This bill amends existing law to enhance access to claims data for employers sponsoring self-funded health benefit plans. It stipulates that if an employer opts in writing to submit their claims data to the state's comprehensive health care information system, the insurance commissioner is required to provide the employer with annual access to a utilization report based on de-identified and aggregated claims data associated with their plan. The bill also mandates that health carriers and third-party administrators inform employers of their option to opt in for data submission at the time of plan renewal, ensuring that employers are aware of the potential benefits of accessing their claims data.

Key insertions in the bill include provisions that require carriers and administrators to notify employers about the access to their claims data and the privacy protections in place should they choose to opt in. Additionally, the bill clarifies that there is no obligation for self-funded employers to report data or change how their plans are administered. The fiscal impact of the bill is indeterminable, but it is suggested that utilizing claims data could lead to cost reductions and lower premiums for employers, potentially affecting the state's Insurance Premium Tax revenue over time.

Statutes affected:
Introduced: 420-G:11
As Amended by the House: 420-G:11