(a) (1) Upon request from a policyholder with more than fifty (50) insured employees under a comprehensive group health insurance policy, an insurer issuing or delivering a group accident and health insurance policy in this state shall provide to the policyholder the following information for the most recent twelve-month period or for the entire period of coverage, whichever is shorter:(A) (i) A monthly premium, claims, and enrollment report.(ii) A monthly premium, claims, and enrollment report required under subdivision (a)(1)(A)(i) of this section shall include without limitation:(a) Medical claims on a paid basis by month;(b) Pharmacy claims on a paid basis by month;(c) Premiums paid by month; and(d) Total number of enrolled members, including dependents by month; and(B) (i) A high-cost claimant report that is applicable to an enrolled member with claims exceeding ten thousand dollars ($10,000).(ii) A high-cost claimant report required under subdivision (a)(1)(B)(i) of this section shall include for each enrolled member:(a) Current coverage status, either active or terminated;(b) Total medical claims on a paid basis by month; and(c) Total pharmacy claims on a paid basis by month.(2) A report required under subdivision (a)(1)(A)(i) or subdivision (a)(1)(B)(i) of this section shall be provided to the policyholder no later than thirty (30) days from the date of the request of the policyholder.(3) A policyholder may request reporting under this section no more frequently than on a quarterly basis.
(1) Upon request from a policyholder with more than fifty (50) insured employees under a comprehensive group health insurance policy, an insurer issuing or delivering a group accident and health insurance policy in this state shall provide to the policyholder the following information for the most recent twelve-month period or for the entire period of coverage, whichever is shorter:(A) (i) A monthly premium, claims, and enrollment report.(ii) A monthly premium, claims, and enrollment report required under subdivision (a)(1)(A)(i) of this section shall include without limitation:(a) Medical claims on a paid basis by month;(b) Pharmacy claims on a paid basis by month;(c) Premiums paid by month; and(d) Total number of enrolled members, including dependents by month; and(B) (i) A high-cost claimant report that is applicable to an enrolled member with claims exceeding ten thousand dollars ($10,000).(ii) A high-cost claimant report required under subdivision (a)(1)(B)(i) of this section shall include for each enrolled member:(a) Current coverage status, either active or terminated;(b) Total medical claims on a paid basis by month; and(c) Total pharmacy claims on a paid basis by month.
(A) (i) A monthly premium, claims, and enrollment report.(ii) A monthly premium, claims, and enrollment report required under subdivision (a)(1)(A)(i) of this section shall include without limitation:(a) Medical claims on a paid basis by month;(b) Pharmacy claims on a paid basis by month;(c) Premiums paid by month; and(d) Total number of enrolled members, including dependents by month; and
(i) A monthly premium, claims, and enrollment report.
(ii) A monthly premium, claims, and enrollment report required under subdivision (a)(1)(A)(i) of this section shall include without limitation:(a) Medical claims on a paid basis by month;(b) Pharmacy claims on a paid basis by month;(c) Premiums paid by month; and(d) Total number of enrolled members, including dependents by month; and
(a) Medical claims on a paid basis by month;
(b) Pharmacy claims on a paid basis by month;
(c) Premiums paid by month; and
(d) Total number of enrolled members, including dependents by month; and
(B) (i) A high-cost claimant report that is applicable to an enrolled member with claims exceeding ten thousand dollars ($10,000).(ii) A high-cost claimant report required under subdivision (a)(1)(B)(i) of this section shall include for each enrolled member:(a) Current coverage status, either active or terminated;(b) Total medical claims on a paid basis by month; and(c) Total pharmacy claims on a paid basis by month.
(i) A high-cost claimant report that is applicable to an enrolled member with claims exceeding ten thousand dollars ($10,000).
(ii) A high-cost claimant report required under subdivision (a)(1)(B)(i) of this section shall include for each enrolled member:(a) Current coverage status, either active or terminated;(b) Total medical claims on a paid basis by month; and(c) Total pharmacy claims on a paid basis by month.
(a) Current coverage status, either active or terminated;
(b) Total medical claims on a paid basis by month; and
(c) Total pharmacy claims on a paid basis by month.
(2) A report required under subdivision (a)(1)(A)(i) or subdivision (a)(1)(B)(i) of this section shall be provided to the policyholder no later than thirty (30) days from the date of the request of the policyholder.
(3) A policyholder may request reporting under this section no more frequently than on a quarterly basis.
(b) This section does not require the insurer to disclose any information that is required by law to be confidential.
(c) As used in this section, “enrolled member”:(1) Means an insured employee under a comprehensive group health insurance policy; and(2) Includes a subscriber or a certificate holder.
(1) Means an insured employee under a comprehensive group health insurance policy; and
(2) Includes a subscriber or a certificate holder.
(d) In conformity with the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, this section does not require an insurer or health maintenance organization to disclose any claims information or data that reasonably, or by reasonable inference, may reveal the identity of an enrolled member under the standards of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191.