SB 977 - Explanations of Benefits

• Insurers and health care entities must provide consumers with easily readable information about coverage exclusions, benefit restrictions, prescription drug deductibles, copayments, coinsurance, and procedures for obtaining noncovered drugs.

• Insurers must make available tools for consumers to accurately determine drug formulary coverage, cost-sharing amounts, prior authorization requirements, specialist network status, and provider/hospital in-network status.

• Consumers who are covered individuals may specify their preferred method for receiving explanations of benefits (mail, email, or electronic-only access) and insurers must comply within three to seven days depending on delivery method.

• Covered individuals not financially liable for benefits may opt out of receiving explanations of benefits entirely without providing a reason or being required to waive other rights.

• Insurers must disclose consumer rights regarding benefit explanations in plain language on policy documents, privacy communications, and websites; the requirements take effect January 1, 2020.