HB 5151 Summary

• Replaces "must" with "shall" in insurance claim payment language and establishes timely payment requirements for insurers to pay benefits or owe 12% interest on unpaid claims unless reasonably in dispute.

• Requires insurers to specify in writing what constitutes satisfactory proof of loss within 30 days of claim receipt and establishes 60-day payment timelines after proof of loss is received.

• Adds exception that benefits are not considered untimely if unpaid within 60 days due to circumstances beyond the insurer's control, and interest is not due in such cases.

• Creates separate claims processing standards for health plans paying health professionals, facilities, and providers, requiring payment of "clean claims" within 45 days and establishing interest penalties at 12% per annum for late payment.

• Establishes complaint procedures with the Director of the Department of Insurance and Financial Services and allows civil fines up to $1,000 per violation (maximum $10,000 aggregate) for violations of health plan payment procedures.