States Mandate Disclosure of Claims Data to Aid Employers; More to Follow?
For many employers, the ability to effectively evaluate and manage their health plan costs begins with the availability of financial and claims data on their health plan from their insurance carriers. While several carriers have set guidelines relating to data disclosure, most only disclose the data to employers with 100 or more employees on their plans. Further, the amount of data they disclose varies by employer size and the type of rating methodology used (fully-insured or self-funded).
Wouldn’t it be better if all employers could have access to their health plan data? Increased transparency of healthcare claims costs would not only allow employers to effectively manage their health plan costs, but also seek competitive rates and better health care benefits for their employees and effectively evaluate their financing options, including self-funding their group health plan. That is an issue that lawmakers across the country have been debating for the past several years – and it is one that has spurred some state legislators into making standardized disclosure of claims data a reality.
Last June, when Texas Governor Rick Perry signed TX House Bill 2015 into law, Texas became the first state to successfully enact legislation requiring the standardized disclosure of health claims data to all employers. The new law, which became effective September 1, 2007 and applies to requests for information made as of January 1, 2008, requires insurance carriers to respond within 30 days to an employer's request for claims, premiums and other necessary underwriting information.
With the passage of this legislation, all employers in the state of Texas can now request and obtain health plan information such as aggregate paid claims by month, total monthly premiums, large claims information, employee census data, and much more regardless of the number of employees on their plan. (Note: Because insurers disclose protected health information (PHI) only if proper certification has been provided by the employer plan sponsor in accordance with strict Federal standards, small employers would have to put the proper safeguards in place that would enable them to provide the proper certification that allows access to PHI.)
About five months after the passage of TX HB 2015, Georgia enacted similar legislation to create a new section under OCGA 33-30-13.1. The new law, originally introduced six years earlier as GA Senate Bill 179, requires insurance carriers to disclose premium and claims information to all employers with 51 or more employees, regardless of funding arrangement, within 30 days of the request.
While Texas and Georgia have been the only states to date to enact legislation that standardizes claims data disclosure from carriers, more are sure to follow as healthcare costs continue to rise at rates higher than inflation. In fact, several states are weighing their approach to this issue as the 2008 legislative session kicks into full gear this month. Is this the beginning of a new trend in healthcare cost transparency? One thing is for sure – it is more than just a remote possibility.
To read more about this issue and the legislation that was passed, please click on the following links:
Texas Leads the Nation in Healthcare Transparency
Full Text of GA SB 179 (OCGA 33-30-13.1)
Questions or comments about this article? Email us at comments@hcwbenefits.com.
* * * * *
Today is the last day to participate in the 2007-2008 NC Healthcare Benefits & Cost Survey at www.capital.org/healthsurvey! All survey participants will receive FREE, electronic summarized results that will provide you with current market trend information to benchmark your medical plan designs and contribution strategies against other businesses in North Carolina and within their specific industry.
Don’t allow your organization to be left in the dark! Participate today!
Please Note: If you no longer wish to receive communications of this nature from Hill, Chesson & Woody, please reply to the sender of the email with the word "unsubscribe" in the header. Thank you.
Important Notice: Hill, Chesson & Woody does not engage in the practice of law, accounting, or medicine. Therefore, the contents of this communication should not be regarded as a substitute for legal, tax, or medical advice.
January 18, 2008
Hill, Chesson & Woody strives to keep our clients' group decision makers abreast of trends influencing the employee benefits market. Look for Eyes on Benefits to bring you news and information affecting you and your employees.
194 Finley Golf Course Road, Suite 200,
Chapel Hill, NC 27517
Phone: 919.403.1986
Fax: 919.913.0237
www.hcwbenefits.com