05 AM 28
0566
ADOPTED
Senators
Shafer of the 48th, Hudgens of the 47th and Moody of the 56th offered the
following amendment:
Amend
HB 291 by inserting after "deductibles;" on line 3 on page 1 "to authorize the
Commissioner of Insurance to establish by rule or regulation a standard or
uniform explanation of benefits form and remittance advice form relating to
certain health insurance policies and contracts;".
By
inserting after line 23 on page 4 the following:
"SECTION
3.
Said
title is further amended by striking Code Section 33-24-10.1, relating to
standard or uniform claim form, and inserting in lieu thereof a new Code Section
33-24-10.1 to read as follows:
'33-24-10.1.
(a)
The Commissioner is authorized to establish by rule or regulation a standard or
uniform claim form to be supplied by insurers on and after January 1, 1994, to
their insureds for the purpose of filing claims under policies or contracts of
accident and sickness insurance.
(b)(1)
The Commissioner is authorized to establish by rule or regulation a standard or
uniform explanation of benefits form and a standard or uniform remittance advice
form to be supplied by an insurer or plan or any agent thereof to an insured,
provider, beneficiary, claimant, or enrollee on and after July 1, 2005, for the
purpose of paying or resolving claims filed under policies or contracts of
accident and sickness insurance other than limited benefit insurance plans or
policies. This authorization shall also apply to any explanation of benefits
form and remittance advice form issued by a managed care plan as defined in Code
Section 33-20A-3 or issued by the state health benefit plan or the board of
regents health plan operated by the Department of Community Health pursuant to
Code Section 31-5A-4.
(2)
For purposes of this Code section, "explanation of benefits" or "remittance
advice" means any written or electronic communication from an insurer or plan or
any agent thereof to an insured, provider, beneficiary, claimant, or enrollee
which explains or attempts to explain the benefits paid or to be paid by the
insurer, the plan, or other persons related to any claim submitted by or on
behalf of the insured, provider, beneficiary, claimant, or
enrollee.
(3)
Such rule or regulation shall, at a minimum, require the explanation of benefits
form and the remittance advice form to be easily understood by a reasonable
consumer and to contain:
(A)
The amount of the claim to be paid by the insurer or plan;
(B)
The amount of the claim to be paid by any other person;
(C)
The amount of the claim for which the insured, beneficiary, claimant, or
enrollee is personally responsible; and
(D)
Any additional information deemed by the Commissioner to be necessary to reduce
confusion and promote the prompt payment and adjudication of
claims.
(c)
The Commissioner shall file and maintain on file in the office of the
Commissioner a true copy of the standard or uniform claim form
and
explanation of benefits form and remittance advice
form designated as such and bearing the
Commissioneŕs
authenticating signature and the date of
filing.'"
By
redesignating Sections 3 through 16 as Sections 4 through 17, respectively.