SB1474 Summary

• Creates the Health Care Professional and Provider Notification of Patients in Health Insurance Exchange Grace Period Act to require QHP issuers to clearly notify health care providers when an enrollee is in the second or third month of a 90-day grace period for unpaid premiums.

• Requires QHP issuers to include specific information in notices to providers, including the enrollee's name, plan identifier, grace period start and end dates, and details about claim payment and recoupment policies.

• Makes QHP issuer determinations binding on themselves if they inform a provider the enrollee is eligible for services without disclosing grace period status, requiring payment of all claims rendered during the grace period.

• Mandates QHP issuers maintain a provider hotline staffed by qualified personnel available 8:00 a.m. to 5:00 p.m. weekdays and 8:00 a.m. to 12:00 p.m. Saturdays, and limits recovery attempts to 60 days after grace period expiration.

• Authorizes the Director of Insurance to investigate violations, issue cease and desist orders, and impose $1,000 fines per violation, with each day of non-compliance counting as a separate offense.