rate increases; public disclosures. For sixty days prior to the implementation of any rate increase, the commissioner and the health maintenance organization shall, at a minimum, make the following information readily available to the public on their respective internet websites, in plain language and in a manner and format specified by the commissioner:
(1) Justifications for any rate increases, including all information and supporting documentation as to why the rate increase is justified;
(2) The health maintenance organization's overall annual medical trend factor assumptions in each rate filing for all benefits;
(3) The health maintenance organization's actual costs, by aggregate benefit category to include hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology; and
(4) The amount of the projected trend attributable to the use of services, price inflation, or fees and risk for annual plan contract trends by aggregate benefit category, such as hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology. A health maintenance organization that exclusively contracts with no more than two medical groups in the State to provide or arrange for professional medical services for the enrollees of the policy shall instead disclose the amount of its actual trend experience for the prior contract year by aggregate benefit category, using benefit categories that are, to the maximum extent possible, the same or similar to those used by other plan contracts.
§432D- Claims data to group purchasers. (a) A health maintenance organization shall annually provide claims data at no charge to a group purchaser if the group purchaser requests the claims data.
(b) The health maintenance organization shall provide claims data in an aggregated form so that the claims data do not identify or do not provide a reasonable basis from which to identify an individual.
(c) Nothing in this section shall be construed to prohibit a health maintenance organization and a group purchaser from negotiating the release of additional information not described in this section.
(d) All disclosures of data to the group purchaser made pursuant to this section shall be in compliance with applicable federal law."
SECTION 4. New statutory material is underscored.
SECTION 5. This Act shall take effect upon its approval.
|
INTRODUCED BY: |
_____________________________ |
|
|
|
Report Title:
Rate Filings; Claims Data; Disclosure
Description:
Requires the insurance commissioner and health insurers, mutual benefit societies, and health maintenance organizations to make public disclosure of rate filings information prior to a rate increase. Requires health insurers, mutual benefit societies, and health maintenance organizations to disclose aggregated claims data to group purchasers upon request.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
