HB 5039 Summary

• Establishes an annual mandated health benefit review program within the Insurance Department, funded by the Insurance Fund, allowing the joint standing committee on insurance to request reviews of up to 10 health benefits per year with reports due January 1st.

• Requires the Insurance Commissioner to provide the Commissioner of Revenue Services with an annual list of all mandated health benefits applicable to health insurance policies in the state, effective January 1, 2019.

• Prohibits health care providers and facilities from billing patients for covered services beyond coinsurance, copayments, or deductibles, including emergency services from nonparticipating providers and surprise bills, establishing these practices as unfair trade violations.

• Requires health carriers to reimburse nonparticipating providers and facilities for emergency services at rates consistent with the Public Health Service Act and to reimburse surprise bills at the in-network rate unless the provider and carrier agree otherwise.

• Mandates health carriers issue explanations of benefits informing patients of billing protections and include statements warning providers against requesting payment beyond patient cost-sharing obligations.