Bill > S636

This bill establishes new requirements for health insurance issuers regarding the reporting of claim information under certain group health plans, including those offered by governmental entities. It defines terms like "employer," "governmental entity," and "group health plan," referencing federal laws for some definitions, and specifies that these definitions apply as they existed on September 1, 2007. The bill mandates that health insurance issuers must provide a written report of claim information within 21 days of a request from a plan, plan sponsor, or plan administrator, with options for electronic delivery or secure website access. This report must include aggregate paid claims, total premiums, number of covered employees by coverage tier, pending claims, and detailed information for individuals with claims exceeding $15,000 in a 12-month period, as well as a statement about precertification requests for long hospital stays. The bill also outlines conditions under which protected health information, as defined by federal privacy regulations, can be disclosed, requiring a specific certification from plan sponsors to receive certain sensitive data. Furthermore, it allows for requests for additional information regarding prognosis, recovery, and case management for specified individuals, with a response due within 15 days. Importantly, compliance with these reporting requirements will not create liability for the health insurance issuer, and non-compliance will be subject to administrative penalties.