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Legislative Proposals

DPFR-

AN ACT to Improve Transparency in the Health Insurance Markets

Be it enacted by the people of the State of Maine as follows:

Sec. 1. 24-A MRSA § 2809-A, sub-§ 1-A(B-2) is enacted to read:

B-2. All notices of cancellation sent to certificateholders pursuant to subsection B-1 shall include a telephone number that certificateholders can call to determine if the policy has been cancelled for nonpayment of premium or if the policy has been reinstated because the premium has been paid. If a notice of cancellation has been mailed to certificate holders pursuant to subsection B-1, and the policy is not thereafter cancelled because the premium has been paid, or the policy is reinstated, the insurer shall mail notice of noncancellation or reinstatement to certificateholders by first class mail as expeditiously as possible, but in no event more than 10 days after premium for continued coverage or reinstatement has been received by the insurer. Notice pursuant to this paragraph shall be provided in the same manner as notice provided pursuant to paragraph B-1.

Sec. 2. 24-A MRSA §4303, sub-§ 12 is enacted to read:

12. Publication of policies by carriers. A carrier must publish on its publicly available website at least five individual policies, or all individual policies if the carrier offers fewer than five policies, having the highest level of Maine enrollment, and at least five small group policies, or all small group policies if the carrier offers fewer than five policies, having the highest level of Maine enrollment. The carrier must publish such policies in a manner that will allow consumers to review the coverages offered under each of these policies. The appearance of a policy published on the carrier’s website must duplicate the actual policy an individual would receive if he or she were to request a paper copy of the policy. The carrier must publish the required policies on its website within 90 days after the effective date of this subsection. Thereafter, the insurer must update its website within 14 days after the Superintendent’s action on a policy pursuant to section 2412.

Sec. 3. 24-A MRSA § 4303, sub-§ 13 is enacted to read:

13. Explanations of benefits. A carrier offering an individual expense incurred health plan to Maine residents or an expense incurred group health plan to a Maine employer shall provide individual policyholders and group certificate holders with clear written explanations of benefit documents in response to the filing of any claim providing for coverage of hospital or medical expenses. The explanation of benefits shall include all of the following information, as well as any additional information required by rule.

A. The date of service;

B. Provider of the service;

C. An identification of the service for which the claim is made;

D. Any amount the insured is obligated to pay under the policy for co-payment or coinsurance;

E. A telephone number and address where an insured may obtain clarification of the explanation of benefits;

F. A notice of appeal rights;

G. A notice of the right to file a complaint with the Bureau of Insurance; and

H. Such other information as the superintendent may require by rule.

The superintendent shall establish by rule the minimum information, and minimum standards for the accuracy and clarity of the information presented, to appear in an explanation of benefits. Rules adopted pursuant to this section are routine technical rules. The rule shall require explanations of benefits to include at least the information required by this section, and may require explanations of benefits to contain any additional information helpful to policyholders in understanding how their policies are being administered.

The section shall apply to all explanations of benefits issued after January 1, 2010.

 

SUMMARY

This bill amends the Insurance Code to require that health insurers provide updated information to group enrollees regarding the status of their employer sponsored insurance coverage when a notice of termination for nonpayment has been issued; post on their websites current versions of their individual and small group policies that have the most Mainers enrolled, and send clear explanations of benefits to explain the services and payments made by insurance companies on behalf of their policyholders,

 

Last Updated: August 22, 2012