This bill proposes the establishment of a health care claims consumer assistance program within the Department of Insurance and Financial Institutions, aimed at supporting consumers enrolled in or seeking health plans. The program will assist consumers with filing complaints, settling disputes, educating them on their rights, and providing information on obtaining health insurance coverage and federal tax credits. Additionally, it mandates health insurers to include a notice about this program in their communications and allows the department to contract with a nonprofit entity to manage the program.

The bill also introduces stricter penalties for health insurers that wrongfully deny or insufficiently cover valid claims, including potential license suspension or revocation and civil penalties of up to $25,000 for repeated violations. It requires the department to review various factors when determining penalties and mandates annual adjustments based on premium rate changes or inflation. Furthermore, the bill stipulates that health insurers must disclose data on wrongful claims denials and allows the department to investigate violations, compile annual reports on claims denials, and adopt rules for implementation.

Statutes affected:
Introduced Version: 20-127