Requires insurance companies to disclose claims information to municipalities employing 400 or more employees

Title of bill

An act to amend the insurance law, in relation to requiring insurance companies to disclose claims information to municipalities

Purpose or general idea of bill

This bill allows the different levels of government employing 400 or more workers an opportunity to assess accurately the true needs of their employees when addressing health care benefits. It will create transparency allowing these governments to' negotiate more effectively with all insurance companies that are bidding on future contracts.

Summary of specific provisions

Section 1. Amends the insurance law by adding a new section 3217-e to read as follows:

§3217-C Disclosure of information, to municipalities. (a) Every insurer contracting with municipalities, including cooperative health benefit plans certified pursuant to article forty-seven of this chapter shall provide upon request the following information to the insured municipality.

1. Specific claims information must be furnished by the insurer under community rated or experience rated policies;

2. Average annual per member cost of claims reimbursement;

3. Number of members that did not file a claim within a 12 month period;

4. A comparison of emergency services used by members to out-patient services; and

5. Provide municipality with loss ratio report.

6. Claims history for the last 12 months must be provided for experience rated plans separated by medical and prescription.

7 Information regarding cost on to 25 prescription drug being used by member employees.

8. Large loss claims report indicating diagnosis and prognosis for claims greater than $30 000.00.

9. Medical loss ratio report.

10. Any other statistical information the municipality requests to determine use of benefits by members.

B. The superintendent shall impose a fine of three hundred thousand dollars ($300,000) for failure to provide within thirty days of a written request by the insured municipality the information required by paragraph one of subsection (a) of this section regarding the insured employees. A fine of ten thousand dollars ($10,000) a day will be imposed for every day such failure continues. Any fines imposed shall be paid directly to the municipality requesting such information.

C. All information being released shall be done so in compliance with the federal health insurance portability and accountability act (HIPAA) of 1996.

Definition

The experience ratings will include all quantitative measures used by the insurance company such as expenses per member, data supporting said expenses and any historical data that will help determine the risk of future claims. This information will provide transparency for purposes of negotiations in future contracts.

Justification

Every year villages, towns, cities and counties in New York State are forced to put in place a budget that best meets the needs of those governments. It is necessary for those creating budgets to have access to accurate numbers that reflect a true need. Without understanding how well health care programs are being utilized, it is very difficult to negotiate in good faith with insurance carriers. Large insurance carriers will continue to have an unfair advantage over governments until transparencies exist and negotiations reflect actual cost.

Prior legislative history

New Legislation.

Fiscal implications

None.

Effective date

This act will take effect immediately.