2014 -- S 2529

========

LC004561

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2014

____________

A N   A C T

RELATING TO INSURANCE - HEALTH INSURANCE

     Introduced By: Senator Donna M.Nesselbush

     Date Introduced: February 27, 2014

     Referred To: Senate Health & Human Services

     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. Retroactive termination. - A health care entity or health plan operating in the

state shall include in all contracts with employer groups, union plans, and brokers the requirement

that, before processing a request for a retroactive termination of eligibility a health care entity or

health plan must verify that there are no outstanding claims on file for the enrollee, subject to the

retroactive termination request that cover services provided after the date of the requested

retroactive termination and if there are claims on file, the termination will be effective on the

date on which the payer was notified of the termination. For purposes of this section, this

requirement does not apply to Consolidated Omnibus Budget Reconciliation Act (COBRA)

policy holders.

     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. Retroactive termination. – A nonprofit hospital service corporation operating

in the state shall include in all contracts with employer groups, union plans, and brokers the

requirement that, before processing a request for a retroactive termination of eligibility a health

care entity or health plan must verify that there are no outstanding claims on file for the enrollee,

subject to the retroactive termination request that cover services provided after the date of the

requested retroactive termination and if there are claims on file, the termination will be effective

on the date on which the payer was notified of the termination. For purposes of this section, this

requirement does not apply to Consolidated Omnibus Budget Reconciliation Act (COBRA)

policy holders.

     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. Retroactive termination. - A nonprofit medical service corporation operating

in the state shall include in all contracts with employer groups, union plans, and brokers the

requirement that, before processing a request for a retroactive termination of eligibility a health

care entity or health plan must verify that there are no outstanding claims on file for the enrollee,

subject to the retroactive termination request that cover services provided after the date of the

requested retroactive termination and if there are claims on file, the termination will be effective

on the date on which the payer was notified of the termination. For purposes of this section, this

requirement does not apply to Consolidated Omnibus Budget Reconciliation Act (COBRA)

policy holders.

     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. Retroactive termination. - A health maintenance organization operating in the

state shall include in all contracts with employer groups, union plans, and brokers the requirement

that, before processing a request for a retroactive termination of eligibility a health care entity or

health plan must verify that there are no outstanding claims on file for the enrollee, subject to the

retroactive termination request that cover services provided after the date of the requested

retroactive termination and if there are claims on file, the termination will be effective on the date

on which the payer was notified of the termination. For purposes of this section, this requirement

does not apply to Consolidated Omnibus Budget Reconciliation Act (COBRA) policy holders.

     SECTION 5. This act shall take effect upon passage.

========

LC004561

========

LC004561 - Page 2 of 2

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - HEALTH INSURANCE

***

     This act would require that a health care entity or health plan operating in this state to

include in all contracts with employer groups, union plans and brokers, the requirement that,

before processing a request for retroactive termination of eligibility, the health care entity or

health plan must verify that there are no outstanding claims on file for the enrollee.

     This act would take effect upon passage.

========

LC004561

========

LC004561 - Page 3 of 2