05 LC 28
2350
Senate
Bill 298
By:
Senators Shafer of the 48th, Hudgens of the 47th, Thomas of the 54th, Unterman
of the 45th, Williams of the 19th and others
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
provide a short title; to provide for legislative findings; to amend Code
Section 33-24-10.1 of the Official Code of Georgia Annotated, relating to
standard or uniform claim form, so as to provide a definition; to authorize the
Commissioner of Insurance to establish by rule or regulation a standard or
uniform explanation of benefits form relating to certain health insurance
policies and contracts; to provide for related matters; to repeal conflicting
laws; and for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
This
Act shall be known and may be cited as the "Plain Language Insurance Benefits
Act."
SECTION
2.
The
General Assembly finds that Georgia health care consumers have encountered an
increasingly complex and confusing medical payment system and accompanying
terminology. Such complexity has led to confusion among health care consumers
concerning whether all or part of their claims have been paid and the amount of
any claim for which the consumer is personally responsible. It is therefore in
the best interests of the citizens of Georgia that they be able to easily
understand the explanation of benefits forms used by insurers when processing
health care claims.
SECTION
3.
Code
Section 33-24-10.1 of the Official Code of Georgia Annotated, relating to
standard or uniform claim form, is amended by striking the Code section 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 to be supplied by insurers to their
insureds on and after July 1, 2005, for the purpose of paying or resolving
claims filed under policies or contracts of accident and sickness insurance.
This authorization shall also apply to any explanation of benefits 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' means any written
communication from an insurer or plan or any agent thereof to an insured,
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, beneficiary, claimant, or
enrollee.
(3)
Such rule or regulation shall, at a minimum, require the explanation of benefits
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 designated as
such and bearing the Commissioner´s authenticating signature and the date
of
filing."
SECTION
4.
All
laws and parts of laws in conflict with this Act are repealed.