Report Title:

Health Insurance; Claims Experience

Description:

Requires insurers, mutual benefit societies, and health maintenance organizations to provide employers with employee group health claims experience under the employer health plan for the current policy period within 90 days of a request. Authorizes a fee of not more than $100. Provides exceptions. Effective date July 1, 2050. (HB106 HD1)

HOUSE OF REPRESENTATIVES

H.B. NO.

106

TWENTY-THIRD LEGISLATURE, 2005

H.D. 1

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to health insurance.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. It is in the best interest of the entire community that individual privacy is both valued and protected. Because the majority of businesses in Hawaii are small businesses, certain safeguards need to be put in place to protect the sharing of highly confidential claims experience information from which employers might reasonably be able to infer which of their employees are using more benefits than others. The intent of this Act is to ensure that this sensitive information is safeguarded and that individuals are not penalized for their respective health conditions.

The purpose of this Act, therefore, is to define what types of healthcare information and under what circumstances this data may be provided to employer groups.

SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§431- Health claims experience request. (a) Except as provided in subsection (d), an insurer upon written request shall provide an employer that provides health care coverage to its employees, the employer’s aggregate group health claims experience for the current policy period.

(b) The insurer shall provide the information under subsection (a) no more than ninety days after receiving a request from the employer.

(c) The insurer may charge the employer a reasonable processing fee of not more than $100 for providing the information under subsection (a).

(d) An insurer is not required to provide the information under subsection (a):

(1) To employers that provide coverage under a particular policy for less than one hundred employees;

(2) For any time more than eighteen months prior to the date of the request;

(3) With regard to any individual;

(4) If the information identifies an individual; or

(5) If the information is confidential under section 325-101, 334-5, 431:3A-301, 432D-21, 577-26, or 577A-3."

SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§432- Health claims experience request. (a) Except as provided in subsection (d), a mutual benefit society upon written request shall provide an employer that provides health care coverage to its employees, the employer’s aggregate group health claims experience for the current policy period.

(b) The mutual benefit society shall provide the information under subsection (a) no more than ninety days after receiving a request from the employer.

(c) The mutual benefit society may charge the employer a reasonable processing fee of not more than $100 for providing the information under subsection (a).

(d) A mutual benefit society is not required to provide the information under subsection (a):

(1) To employers that provide coverage under a particular policy for less than one hundred employees;

(2) For any time more than eighteen months prior to the date of the request;

(3) With regard to any individual;

(4) If the information identifies an individual; or

(5) If the information is confidential under section 325-101, 334-5, 431:3A-301, 432D-21, 577-26, or 577A-3."

SECTION 4. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§432D- Health claims experience request. (a) Except as provided in subsection (d), a health maintenance organization upon written request shall provide an employer that provides health care coverage to its employees, the employer’s aggregate group health claims experience for the current policy period.

(b) The health maintenance organization shall provide the information under subsection (a) no more than ninety days after receiving a request from the employer.

(c) The health maintenance organization may charge the employer a reasonable processing fee of not more than $100 for providing the information under subsection (a).

(d) A health maintenance organization is not required to provide the information under subsection (a):

(1) To employers that provide coverage under a particular policy for less than one hundred employees;

(2) For any time more than eighteen months prior to the date of the request;

(3) With regard to any individual;

(4) If the information identifies an individual; or

(5) If the information is confidential under section 325-101, 334-5, 431:3A-301, 432D-21, 577-26, or 577A-3."

SECTION 5. New statutory material is underscored.

SECTION 6. This Act shall take effect July 1, 2050.