HB 146

Abstract

Insurance; examinations; provider complaints. Provides that any person may submit a complaint of noncompliance by an insurer with any insurance law, regulation, or order of the State Corporation Commission on behalf of a health care provider. The bill provides that the Commission shall investigate such complaints and notify the complainants of the outcomes, but that the Commission shall not have jurisdiction to adjudicate individual controversies or matters of contractual dispute.

Insurance; examinations; health care providerpanels. Requires the State Corporation Commission to conductan examination of the business and affairs of an insurer upon (i)request by a statewide association representing health care professionalsaffirming no less than 10 complaints alleging insurer misconductin a six-month period from providers participating in such insurer's network or (ii) verifiable information that such insurer has violatedany law, regulation, or prior order of the Commission. The bill requiresthe Commission to publish a reasonably detailed summary of each violationand any corrective action plan on the Commission website within 60days of the completion of an examination. The bill requires a healthinsurer that uses a provider panel to establish procedures for (a)notifying a provider at least 90 days prior to the implementationof a policy that restricts enrollee access to the provider's services,(b) providing reasonable notice to primary care providers in the insurer's provider panel prior to the implementation of a policy thatrestricts enrollee access to the specialty referral services provider,and (c) notifying the purchaser of the health benefit plan of anychange in policy that restricts enrollee access to a contracted provider.Finally the bill requires a health insurer to provide with a renewalcoverage proposal written notice of intent to increase by more than15 percent the annual premium charged for coverage.