SENATE DOCKET, NO. 1110        FILED ON: 1/17/2013

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 436

The Commonwealth of Massachusetts

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PRESENTED BY:

Benjamin B. Downing

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act relative to collection of health care co-insurance and deductibles.

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PETITION OF:

SENATE DOCKET, NO. 1110        FILED ON: 1/17/2013

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 436

The Commonwealth of Massachusetts

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In the Year Two Thousand Thirteen

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An Act relative to collection of health care co-insurance and deductibles.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1:  Section 24B of chapter 175 of the General Laws, as appearing in the 2010 Official Edition, is hereby amended by inserting after the first paragraph the following paragraph:-

The commissioner shall further require a carrier; as defined under section 1 of chapter 176O, to recover all co-insurance and deductible amounts due from patients for covered services as required under the carrier’s health benefit plan.  For purposes of this paragraph, “co-insurance” is defined as a percentage of the allowed charge, after a co-payment, if any, that an insured will pay for covered benefits.  A “deductible” is defined as an annual dollar amount that must be paid by an insured for covered benefits that the insured uses before the carrier’s health benefit plan becomes obligated to pay for covered benefits; such deductible does not include any portion of premiums paid by an insured.  Carriers shall include the co-insurance and deductible amounts due from the insured for covered benefits in their payments to providers; provided however, that such payment shall not be dependent on the carrier recovering the co-insurance and deductible prior to processing and paying a claim made by a provider. Nothing in this section shall prohibit providers and carriers from mutually agreeing to alternative billing and payment processes when it has been determined that the insured has secondary health benefits for the health care services provided.  This paragraph shall not pertain to the collection of co-payments, which is a fixed dollar amount structured by the carrier that is paid by an insured to a provider, at the time the insured receives covered services. 

SECTION 2:  The Commissioner of Insurance shall promulgate regulations to enforce the provisions of this Act no later than 90 days after the effective date of the Act, which shall be effective for provider contracts which are entered into, renewed, or amended on or after the regulations effective date.