Report Title:

Health Insurance

Description:

Establishes the circumstances under which insurers, mutual benefit societies, and health maintenance organizations are required to provide employers with employer-sponsored group health claims experience. Establishes what type of information can be requested and provided. (SD1)

THE SENATE

S.B. NO.

126

TWENTY-THIRD LEGISLATURE, 2005

S.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. In 1996 Congress passed sweeping legislation aimed at improving the portability and protecting the privacy of individual medical records. This new law, the Health Insurance Portability and Accountability Act of 1996, commonly referred to as HIPAA, establishes guidelines for health insurers to follow in protecting this private member information. The HIPAA privacy rule defines health information as any individually identifiable health information that is communicated, stored, or transmitted in any form (i.e., electronic, printed, or orally) by a covered entity. Health information relates to past, present, or future physical or mental health conditions, or the provision of or payment for health care. It is "individually identifiable" if it identifies the individual or if it is reasonable to believe that the individual could be identified based on the information provided.

The legislature finds that it is in the best interest of the entire community that individual privacy be both valued and protected. The legislature further finds that this sensitive information should be safeguarded and that individuals should not be penalized for their respective health conditions.

The purpose of this Act is to define what type of health care information and under what circumstances this information can be provided to employer groups.

SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:

"§431-   Request for health claims experience; circumstances and types of information. (a) Upon written request, an insurer shall provide an employer that provides health insurance coverage to its employees with the employer's aggregate group health claims experience for the current policy period, except:

(1) An insurer shall not be required to provide the information unless the employer requesting the information provides coverage under the particular policy being requested for at least twenty-five employees;

(2) An insurer shall not be required to provide health claims experience for any period of time prior to eighteen months before the date on which the information is requested;

(3) An insurer shall not be required to provide the employer with the health claims experience of any individual; and

(4) An insurer shall not be required to provide information that identifies an individual or that is confidential under sections 325-101, 431:3A-301, 334-5, 432D-21, 577A-3, and 577-26.

(b) The insurer shall provide the information no later than sixty days after receiving a request for the information from the employer.

(c) The insurer may charge the employer a reasonable processing fee of no more than $50 for providing the information."

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

"§432-   Request for health claims experience; circumstances and types of information. (a) Upon written request, a mutual benefit society shall provide an employer that provides health care coverage to its employees with the employer’s aggregate group health claims experience for the current policy period, except:

(1) A mutual benefit society shall not be required to provide the information unless the employer requesting the information provides coverage, under the particular policy being requested, for at least twenty-five employees;

(2) A mutual benefit society shall not be required to provide health claims experience for any period of time prior to eighteen months before the date on which the information is requested;

(3) A mutual benefit society shall not be required to provide the employer with the health claims experience of any individual; and

(4) A mutual benefit society shall not be required to provide information that identifies an individual or that is confidential under sections 325-101, 431:3A-301, 334-5, 432D-21, 577A-3, and 577-26.

(b) The mutual benefit society shall provide the information no later than sixty days after receiving a request for the information from the employer.

(c) The mutual benefit society may charge the employer a reasonable processing fee of no more than $50 for providing the information."

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

"§432D-   Request for health claims experience; circumstances and types of information. (a) Upon written request, a health maintenance organization shall provide an employer that provides health care coverage to its employees with the employer’s aggregate group health claims experience for the current policy period except:

(1) A health maintenance organization shall not be required to provide the information unless the employer requesting the information provides coverage, under the particular policy being requested, for at least twenty-five employees;

(2) A health maintenance organization shall not be required to provide health claims experience for any period of time prior to eighteen months before the date on which the information is requested;

(3) A health maintenance organization shall not be required to provide the employer with the health claims experience of any individual; and

(4) A health maintenance organization shall not be required to provide information that identifies an individual or that is confidential under sections 325-101, 431:3A-301, 334-5, 432D-21, 577A-3, and 577-26.

(b) The health maintenance organization shall provide the information no later than sixty days after receiving a request for the information from the employer.

(c) The health maintenance organization may charge the employer a reasonable processing fee of no more than $50 for providing the information."

SECTION 5. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.