|S.F. No. 1998 - Health Plan Company Regulatory Changes (first engrossment)|
|Author:||Senator Brian LeClair|
|Prepared by:||Christopher B. Stang, Senate Counsel (651/296-0539)|
|Date:||April 19, 2005|
Section 2 eliminates an annual report required of health plan companies, stating how many people were covered in the preceding year by its qualified plans and by each of its unqualified plans.
Section 3 eliminates obsolete language.
Section 4 provides that a "clean claim" includes "coordination of benefits" information. Prohibits health plan companies and third-party administrators (TPAs) from requiring a health care provider to bill a health plan company for interest before an interest payment is made for late payment of claims. Requires health care providers to bill health plan companies and TPAs no later than six months after providing the service or learning the identity and address of the applicable health plan company or TPA, whichever is later. A provider who fails to comply may not collect the charge from the patient or third-party payer.
Section 5 requires health insurers to comply with the prompt payment law, and prohibits the commissioner from imposing an administrative financial penalty for failing to do so. Permits health insurers to not send an explanation of benefits (EOB) when there is a zero balance (meaning the enrollee does not owe the provider anything in addition to a copayment already paid). Requires an insurer that does not send zero balance EOBs to send the enrollee a summary every six months.
Section 6 eliminates a reference to a section repealed in this bill.
Section 7 eliminates a requirement that health insurers and other third-party payers document their compliance with the 2 percent provider tax pass-through requirement.
Section 8 repeals (a) a law requiring reporting by self-insured employer health plans; (b) a law requiring health plan companies to maintain expanded provider networks of non-physician providers; and (c) a law requiring health plan companies to annually file a report on their compensation of their five most highly compensated employees with the Consumer Advisory Board, which no longer exists.
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