SB 1474

Abstract

Creates the Health Care Professional and Provider Notification of Patients in Health Insurance Exchange Grace Period Act. Provides that when a health care professional or provider or a representative of the health care professional or provider requests information from a QHP issuer regarding (i) an enrollee's eligibility, (ii) an enrollee's coverage or health plan benefits, or (iii) the status of a claim or claims for services provided to an enrollee, or reports a claim in a remittance advice, and the request or service is for a date within the second or third month of a grace period, the QHP issuer shall clearly identify that the applicable enrollee is in the grace period and provide additional information. Provides that if the QHP issuer informs the health care professional or provider or a representative of the health care professional or provider that the enrollee is eligible for services, and does not inform the health care professional or provider that the enrollee is in the grace period, that determination shall be binding on the QHP issuer, and the claim or claims for services rendered shall be paid by the QHP issuer. Requires QHP issuers to maintain a hotline for questions from a health care professional or provider. Requires that QHP issuers seeking to recoup claims made during the last 60 days of the grace period must commence such recovery or recoupment efforts no later than 60 days after the expiration of the grace period. Provides that the Director of Insurance shall investigate all complaints of violations of the Act. Provides that the Director shall issue cease and desist orders to any QHP issuers found to be in violation of the Act. Provides that failure to comply with a cease and desist order shall result in fines of $1,000 for each violation, and each day the QHP issuer is in violation of the Act is a separate offense. Effective immediately.