Bill Text: MS HB1185 | 2016 | Regular Session | Introduced
Bill Title: Health insurers; require to release certain claims data upon request of group policyholder.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Failed) 2016-02-23 - Died In Committee [HB1185 Detail]
Download: Mississippi-2016-HB1185-Introduced.html
MISSISSIPPI LEGISLATURE
2016 Regular Session
To: Insurance; Judiciary A
By: Representatives Busby, DeLano
House Bill 1185
AN ACT TO PROVIDE THAT EVERY HEALTH AND ACCIDENT INSURANCE ISSUER, INCLUDING A HEALTH MAINTENANCE ORGANIZATION, SHALL, UPON REQUEST, RELEASE TO EACH GROUP POLICYHOLDER OR AGENT OF A POLICY HOLDER CERTAIN CLAIMS DATA; TO PROVIDE IMMUNITY FROM CIVIL LIABILITY TO A HEALTH AND ACCIDENT INSURER THAT PROVIDES SUCH DATA; TO REQUIRE CERTIFICATION BY A PLAN SPONSOR BEFORE RECEIVING PROTECTED HEALTH INFORMATION; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. (1) As used in this section, unless the context clearly indicates otherwise:
(a) "Claim identifier" means data that reflects a number designation including, but not limited to, an alphabetic or alphanumeric designation which shall not be a name identifier of an employee, employee's spouse or employee's dependent.
(b) "Limited benefit insurance policies" means health and accident insurance policies designed, advertised and marketed to supplement major medical insurance that includes accident-only, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), dental, disability income, fixed indemnity, long-term care, Medicare supplement, specified disease, vision, and any other health and accident insurance, other than basic hospital expense, basic medical-surgical expense, or other major medical insurance.
(c) "Health and accident insurer" or "health and accident insurance issuer" shall include a health maintenance organization.
(d) "Policy" shall include a subscriber agreement, and "policyholder" shall include an enrollee or subscriber of a health maintenance organization.
(2) Not less than ninety (90) days prior to the renewal of a policy, every health and accident insurance issuer, including a health maintenance organization, shall, upon request, release to each group policyholder or agent of a policyholder claims data and shall provide this data within no more than fourteen (14) business days of receipt of the request, which shall include the following items:
(a) The net claims paid by month during the policy period.
(b) The monthly enrollment by employee only, employee and spouse, and employee and family during the policy period.
(c) The amount of any claims reserve established by the insurance provider against future claims under the policy.
(d) Claims over Ten Thousand Dollars ($10,000.00) including claim identifier, the date of occurrence, the amount of claims paid and those unpaid or outstanding, and claimant health condition or diagnosis.
(e) A complete listing of all potential catastrophic diagnoses and prognoses involving persons covered under the policy provisions.
(3) A health and accident insurer that discloses data or information in compliance with the provisions of this section may condition any such disclosure upon the execution of an agreement for immunity from civil liability.
(4) A health and accident insurer that provides data or information in compliance with the provisions of this section shall be immune from civil liability for any acts or omissions of any person's subsequent use of such data or information.
(5) The provisions of this section shall not be construed to authorize the disclosure of the identity of a particular employee covered under the group policy nor the discloser of any individual employee's particular health insurance claim, condition, diagnosis, or prognosis, which would violate federal or state law.
(6) The provisions of this section shall not apply to limited benefit insurance policies.
(7) A plan sponsor is entitled to receive protected health information under this section only after an appropriately authorized representative of the plan sponsor makes to the health and accident insurer a certification substantially similar to the following certification:
"I hereby certify and have demonstrated that the plan documents comply with the requirements of 45 C.F.R. Section 164.504(f)(2) and that the plan sponsor will safeguard and limit the use and disclosure of protected health information that the plan sponsor may receive from the group health plan to perform the plan administration functions."
(8) A plan sponsor that does not provide the certification required in subsection (7) of this section is not entitled to receive the protected health information described in paragraphs (d) and (e) of subsection (2), but is entitled to receive a report of claim information that includes the other information required by this section.
SECTION 2. This act shall take effect and be in force from and after July 1, 2016.
