376.435. Claim information to be reported, when--covered lives defined.
Claim information to be reported, when--covered lives defined.
376.435. 1. Beginning January 1, 2008, a health carrier providing agroup health benefit plan or plans, as such terms are defined in section376.1350, to an employer who meets the requirements specified in subsection2 of this section shall, upon request by the employer or the employer'sproducer of record, provide a report of the total dollar amount and totalnumber of claims paid under the plan or plans for each of the prior threeyears or for each year coverage was in place if less than three years atthe time of the request. In the case of an employer with multiple plans,the total dollar amounts shall be aggregated into one report. The reportshall be provided within thirty days of the request; however, a healthcarrier shall not be required to provide such report for the employer orthe employer's producer of record more than twice in any calendar year.The information provided to the employer or the employer's producer ofrecord shall be furnished in a manner that does not individually identifyany employee or other person covered by the health benefit plan and shallcomply with all applicable federal and state privacy laws regarding thedisclosure of health records.
2. For purposes of subsection 1 of this section, an "employer" is onewho:
(1) Provides an employee health benefit plan with at least fifty-onecovered lives either at the time of the request or at the start of thereporting period; and
(2) Has been insured continuously with the health carrier or acarrier affiliated with the health carrier for at least the precedingtwenty-two months.
3. As used in this section, the term "covered lives" means employees,their spouses, and dependents insured under the health benefit plan forwhich a report is requested.
(L. 2007 H.B. 791)