HB 1555 Summary

• Requires health benefit exchange carriers to notify providers within 3 business days when inquiries concern dates falling in the second or third month of a coverage grace period, as defined in federal regulation 45 CFR 156.270(d).

• Mandates that notices to providers include the individual's name and identifying numbers, plan name and identifier, carrier name, and specific grace period start and end dates.

• Requires carriers to pay claims for services furnished during grace periods if they inform providers coverage is active but fail to disclose the grace period status; prohibits payment recovery attempts.

• Mandates carriers post conspicuous explanations on their websites describing how they will handle claims during and after grace periods, including whether they will hold payments and attempt recovery if premiums are unpaid.

• Establishes that carriers cannot attempt to recover grace period claim payments after 60 days, must maintain a provider hotline (Monday-Friday 8:00 a.m.-5:00 p.m., Saturday 8:00 a.m.-12:00 p.m.), and violations constitute unfair and deceptive insurance practices allowing providers to seek injunctive relief.