NC S543

Requires health insurance issuers to provide written reports of claim information to plans, plan sponsors, and plan administrators within 30 calendar days of request, limited to twice per 12-month period.

Reports must include aggregate paid claims by month (medical, dental, pharmacy), total premiums, covered employee counts by tier, pending claims amounts, and individual claims reports for anyone exceeding $15,000 in claims during the preceding 12 months.

Requires individual claims reports to contain a unique identifier, amounts paid, dates of service, and applicable procedure and diagnosis codes, but only if plan sponsor provides HIPAA-compliant certification.

Health insurance issuers may withhold protected health information if prohibited by more stringent state or federal privacy laws, but must notify the requesting party and provide a list of withheld information categories.

Protects health insurance issuers from civil liability and criminal prosecution for releasing information in compliance with this Act; non-compliance subjects issuers to civil penalties under G.S. 58-2-70; effective October 1, 2017.