Texas is leading the nation toward establishing transparency in the cost of health care.
House Bill, 2015, passed by the 2007- 80th Texas Legislature, enacted new Chapter 1215 of the Insurance Code and applies to fully insured Employer Groups. It repeals existing requirements for insurers to provide groups with historical claims experience, and effective 09/01/07 replaces certain prior laws for report requests received on and after 01/01/08.
The new legislation allows fully insured group plans to request a broader range of historical claims data, including high-dollar claims information, as long as certain HIPAA privacy protections are satisfied. Greater transparency through standardized disclosure of health claims data will allow employers in this state to seek competitive rates and better health care benefits for their hard-working employees.
This legislation requires an insurer to respond within 30 days to an employer’s request for claims, premium, and other necessary underwriting information. The bill specifies what information is to be provided, and the list is extensive. This will give employers great tools for designing and negotiating their health plans.
Under the bill, insurers disclose protected health information only if proper certification has been provided by the employer plan sponsor in accordance with strict Federal standards.
We here at SB&K Benefits, LLC are already using this new bill to our clients’ advantage. We’ve created the necessary letters to send and have spoken with the carriers to see how they are responding to this new legislation.