SB568 HHFA JUDWestfall AM3-10 #1 Holtzapfel 3382 The  CommitteeDelegates onWestfall theand JudiciaryStorch moved to amend the bill byon strikingpage everything1, aftersection the§33-16-3c, enactingline clause5, and insertingon inpage lieu2, thereofsection §33-25-10a, line 5 by inserting after the following:word “premiums”:

ARTICLEMedical 16.claims do not include dental only or vision only coverage.

GROUPAnd; ACCIDENT AND SICKNESS INSURANCE.

§33-16-3c.On page 2, section §33-25A-7b, line 6, by inserting after the word “premiums”:

Loss“: ratio.

IfProvided, anHowever, insurerthat considersmedical aclaims lossdo rationot atinclude thedental timeonly ofor renewalvision ofonly acoverage.” policy,  the  insurerAdopted shall,Rejected upon request of an insured, provide the loss ratio and the components of the loss ratio calculation to the insured no more than 90 days but no less than 60 days before the renewal date of the policy.

For purposes of this section, “loss ratio” means the total losses paid out in medical claims divided by the total earned premiums.

ARTICLE 24.

HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS, AND HEALTH SERVICE CORPORATIONS.

§33-24-6a.

Loss ratio.

If a corporation utilizes a group’s loss ratio as a rating factor at the time of renewal of a policy, plan, or contract, the corporation shall, upon request of an insured or subscriber, provide the loss ratio and the components of the loss ratio calculation to the insured or subscriber no more than 90 days but no less than 60 days before the renewal date of the policy, plan, or contract.  For purposes of this section, “loss ratio” means the total losses paid out in medical claims divided by the total earned premiums:

Provided, That that the requirements of this section do not apply to a dental service corporation as that term is defined in this article.

ARTICLE 25.

HEALTH CARE CORPORATIONS.

§33-25-10a.

Loss ratio.

If a corporation considers a loss ratio at the time of renewal of a policy, plan, or contract, the corporation shall, upon request of a subscriber, provide the loss ratio and the components of the loss ratio calculation to the subscriber no more than 90 days but no less than 60 days before the renewal date of the policy, plan, or contract.

For purposes of this section, “loss ratio” means the total losses paid out in medical claims divided by the total earned premiums.

ARTICLE 25A.

HEALTH MAINTENANCE ORGANIZATION ACT.

§33-25A-7b.

Loss ratio.

If a health maintenance organization considers a loss ratio at the time of renewal of a policy, plan, or contract, the health maintenance organization shall, upon request of a subscriber, provide the loss ratio and the components of the loss ratio calculation to the subscriber no more than 90 days but no less than 60 days before the renewal date of the policy, plan, or contract.

For purposes of this section, “loss ratio” means the total losses paid out in medical claims divided by the total earned premiums.

For purposes of this section, “subscriber” does not include a subscriber or beneficiary of any policy, plan, or contract approved by the Bureau of Medical Services of the Department of Health and Human Resources and entered into by a health maintenance organization with Medicaid or the Children's Health Insurance Program.

      Adopted Rejected