How HB 2582 changes current law

AI-generated reading aid from the bill's amendatory text — verify against the official bill.

This bill adds a requirement for insurers to furnish claims experience to group policyholders within a specified timeframe upon request.

• Section 621.6

  Furnishing Claims Experience to Policyholders.--(a) Subject to the other provisions of this section, each insurer shall furnish, regardless of the rating methodology used, claims experience to group policyholders within thirty days of a policyholder's request unless the information has been furnished to the group policyholder within the preceding six months. (b) Claims experience shall be furnished for all groups of fifty-one or more covered employes, members or enrollees, not including dependents. (c) Claims experience shall include, but not be limited to, the following: (1) Earned premiums separated by policy year for at least the last two policy years, if applicable. (2) Total paid claims and total incurred claims, inclusive of any high amount or pooled claims, including both capitated and noncapitated expenses specified in the same manner as premiums. (3) Any amounts in excess of the individual pooling or stop-loss point applicable to the group. (d) An insurer that utilizes provider contracting methods, including financial devices such as global fee arrangements, to cover all medical expenses may apply to the commissioner for approval of the use of an alternative form of claims experience reporting. The following shall apply: (1) The insurer shall provide Commonwealth experience on a group-specific basis or on another reasonable basis as the commissioner may approve for the insurer, in advance, based upon a submission of an explanation and supporting documentation. (2) An insurer that received approval for an alternative form of group claims experience reporting to policyholders shall be required to seek the commissioner's advance approval of a proposed response letter to group policyholders who request experience reporting. The letter shall describe the insurer's reasons for seeking an alternative reporting process and describe the alternative form of reporting approved by the commissioner. e) An insurer may charge a reasonable fee for providing the information under this section to group policyholders. The schedule or amount of fees to be charged to group policyholders for providing the information shall be filed by each insurer with the commissioner. (f) In providing claims experience to group policyholders under this section, an insurer shall adhere to all Federal and State laws regarding disclosure of protected health or personal information. (g) As used in this section: "Commissioner" means the Insurance Commissioner of the Commonwealth. "Insurer" means an entity licensed by the Insurance Department with accident and health authority to issue a policy, subscriber contract, certificate or plan that provides medical or health care coverage, including emergency services, and is offered or governed under any of the following: (1) This act, including section 630 and Article XXIV. (2) The act of December 29, 1972 (P.L.1701, No.364), known as the "Health Maintenance Organization Act." (3) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations).

  This establishes a legal requirement for insurers to provide claims experience information to policyholders, promoting transparency and accountability.