By Mr. Mariano of Quincy, petition (accompanied by bill, House, No. 1018) of Ronald Mariano relative to insurance contracts between carriers and health care providers.  Financial Services.

The Commonwealth of Massachusetts

——————

PETITION OF:

Ronald Mariano

——————

In the Year Two Thousand and Seven.

——————

An Act to regulate health insurance contracts/policies.

    Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. Section 2 of Chapter 176O, as appearing in the 2004 Official Edition of the General Laws, is amended by re-designating subsection (h) as subsection (i) and by inserting after subsection (g) the following new subsection (h):—
(h) The Bureau of Managed Care shall study the effect of cost-sharing arrangements on access and coverage for medically necessary care, including but not limited to low-income individuals, pursuant to the provisions outlined in Sections 6 and 7 of this Chapter.

SECTION 2. Section 6 of Chapter 176O, as appearing in the 2004 Official Edition of the General Laws, is hereby amended by adding at the end thereof the following new subsection (b):
(b) Notwithstanding the provisions of Subsection (a) of this section, a carrier must demonstrate evidence that it can administer any health benefit plan offered to an insured. Said evidence of administration of the health benefit plan shall include that:
(1) the carrier has provided to an insured, at the time of enrollment, information regarding the insured’s financial obligations under the health benefit plan, including specific examples of: each co-payment amount that the insured may be subject to under the health benefit plan, applicable deductibles, co-insurance amounts and a clear explanation of the consequences of non-payment;
(2) the carrier has provided to the insured, after enrollment in a health benefit plan and before or at the time health care services are rendered, the insured’s financial obligation amount under the specific product, such provision of financial information shall not occur on a retrospective basis. Methodologies that do not allow for disclosure of the insured’s financial obligation at or before the time of service shall not be permitted;
(3) the carrier has demonstrated that it can administer the health benefit plan(s) and the carrier has not delegated the collection of insured cost sharing features, including but not limited to, collection of co-payment, deductibles or co-insurance amounts to any other organization or provider that has not explicitly agreed to such delegation; and
(4) providers have been given the option to transfer the collection of cost sharing features including co-payment, deductible and co-insurance collection to the carrier.

SECTION 3.  The provisions of Section 2 of the Act shall be effective in contracts between carriers and health care providers that are entered into, renewed, or amended on or after the effective date of this Act.