Requires health plans providing coverage under the affordable care act to, upon request of a health care provider, provide information on an enrollee's eligibility during the grace period

BILL NUMBER:S7501

Title of bill

An act to amend the insurance law, in relation to quali- fied health plans

Purpose

This bill amends the insurance law in relation to notification requirements for Qualified Health Plans under specific circumstances.

Provisions

Section 1 amends the insurance law to establish certain notification requirements for Qualified Health Plans (QHPs) when enrol- lees enter the second and third months of the 90 day grace period for nonpayment of premiums for health insurance purchased through the health insurance exchange.

Section 2 - Effective date.

Justification

This legislation adds a new section 3242 to the Insur- ance Law that would establish notification requirements for a health plan when an enrollee has entered the second and third months of the grace period. Subsection (b) of such section would require QHPs to noti- fy a provider, upon request, that an enrollee is in the grace period within three business days after the submittal of a claim or upon request by a provider.

Under the Affordable Care Act, a QHP must provide a grace period of three consecutive months before terminating coverage if an enrollee receiving advanced payments of the premium tax credit has previously paid at least one full month's premium during the benefit year. During the grace period, the QHP must pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period. QHPs must also notify providers of the possibility for denied claims for enrollees within the second and third months of the grace period; however, there is no guidance on how notifi- cations must be provided or the time period in which such notifications must be given.

Without sufficient notification, patients may risk receiving potentially uncovered services, perhaps unknowingly. Timely notification enables providers, if necessary, to provide additional information to patients about financial assistance and will also help such providers anticipate or mitigate the effect of potential claim denials.

Prior legislative history

New bill

Fiscal implications

None

Effective date

This act shall take effect July 1, 2015.