Bill Text: AZ HB2218 | 2016 | Fifty-second Legislature 2nd Regular | Introduced
Bill Title: Insurance; estimated cost of services
Spectrum: Partisan Bill (Republican 7-0)
Status: (Introduced - Dead) 2016-01-20 - Referred to House INS Committee [HB2218 Detail]
Download: Arizona-2016-HB2218-Introduced.html
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REFERENCE TITLE: insurance; estimated cost of services |
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State of Arizona House of Representatives Fifty-second Legislature Second Regular Session 2016
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HB 2218 |
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Introduced by Representatives Kern: Campbell, Finchem, Lawrence, Mitchell, Thorpe, Weninger
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AN ACT
amending title 38, chapter 4, article 4, Arizona Revised Statutes, by adding sections 38-651.06 and 38-651.07; relating to state employee health insurance.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 38, chapter 4, article 4, Arizona Revised Statutes, is amended by adding sections 38-651.06 and 38-651.07, to read:
38-651.06. Estimate of charges before an admission, procedure or service; definitions
A. Before an admission, procedure or service and on the request of a patient or prospective patient who is an employee of this state, a health care entity, within two working days, shall disclose the allowed amount, if the health care entity is in the patient's insurer network, or the amount that will be charged, if the health care entity is outside the patient's insurer network, of the admission, procedure or service, including the amount for any facility fees required. If a health care entity is unable to quote a specific amount in advance due to the health care entity's inability to predict the specific treatment or diagnostic code, the health care entity shall disclose what is known for the estimated allowed amount, if the health care entity is in the patient's insurer network, or the amount that will be charged, if the health care entity is outside the patient's insurer network, for a proposed admission, procedure or service, including the amount for any facility fees required. The health care entity shall disclose the incomplete nature of the estimate and inform the patient or prospective patient of the patient's or prospective patient's ability to obtain an updated estimate once additional information is obtained.
B. If a patient or prospective patient who is an employee of this state is covered by insurance, a health care entity that participates in the health insurer's network on request of the patient or prospective patient, based on the information available to the health care entity at the time of the request, shall provide sufficient information regarding the proposed admission, procedure or service for the patient or prospective patient to use that health insurer's applicable toll‑free telephone number and website to disclose out‑of‑pocket costs pursuant to section 38‑651.07. A health care entity may assist a patient or prospective patient in using a health insurer's toll-free telephone number and website.
C. For the purposes of this section:
1. "Allowed amount" means the contractually agreed on amount paid by a health insurer to a health care entity for health care services provided to a patient who is covered by insurance.
2. "Health care entity" means a person who is licensed pursuant to title 32, chapter 13 or 17, hospital, outpatient surgical center, health care laboratory, diagnostic imaging center or urgent care center.
3. "Health insurer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital and medical service corporation as described in title 20 that is contracted with this state to provide health insurance coverage to state employees.
38-651.07. Cost of health care services; estimate; payment; definitions
A. A health insurer offering a health plan to this state for the health insurance coverage of state employees shall comply with all of the following requirements with respect to the costs of health care services:
1. The health insurer shall establish a toll‑free telephone number and website that enables an enrollee to request and obtain from the health insurer information on the average price paid in the past twelve months to a network health care provider for a proposed admission, procedure or service in each geographic rating area established by the health insurer and to request an estimate pursuant to paragraph 2 of this subsection.
2. Within two business days after an enrollee's request, a health insurer shall provide an estimate for the maximum allowed amount or charge for a proposed admission, procedure or service and the estimated amount the enrollee will be responsible to pay for a proposed admission, procedure or service that is a medically necessary covered benefit, based on the information available to the health insurer at the time the request is made and including any facility fee, copayment, deductible, coinsurance or other out‑of‑pocket amount for any covered health care benefits. An enrollee is not required to pay more than the disclosed amounts for the covered health care benefits that were actually provided, except that this paragraph does not prohibit a health insurer from imposing cost sharing requirements disclosed in the enrollee's certificate of coverage for unforeseen health care services that arise out of the proposed admission, procedure or service. A health insurer shall notify an enrollee that these are estimated costs and that the actual amount the enrollee will be responsible to pay may vary due to unforeseen services that arise out of the proposed admission, procedure or service.
3. If an enrollee elects to receive health care services from a provider that costs less than the average cost for a particular admission, procedure or service, the enrollee's health insurer shall pay to the enrollee fifty percent of the saved cost, except that the health insurer is not required to make a payment if the saved cost is less than fifty dollars. If an enrollee has an out‑of‑network benefit and the enrollee elects to receive health care services from an out‑of‑network provider that costs less than the average cost for a particular admission, procedure or service, a health insurer shall apply the enrollee's share of the cost of those health care services as specified in the enrollee's health plan toward the enrollee's out‑of‑pocket limit as if the health care services were provided by a network provider.
B. For the purposes of this section, "allowed amount", "health care entity" and "health insurer" have the same meanings prescribed in section 38‑651.06.
Sec. 2. Applicability
Section 38‑651.06 and 38‑651.07, Arizona Revised Statutes, as added by this act, apply to any contract for health insurance coverage for state employees that is issued or renewed on or after ________.
