Credit Covered Person Expenses Insurer Insolvency

For small group and individual health benefit plans, if an individual who is entitled to receive benefits or services under a health benefit plan has incurred a covered person has paid any out-of-pocket expenses including payments for a deductible or other coinsurance amount, under the health benefit plan during a plan year, and the individual's health insurance carrier exits the health insurance market and can no longer provide coverage health insurance benefits to the individual, the bill requires the individual's new health insurance carrier to credit all of the out-of-pocket expenses paid by the individual in accordance with the original health benefit plan in the given plan year to the new health benefit plan if the individual enrolls in the new health benefit plan in the established special enrollment period. The new health insurance carrier may file a claim for the amount of any claims liability that results from the new costs to the carrier; except that a claim may not be filed with the estate of the new carrier. The bill grants an exception for carriers from crediting the out-of-pocket expenses if doing so would make the carrier insolvent.

The bill grants rule-making authority to the commissioner of insurance.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)