Report Title:

Health Plans to Reimburse Nonparticipating Providers

Description:

Requires health plans to directly reimburse nonparticipating providers rather than the patient, upon the request of the patient. Specifics that the reimbursement check needs the endorsement of both the patient and the provider. Requires the provider to disclose nonparticipating status and the related cost consequences to the patient.

THE SENATE

S.B. NO.

2888

TWENTY-SECOND LEGISLATURE, 2004

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to insurance.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. Chapter 431, Hawaii Revised Statutes, is amended by adding to part VI of article 10A a new section to be appropriately designated and to read as follows:

"431:10A- Reimbursement payments to be made directly to nonparticipating providers. (a) Each policy of accident and sickness insurance issued or renewed in this State, each employer group health policy, contract, plan, or agreement issued or renewed in this State, all policies providing family coverage as defined in section 431:10A-103, and all policies providing reciprocal beneficiary family coverage as defined in section 431:10A-601, shall, at the request of the patient, reimburse a nonparticipating provider of a covered medical and dental service at the nonparticipating provider rate by paying the nonparticipating provider directly rather than reimbursing the patient.

The reimbursement check shall require the endorsement of both the patient and the provider, regardless of whether it is sent first to the patient or the provider.

(b) Prior to treatment the nonparticipating provider shall disclose to the insured that:

(1) The provider does not participate in the patient's health care plan; and

(2) The amount payable by the patient may be higher as a result."

SECTION 2. Chapter 432, Hawaii Revised Statutes, is amended by adding to article 1 a new section to be appropriately designated and to read as follows:

"432:1- Reimbursement payments to be made directly to nonparticipating providers. (a) All individual and group hospital and medical service plan contracts and medical service corporation contacts under this chapter shall, at the request of the patient, reimburse a nonparticipating provider of a covered medical and dental service at the nonparticipating provider rate by paying the nonparticipating provider directly rather than reimbursing the patient.

The reimbursement check shall require the endorsement of both the patient and the provider, regardless of whether it is sent first to the patient or the provider.

(b) Prior to treatment the nonparticipating provider shall disclose to the insured that:

(1) The provider does not participate in the patient's health care plan; and

(2) The amount payable by the patient may be higher as a result."

SECTION 3. New statutory material is underscored.

SECTION 4. This Act shall take effect upon its approval.

INTRODUCED BY:

_____________________________

BY REQUEST