HB 261 — AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO COMMON SUMMARY PAYMENT FORM FOR SENSITIVE HEALTH CARE SERVICES.

Summary

The ability of insured dependents and other insured members to receive confidential sensitive health care services without the knowledge of the insured policyholder is greatly impeded through traditional billing processes utilized by health insurers. The most frequent form used is an explanation of benefit (EOB) sent to the policyholder after anyone covered under the policy receives care. The lack of confidentiality for sensitive health care services significantly impacts young adults between the ages of 18-26 years of age that are on their parents’ health insurance plans and adults covered as dependents under abusive spouse or family member’s plans. This results in dependents simply avoiding necessary health care for these sensitive health care services. This Act (1) requires health carriers to use a common summary of payment form, developed by the Department of Insurance, in collaboration with health insurers, for defined sensitive health care services; (2) prohibits the health carriers from specifying any defined sensitive health care services in the form; (3) allows health carriers to address the form to the insured member; (4) allows insured member to choose their preferred method of receiving said form; (5) allows the insured member to opt-out of receiving the form when there is no payment liability for the visit or service provided; (6) requires the Department of Insurance and Division of Public Health to educate health care providers and health carriers on the new law. The effective dates for guidance and education requirement are 3 and 6 months, respectively, after enactment.

Bill Text

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The bill requires the creation of a common summary of payment form for sensitive health care services, enhancing confidentiality for insured members.

• § 3371

  Health carriers shall not specify or describe sensitive health care services in a common summary of payments form.

  Health carriers are prohibited from detailing sensitive health care services on the payment form.

• § 3371

  The Department shall develop a common summary of payment form to be used by all health carriers in Delaware.

  The Department is mandated to create a standard payment form for all health carriers.

• § 3371

  If the insured member has received sensitive health care services, health carriers shall issue a common summary of payment form only to the insured member receiving care unless the insured member receiving care agrees, in writing or verbally on a recorded telephone line, that a third party may receive the common summary of payment form.

  Payment forms for sensitive services will only be sent to the insured member unless they consent otherwise.

• § 3371

  Health carriers shall permit the following individuals to choose, in writing, an alternative method of receiving the common summary of payment form, if the insured member receiving care has consented.

  Certain individuals can choose how they receive the payment form if the insured member agrees.

• § 3371

  All health carriers shall also permit an individual not authorized under subsection (d) but who is legally authorized to consent to care for an insured member to request, and shall accommodate a reasonable request by such individual to receive, the forms.

  Others legally authorized to consent can request to receive payment forms on behalf of the insured member.

• § 3371

  The preferred method of receipt selected pursuant to subsections (d) and (e) shall be valid until the insured member submits a request in writing for a different method.

  The method of receipt for payment forms can be changed by the insured member.

• § 3371

  In the event that the insured member has no liability for payment for any procedure or service, health carriers shall permit all insured members who are legally authorized to consent to care or parties legally authorized to consent to care for the insured member, to request suppression of common summary of payment forms for a specific service or procedure.

  Members can request that no payment form be issued if they are not responsible for payment.

• § 3371

  The ability to request the preferred method of receipt pursuant to subsections (d) and (e) shall be communicated in plain language and in a clear and conspicuous manner.

  Health carriers must clearly inform members about their options for receiving payment forms.

• § 3371

  The Department shall issue guidance as necessary to implement and enforce this section.

  The Department is responsible for providing necessary guidance for implementation.

• § 3371

  The Department shall develop and implement a plan to educate providers and consumers regarding the rights of insured members.

  A plan for educating stakeholders about new rights and responsibilities must be developed.

Action History

1. June 23, 2022

   Stricken in House

2. June 30, 2021

   Introduced and Assigned to Economic Development/Banking/Insurance & Commerce Committee in House

Sponsors

• Kyle Evans Gay · Primary
• Sarah McBride · Primary
• Krista Griffith · Primary
• Marie Pinkney · Primary
• Stephanie L. Hansen · Primary
• Nicole Poore · Primary
• Laura V. Sturgeon · Primary
• Debra Heffernan · Primary
• Kendra Johnson · Primary
• Larry Lambert · Primary
• Melissa Minor-Brown · Primary
• Sherae'a Moore · Primary
• Kimberly Williams · Primary
• Madinah Wilson-Anton · Primary
• Eric Morrison · Cosponsor
• Sherry Dorsey Walker · Primary
• Valerie Longhurst · Primary

Subjects