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 South Carolina Department of Consumer Affairs. This program will assist consumers in navigating health insurance claims, including filing complaints and appeals, settling disputes, and educating them about their rights. Health plans and insurers are mandated to include a notice about H-CAP on all relevant communications, and the Department is authorized to contract with a nonprofit entity to operate the program.

Additionally, the bill prohibits health plans and insurers from wrongfully denying or inadequately covering valid insurance claims, with the Department empowered to impose civil penalties and award damages to affected consumers. If a claim is found to be wrongfully denied, the insurer must pay double the denied amount plus attorney's fees. The Department will also collect data on claim denials and report annually on the status of claims and violations, ensuring transparency and accountability in the health insurance sector.

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