AN ACT CONCERNING TRANSPARENCY IN HEALTH INSURANCE CLAIMS DATA.
AN ACT CONCERNING TRANSPARENCY IN HEALTH INSURANCE CLAIMS DATA.
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General Assembly

Raised Bill No.

February Session, 2010

LCO No. 122

*00122_______INS*

Referred to Committee on

Introduced by:

(INS)

AN ACT CONCERNING TRANSPARENCY IN HEALTH INSURANCE CLAIMS DATA.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective July 1, 2010) (a) As used in this section:

(1) "Claims paid" means the amounts paid for the covered employees of an employer or governmental entity by an insurer, health care center, hospital service corporation, medical service corporation or other entity as specified in subsection (b) of this section for medical services and supplies and for prescriptions filled, but does not include expenses for stop-loss coverage, reinsurance, enrollee educational programs or other cost containment programs or features, administrative costs or profit.

(2) "Employer" means any town, city, borough, school district, taxing district or fire district employing more than fifty employees.

(3) "Utilization data" means (A) the aggregate number of procedures or services performed for the covered employees of the employer, by practice type and by service category, or (B) the aggregate number of prescriptions filled for the covered employees of the employer, by prescription drug name.

(b) Each insurer, health care center, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, amending or continuing in this state any group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes shall:

(1) Disclose to an employer sponsoring such policy, upon request by such employer, the following information for the most recent thirty-six-month period or for the entire period of coverage, whichever is shorter, ending not more than sixty days prior to the date of the request, in a format as set forth in subdivision (3) of this subsection:

(A) Complete and accurate medical, dental and pharmaceutical utilization data, as applicable;

(B) Claims paid by year, aggregated by practice type and by service category, each reported separately for in-network and out-of-network providers, and the total number of claims paid;

(C) Premiums paid by such employer by month; and

(D) The number of insureds by coverage tier, including, but not limited to, single, two-person and family including dependents, by month;

(2) Include in such requested information specified in subdivision (1) of this subsection only health information that has had identifiers removed, as set forth in 45 CFR 164. 514, is not individually identifiable, as defined in 45 CFR 160. 103, and is permitted to be disclosed under the Health Insurance Portability and Accountability Act of 1996, P. L. 104-191, as amended from time to time, or regulations adopted thereunder; and

(3) Disclose such requested information (A) in a written report, (B) through an electronic file transmitted by secure electronic mail or a file transfer protocol site, or (C) through a secure web site or web site portal that is accessible by the employer insured by such insurer, health care center, hospital service corporation, medical service corporation or other entity.

Such insurer, health care center, hospital service corporation, medical service corporation or other entity shall not be required to provide such information to the employer more than once in any twelve-month period.

(c) Any information disclosed to an employer in accordance with this section shall be confidential by law and privileged and shall not be subject to disclosure under section 1-210 of the general statutes, subject to subpoena, or subject to discovery or be admissible in evidence in any private civil action, except that an employee organization, as defined in section 7-467 of the general statutes, that is the exclusive bargaining representative of the employees of such employer shall be entitled to receive claim information from such employer in order to fulfill its duties to bargain collectively pursuant to section 7-469 of the general statutes.

(d) Information disclosed to an employer pursuant to this section shall be used by such employer only for the purposes of obtaining competitive quotes for group health insurance or to promote wellness initiatives for the employees of such employer.

This act shall take effect as follows and shall amend the following sections:

Section 1

July 1, 2010

New section

Statement of Purpose:

To require insurers to disclose to certain employers upon request certain claims data.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined. ]