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 with filing complaints, settling disputes, educating consumers about their rights, and providing information on obtaining health insurance coverage and federal tax credits. Additionally, health insurers will be required to include a notice about this program in their communications, and the Department may contract with a nonprofit entity to manage the program.

The bill also introduces new provisions regarding the accountability of health insurers for wrongful claims denials. It establishes penalties for insurers that wrongfully deny claims, including potential license suspension or revocation and civil penalties for repeated violations. The Department will be responsible for collecting data on claims denials, conducting investigations, and compiling annual reports on the status of claims and violations. Furthermore, the bill outlines factors to consider when determining penalties and damages, ensuring that consumers are protected and that insurers are held accountable for their actions.

Statutes affected:
Introduced Version: 20-128