§ 27-18.6-12 - Health plan loss information.
SECTION 27-18.6-12
§ 27-18.6-12 Health plan loss information.– (a) To ensure maximum competition in the purchase of group health insurance,all employers with at least one hundred (100) employees enrolled in their grouphealth plan shall be entitled to receive their health plan loss informationupon request and without charge. No contract between any health insurancecarrier, third-party administrator, employer group, or pool of employers shallabridge this right in any manner. For purposes of this section, "health planloss information" shall mean: (1) aggregate total cost figures for four (4)separate categories of medical claims covered by the employer's group healthplan: physician, hospital, prescription drug, and miscellaneous; and (2) thatwere incurred for the twelve (12) month period paid through the fourteen (14)months which end within the sixty (60) day period prior to the date of therequest. "Health plan loss information" shall not include any information: (1)pertaining to specific medical diagnoses, treatments or drugs; or (2) thatidentifies or reasonably could lead to the identity of any individuals coveredunder the group health plan; or (3) that is defined as protected orconfidential health information under state or federal laws.
(b) Upon written request from any employer with one hundred(100) or more employees enrolled in its group health plan, every healthinsurance carrier shall provide that employer's health plan loss informationwithin thirty (30) calendar days of receipt of the request. An employer shallnot be entitled by this section to more than two (2) health plan lossinformation requests in any twelve (12) month period, however, nothing shallprohibit a carrier from fulfilling more frequent requests on a mutually agreedupon basis.
(c) If an employer requests health plan loss information froman insurance agent or other authorized representative, the agent or authorizedrepresentative shall transmit the request to the health insurance carrierwithin four (4) working days.