2014 -- H 7797

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LC004986

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2014

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A N   A C T

RELATING TO HEALTH INSURANCE -- CO-INSURANCE AND DEDUCTIBLES

     Introduced By: Representatives Naughton, Ferri, Shekarchi, Hull, and Bennett

     Date Introduced: March 04, 2014

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

Insurance Policies" is hereby amended by adding thereto the following section:

     27-18-82. Co-Insurance and deductible responsibility. -- The commissioner shall

require a health care entity or health plan operating in the state to recover all co-insurance and

deductible amounts due from patients for covered services as required under the insured's health

benefit plan. For purposes of this section, "co-insurance" is defined as a percentage of the

allowable charge, after a co-payment, if any, that an insured will pay for covered benefits. A

"deductible" is defined, for purposes of this section, as an annual dollar allowable charge, after a

co-payment, if any, that an insured will pay for covered benefits. A "deductible" is defined, for

purposes of this section, as an annual dollar amount that must be paid by an insured for covered

benefits that the insured uses before the carrier's health benefit plan becomes obligated to pay for

covered benefits: such deductible does not include any portion of premiums paid by an insured.

Insurers shall include the co-insurance and deductible amounts due from the insured for covered

benefits in their payments to providers; provided, however, that such payment shall not be

dependent on the insurer recovering the co-insurance and deductible prior to processing and

paying a claim made by a provider. Nothing in this section shall prohibit providers and insurers

from mutually agreeing to alternative billing and payment processes, when it has been determined

that the insured has secondary health benefits for the health care services provided. This section

shall not pertain to the collection of co-payments which is a fixed dollar amount structured by the

insurer that is paid by an insured to a provider, at the time the insured receives covered services.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-73. Co-Insurance and deductible responsibility. -- The commissioner shall

require a nonprofit hospital service corporation operating in the state to recover all co-insurance

and deductible amounts due from patients for covered services as required under the insured's

health benefit plan. For purposes of this section, "co-insurance" is defined as a percentage of the

allowable charge after a co-payment, if any, that an insured will pay for covered benefits. A

"deductible" is defined, for purposes of this section, as an annual dollar allowable charge, after a

co-payment, if any, that an insured will pay for covered benefits. A "deductible" is defined, for

purposes of this section, as an annual dollar amount that must be paid by an insured for covered

benefits that the insured uses before the carrier's health benefit plan becomes obligated to pay for

covered benefits; such deductible does not include any portion of premiums paid by an insured.

Insurers shall include the co-insurance and deductible amounts due from the insured for covered

benefits in their payments to providers; provided, however, that such payment shall not be

dependent on the insurer recovering the co-insurance and deductible prior to processing and

paying a claim made by a provider. Nothing in this section shall prohibit providers and insurers

from mutually agreeing to alternative billing and payment processes when it has been determined

that the insured has secondary health benefits for the health care services provided. This section

shall not pertain to the collection of co-payments which is a fixed dollar amount structured by the

insurer that is paid by an insured to a provider, at the time the insured receives covered services.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Non-profit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-69. Co-Insurance and deductible responsibility. -- The commissioner shall

require a nonprofit medical service corporation operating in the state to recover all co-insurance

and deductible amounts due from patients for covered services as required under the insured's

health benefit plan. For purposes of this section, "co-insurance" is defined as a percentage of the

allowable charge, after a co-payment, if any, that an insured will pay for covered benefits. A

"deductible" is defined, for purposes of this section. as an annual dollar allowable charge, after a

co-payment, if any, that an insured will pay for covered benefits. A "deductible" is defined, for

purposes of this section, as an annual dollar amount that must be paid by an insured for covered

benefits that the insured uses before the carrier's health benefit plan becomes obligated to pay for

covered benefits; such deductible does not include any portion of premiums paid by an insured.

Insurers shall include the co-insurance and deductible amounts due from the insured for covered

LC004986 - Page 2 of 4

benefits in their payments to providers; provided, however, that such payment shall not be

dependent on the insurer recovering the co-insurance and deductible prior to processing and

paying a claim made by a provider. Nothing in this section shall prohibit providers and insurers

from mutually agreeing to alternative billing and payment processes when it has been determined

that the insured has secondary health benefits for the health care services provided. This section

shall not pertain to the collection of co-payments, which is a fixed dollar amount structured by the

insurer that is paid by an insured to a provider at the time the insured receives covered services.

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-86. Co-Insurance and deductible responsibility. -- The commissioner shall

require a health maintenance organization operating in the state to recover all co-insurance and

deductible amounts due from patients for covered services as required under the insured's health

benefit plan. For purposes of this section, "co-insurance" is defined as a percentage of the

allowable charge, after a co-payment, if any, that an insured will pay for covered benefits. A

"deductible" is defined, for purposes of this section, as an annual dollar allowable charge, after a

co-payment, if any, that an insured will pay for covered benefits. A "deductible" is defined, for

purposes of this section, as an annual dollar amount that must be paid by an insured for covered

benefits that the insured uses before the carrier's health benefit plan becomes obligated to pay for

covered benefits; such deductible does not include any portion of premiums paid by an insured.

Insurers shall include the co-insurance and deductible amounts due from the insured for covered

benefits in their payments to providers; provided, however, that such payment shall not be

dependent on the insurer recovering the co-insurance and deductible prior to processing and

paying a claim made by a provider. Nothing in this section shall prohibit providers and insurers

from mutually agreeing to alternative billing and payment processes when it has been determined

that the insured has secondary health benefits for the health care services provided. This section

shall not pertain to the collection of co-payments, which is a fixed dollar amount structured by the

insurer that is paid by an insured to a provider, at the time the insured receives covered services.

     SECTION 5. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH INSURANCE -- CO-INSURANCE AND DEDUCTIBLES

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     This act would require healthcare entities, health plans, non-profit hospital service

providers, non-profit medical service corporations, and health maintenance organizations to

recover all co-insurance and deductible amounts due from patients for covered services as

required under the insured's health benefit plan.

     This act would take effect upon passage.

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LC004986

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