CLAIMS UTILIZATION & COST INFORMATION                                                           S.B. 447 (S-2):

                                                                                                                                                                                SUMMARY OF BILL

                                                                                                                                                REPORTED FROM COMMITTEE

Senate Bill 447 (Substitute S-2 as reported)

Sponsor:   Senator Dan Lauwers

Committee:   Insurance and Banking

CONTENT

The bill would amend Chapter 34 (Disability Insurance Policies) of the Insurance Code to the following:

 --     Require an insurer to provide, on request, a large employer group with claims utilization and cost information on presentation of a signed nondisclosure agreement (NDA).

 --     Require an insurer to compile and make available to the large employer group, within 30 days after a request, complete and accurate claims utilization and cost information for the medical benefit plan in the aggregate and for each large employer group entitled to that information and each subgroup of employees of the large employer group if the subgroup had 100 or more employees covered by the medical benefit plan, including incurred and paid claims data for the employee group covered by the medical benefit plan and a census of all covered employees.

 --     Require a large employer group or combined large employer group to disclose the claims utilization and cost information to any carrier or administrator it solicited to provide benefits or administrative services for its medical benefit plan.

 --     Require a large employer group or combined large employer group to disclose the claims utilization and cost information on request to a carrier or administrator who requested the opportunity to submit a proposal to provide benefits or administrative services for the medical benefit plan at the time of the request for bids, within 30 days of the request.

 --     Require an insurer to provide, on request, the tax identification number or national provider identifier of each provider rendering service or care on presentation of a signed NDA to an insurer.

 --     Prohibit a large employer group from requesting claims utilization and cost information more than once per calendar year.

 --     Specify that claims utilization and cost information required to be produced under the bill include only health information as permitted under the Health Insurance Portability and Accountability Act.  

Proposed MCL 500.3471                                                       Legislative Analyst:   Stephen Jackson

FISCAL IMPACT

The bill would have no fiscal impact on State or local government.

Date Completed:   10-29-21                                                                 Fiscal Analyst:   Steve Angelotti

This analysis was prepared by nonpartisan Senate staff for use by the Senate in its deliberations and does not constitute an official statement of legislative intent.