§ 27-18.6-12. Health plan loss information.
(a) To ensure maximum competition in the purchase of group health insurance, all employers
with at least one hundred (100) employees enrolled in their group health plan shall
be entitled to receive their health plan loss information upon request and without
charge. No contract between any health insurance carrier, third-party administrator,
employer group, or pool of employers shall abridge this right in any manner. For purposes
of this section, "health plan loss information� shall mean:
(1)Aggregate total cost
figures for four (4) separate categories of medical claims covered by the employer's
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§ 27-18.6-12. Health plan loss information.
(a) To ensure maximum competition in the purchase of group health insurance, all employers
with at least one hundred (100) employees enrolled in their group health plan shall
be entitled to receive their health plan loss information upon request and without
charge. No contract between any health insurance carrier, third-party administrator,
employer group, or pool of employers shall abridge this right in any manner. For purposes
of this section, "health plan loss information� shall mean: (1) Aggregate total cost
figures for four (4) separate categories of medical claims covered by the employer's
group health plan: physician, hospital, prescription drug, and miscellaneous; and
(2) That were incurred for the twelve-month (12) period paid through the fourteen
(14) months that end within the sixty-day (60) period prior to the date of the request.
"Health plan loss information� shall not include any information: (1) Pertaining to
specific medical diagnoses, treatments, or drugs; or (2) That identifies or reasonably
could lead to the identity of any individuals covered under the group health plan;
or (3) That is defined as protected or confidential health information under state
or federal laws.
(b) Upon written request from any employer with one hundred (100) or more employees enrolled
in its group health plan, every health insurance carrier shall provide that employer's
health plan loss information within thirty (30) calendar days of receipt of the request.
An employer shall not be entitled by this section to more than two (2) health plan
loss information requests in any twelve-month (12) period, however, nothing shall
prohibit a carrier from fulfilling more frequent requests on a mutually agreed upon
basis.
(c) If an employer requests health plan loss information from an insurance agent or other
authorized representative, the agent or authorized representative shall transmit the
request to the health insurance carrier within four (4) working days.