HB2518 H B&I AM 2-12

            The Committee on Banking and Insurance moves to amend the bill on page 1, section 18, line 19, by striking all of section 18 and inserting in lieu thereof the following:

Ҥ33-16-18. Claims loss experience to be furnished to certain employer group accident and sickness policyholders.

            (a) In cases of employers providing group healthcare coverage either insured or self-insured to one hundred or more covered employees, retirees, members or enrollees, not including dependents in the State of West Virginia, all third party administrators and insurers shall furnish to the employer within thirty days of the renewal date if requested, the employer's claims loss experience.

            (b) All insurers and third party administrators shall provide the information annually to the employer group policyholder if requested. The information shall include, but is not limited to:

            (1) Earned premiums separated by policy year for at least the last two years, if applicable;

            (2) For all employees, retirees, members, enrollees and dependants, total paid claims and total incurred claims by month, with medical and prescription drug claims reported separately when requested, inclusive of any high dollar or pooled claims over $50,000, and including both capitated and noncapitated expenses set forth in the same manner as premiums; and  

            (3) Any amount in excess of the individual pooling or stop loss trigger point applicable to the group.

            (c) The claims loss experience information may not include any information prohibited from disclosure by any applicable federal law or law of this state.”

Adopted

Rejected