The "Fair Claims Accountability Act" aims to enhance consumer protection in health insurance by establishing the Healthcare Claims Consumer Assistance Program (H-CAP) within the Department of Consumer Affairs. This program will assist consumers in navigating health insurance claims, including filing complaints and appeals, settling disputes, and obtaining necessary coverage. Health plans and insurers are mandated to provide clear notices about H-CAP on all relevant communications. Additionally, the act prohibits wrongful denial or insufficient coverage of valid insurance claims, allowing the Department of Consumer Affairs to impose civil penalties and award damages to affected consumers.

The bill outlines specific penalties for health plans and insurers that violate these provisions, including potential double damages for wrongful claim denials and the possibility of additional penalties based on the severity of the violation. The Department is also tasked with collecting data on denied claims and reporting this information annually to state leaders. Furthermore, the act emphasizes the importance of protecting personal information in the administration of these provisions, ensuring that data is handled responsibly and only shared in a deidentified manner. The act will take effect upon the Governor's approval.

Statutes affected:
12/12/2024: 37-4-305
02/05/2025: 37-4-305
Latest Version: 37-4-305