S.R. NO.



S.D. 1













     WHEREAS, insurance recoupment occurs when a health insurance plan pays benefits to providers and later seeks reimbursement for the benefits, after the health insurance plan determines that the benefits were paid out in error; and


     WHEREAS, health care providers in Hawaii have a time limit in which to submit claims to health insurance plans; and


     WHEREAS, however, there is no similar time limit in Hawaii that prevents health insurance plans from attempting to recoup funds previously paid to health care providers; and


     WHEREAS, the lack of a time limit on insurance recoupment results in an ongoing, open-ended liability for health care professionals and health care providers and undermines the ability for these professionals and providers to build upon and plan a viable, economically feasible practice; and


     WHEREAS, thirty states and the District of Columbia have passed legislation limiting the time during which a health insurance plan may take money back for services that have already been provided; and


     WHEREAS, time limits for insurance recoupment in these jurisdictions are between six months to sixty months, with the average time frame ranging from twelve to twenty-four months; and


     WHEREAS, assessing the issues surrounding insurance recoupment is paramount to maintaining a robust and sustainable health care system; now, therefore,


     BE IT RESOLVED by the Senate of the Twenty-seventh Legislature of the State of Hawaii, Regular Session of 2013, that the Insurance Commissioner is requested to form a working group to study insurance recoupment; and


     BE IT FURTHER RESOLVED that the insurance recoupment working group include the following members:


     (1)  Insurance Commissioner, who shall serve as chair;


     (2)  Director of Health, or the Director's designee;


     (3)  Director of Human Services, or the Director's designee;


     (4)  Representatives from the health care provider community;


     (5)  Representatives of health care professionals;


     (6)  Representatives from the Hawaii Association of Health Plans;


     (7)  A representative from the Healthcare Association of Hawaii;


     (8)  A representative from the Hawaii Medical Association; and


     (9)  A representative from the Hawaii Primary Care Association, who shall advocate for consumer interests; and


     BE IT FURTHER RESOLVED that the working group is requested to assess the problems of insurance recoupment, if any, study the impact of limiting the period allowed to initiate any recoupment or offset demand efforts, and review how other states mandate recoupment; and


     BE IT FURTHER RESOLVED that the working group is requested to report its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2014; and


     BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Insurance Commissioner, Director of Health, Director of Human Services, Hawaii Association of Health Plans, Healthcare Association of Hawaii, Hawaii Medical Association, and Hawaii Primary Care Association.

Report Title: 

Insurance Recoupment; Insurance Commissioner; Health Insurance; Working Group  (SD1)