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Summary:

Any data submitted by a health insurer to the United States Secretary of Health and Human Services for purposes of the risk adjustment program under the Patient Protection and Affordable Care Act shall be concurrently submitted to the Department of Insurance, and in the same format. The department shall use the information to ensure that insurers are in compliance with federal requirements related to risk adjustment.

Summary:

This provision enumerates prohibited terms in a contract between insurers and health care providers. One such prohibited term is (b)(4) a requirement to permit access to patient information in violation of federal or state laws concerning the confidentiality of patient information.

Summary:

Unauthorized disclosure of identifiable genetic test results contained in an applicant or enrollee's medical records by a life or disability insurer (for policies issued prior to Jan. 1, 1995) is punishable as a misdemeanor, with civil fines, or both, depending on if the disclosure was willful or negligent.

Summary:

Every disability insurer that covers hospital, medical, or surgical benefits shall provide an external, independent review process to examine the insurer's coverage decisions regarding experimental or investigational therapies for individual insureds who meet specified criteria, including certification by the insured's physician. The physician certification shall include a statement of the evidence relied upon by the physician in certifying his or her recommendation.

Summary:

No life or disability income insurer shall require a test for the presence of a genetic characteristic for the purpose of determining insurability other than for those policies that are contingent on review or testing for other diseases or medical conditions. The test shall be done in accordance with the informed consent and privacy protection provisions as required by law. Written informed consent shall include a description of the test to be performed, the meaning of its results, procedures for notifying the applicant of the results, and the right to confidential treatment of the results.

Summary:

Unauthorized disclosure of results of a test for a genetic characteristic requested by a life or disability insurer is punishable as a misdemeanor, with civil fines, or both, depending on whether the disclosure was willful or negligent.

Summary:

Under the Independent Medical Review System in the Department of Insurance, all insured grievances involving a disputed health care service are eligible for review if certain requirements are met. Application forms for independent medical review will include a statement indicating the insured's consent to obtain any necessary medical records from the insurer and any of its providers. The insurer or its contracting providers shall provide to the independent medical review organization a copy of all of the insured's medical records in their possession, a copy of all information provided to the insured by the insurer and any of its contracting providers concerning insurer and provider decisions regarding the insured's condition and care, etc. The confidentiality of any insured medical information shall be maintained pursuant to applicable state and federal laws. The insurer shall concurrently provide a copy of documents required, except for any information found by the commissioner to be legally privileged infor

Summary:

After removing the names of the parties, including, but not limited to, the insured, all medical providers, the insurer, and any of the insurer's employees or contractors, commissioner decisions adopting a determination of an independent medical review organization shall be made available by the department to the public upon request, at the department's cost and after considering applicable laws governing disclosure of public records, confidentiality, and personal privacy.

Summary:

Every long term care insurer shall maintain a record of all policy or certificate rescissions, and shall annually furnish this information to the commissioner, which shall include the reason for rescission, the length of time the policy or certificate was in force, and the age and gender of the insured person. The commissioner may make public the aggregate data collected.

Summary:

A group health insurance policy that provides coverage of a dependent child of an employee or other member of the covered group will not terminate upon attainment of the limiting age for dependent children if the child is (1) incapable of self-sustaining employment by reason of a physical or mental injury, illness, or condition; and (2) chiefly dependent upon the employee or member for support and maintenance. The employee or member must submit proof of the physical or mental condition before the child attains the limiting age. The insurer may subsequently request information about a dependent child whose coverage is continued beyond the limiting age, but not more frequently than annually after the two-year period following the child's attainment of the limiting age. If the employee or member changes carriers to another insurer or to a health care service plan, the new insurer or plan shall continue to provide coverage for the dependent child. The new plan or insurer may request information about the dependen

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