Senate Bill S5029A

                                BILL NUMBER:S5029

TITLE OF BILL:

An act to amend the insurance law, in relation to qualified health
plans

PURPOSE:

This bill amends the insurance law in relation to notification
requirements for Qualified Health Plans under specific circumstances.

SUMMARY OF PROVISIONS:

Section 1 amends the insurance law to establish certain notification
requirements for Qualified Health Plans (QHPs) when enrollees enter
the second and third months of the 90 day grace period for nonpayment
of premiums for health insurance purchased through the health
insurance exchange.

Section 2 - Effective date.

JUSTIFICATION:

This legislation adds a new section 3242 to the Insurance Law that
would establish notification requirements for a health plan when an
              

enrollee has entered the second and third months of the grace period.
Subsection (b) of such section would require QHPs to notify a
provider, upon request, that an enrollee is in the grace period within
three business days after the submittal of a claim or upon request by
a provider.

Under the Affordable Care Act, a QHP must provide a grace period of
three consecutive months before terminating coverage if an enrollee
receiving advanced payments of the premium tax credit has previously
paid at least one full month's premium during the benefit year.
During the grace period, the QHP must pay all appropriate claims for
services rendered to the enrollee during the first month of the grace
period and may pend claims for services rendered to the enrollee in
the second and third months of the grace period. QHPs must also notify
providers of the possibility for denied claims for enrollees within
the second and third months of the grace period; however, there is no
guidance on how notifications must be provided or the time period in
which such notifications must be given.

Without sufficient notification, patients may risk receiving
potentially uncovered services, perhaps unknowingly. Timely
notification enables providers, if necessary, to provide additional
information to patients about financial assistance and will also help
such providers anticipate or mitigate the effect of potential claim
denials.

LEGISLATIVE HISTORY:

Same as S.7501 of 2014.

FISCAL IMPLICATIONS:


None.

EFFECTIVE DATE:

This act shall take effect July 1, 2016.