SSSB 3: "An Act relating to a health care insurance policy incentive program; relating to health care services; and providing for an effective date."
00 SPONSOR SUBSTITUTE FOR SENATE BILL NO. 3 01 "An Act relating to a health care insurance policy incentive program; relating to health 02 care services; and providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. The uncodified law of the State of Alaska is amended by adding a new section 05 to read: 06 SHORT TITLE. This Act may be known as the Alaska Health Care Consumer's Right 07 to Shop Act. 08 * Sec. 2. AS 21.06.110 is amended to read: 09 Sec. 21.06.110. Director's annual report. As early in each calendar year as is 10 reasonably possible, the director shall prepare and deliver an annual report to the 11 commissioner, who shall notify the legislature that the report is available, showing, 12 with respect to the preceding calendar year, 13 (1) a list of the authorized insurers transacting insurance in this state, 14 with a summary of their financial statement as the director considers appropriate;
01 (2) the name of each insurer whose certificate of authority was 02 surrendered, suspended, or revoked during the year and the cause of surrender, 03 suspension, or revocation; 04 (3) the name of each insurer authorized to do business in this state 05 against which delinquency or similar proceedings were instituted and, if against an 06 insurer domiciled in this state, a concise statement of the facts with respect to each 07 proceeding and its present status; 08 (4) a statement in regard to examination of rating organizations, 09 advisory organizations, joint underwriters, and joint reinsurers as required by 10 AS 21.39.120; 11 (5) the receipts [RECEIPT] and expenses of the division for the year; 12 (6) recommendations of the director as to amendments or 13 supplementation of laws affecting insurance or the office of the director; 14 (7) statistical information regarding health insurance, including the 15 number of individual and group policies sold or terminated in the state; this paragraph 16 does not authorize the director to require an insurer to release proprietary information; 17 (8) the annual percentage of health claims paid in the state that meet 18 [MEETS] the requirements of AS 21.36.495(a) and (d); 19 (9) the total amount of contributions reported and the total amount of 20 credit claimed under AS 21.96.070; 21 (10) the total number of public comments received and the director's 22 efforts, to the extent allowable by law, to improve or maintain public access to 23 information on individual health insurance rate filings before they become effective; 24 [AND] 25 (11) the most recent incentive program report compiled under 26 AS 21.96.260; and 27 (12) other pertinent information and matters the director considers 28 proper. 29 * Sec. 3. AS 21.36.100 is amended to read: 30 Sec. 21.36.100. Rebates. Except as provided in AS 21.96.220 or otherwise 31 expressly provided by law, a person may not knowingly permit or offer to make or
01 make a contract of life insurance, life annuity or health insurance, or agreement under 02 the contract other than as plainly expressed in the contract, or pay, allow, give or offer 03 to pay, allow, or give, directly or indirectly, as inducement to the insurance, or 04 annuity, a rebate of premiums payable on the contract, or a special favor or advantage 05 in the dividends or other benefits, or paid employment or contract for services of any 06 kind, or any valuable consideration or inducement whatever not specified in the 07 contract; or directly or indirectly give, sell, purchase or offer to agree to give, sell, 08 purchase, or allow as inducement to the insurance or annuity or in connection 09 therewith, whether or not to be specified in the policy or contract, an agreement of any 10 form or nature promising returns, profits, stocks, bonds, or other securities, or interest 11 present or contingent in the contract or as measured by the contract, of an insurance 12 company or other corporation, association, or partnership, or dividends or profits 13 accrued or to accrue under the contract; or offer, promise, or give anything of value 14 that is not specified in the contract. 15 * Sec. 4. AS 21.96 is amended by adding new sections to read: 16 Article 2. Health Care Insurance Policy Incentive Program. 17 Sec. 21.96.210. Access to payment information. A health care insurer that 18 offers a health care insurance policy in the group or individual market shall provide 19 comprehensive comparison guidance by telephone and make available on the Internet 20 website of the insurer a price comparison tool that, to the extent practicable, allows an 21 individual enrolled in or covered under a health care insurance policy to compare the 22 amount of cost sharing that the individual would be responsible for paying under the 23 policy for a specific item or service provided in the same policy year and geographic 24 region by each provider participating in the policy. At a minimum, the health care 25 insurer shall comply with 42 U.S.C. 300gg-114. 26 Sec. 21.96.220. Incentive program. (a) A health care insurer that offers a 27 health care insurance policy in the group or individual market shall develop and 28 implement a program that provides a monetary incentive for a covered person enrolled 29 in a health care insurance policy to elect to receive a covered health care service under 30 the health care insurance policy from a health care provider that charges less than the 31 median contracted rate recognized by the health care insurer for that health care
01 service. 02 (b) A health care insurer that offers a health care insurance policy in the group 03 or individual market shall provide an incentive payment to a covered person as 04 provided in this subsection. An incentive may be calculated as a percentage of the 05 difference in price as a flat dollar amount or by another reasonable methodology 06 adopted by the director by regulation. A health care insurer is not required to provide 07 an incentive payment to a covered person if the cost saved by the health care insurer is 08 $200 or less. 09 (c) If a covered person receives coverage under a group health care insurance 10 policy offered by an employer, a health care insurer shall provide the covered person 11 with an incentive of at least 33.4 percent of the costs saved by the health care insurer 12 resulting from the covered person's election to receive a health care service from a 13 health care provider that charges less than the median of the contracted rates 14 recognized by the health care insurer for that health care service. The health care 15 insurer shall provide the employer with at least 33.3 percent of the costs saved by the 16 health care insurer resulting from the covered person's election. 17 (d) If a covered person receives coverage under a health care insurance policy 18 offered in the individual market, a health care insurer shall provide the covered person 19 with an incentive of at least 50 percent of the costs saved by the health care insurer 20 resulting from the covered person's election. 21 (e) An incentive payment to a covered person under this section is not 22 (1) a violation of AS 21.36.100; or 23 (2) an administrative expense of the health care insurer for rate 24 development or rate filing purposes. 25 Sec. 21.96.230. Availability of program; notice. A health care insurer that 26 offers a health care insurance policy in the group or individual market shall make an 27 incentive program under AS 21.96.220 available as a component of a health care 28 insurance policy offered in this state. Annually, at enrollment or renewal, a health care 29 insurer shall provide notice about the availability of the program to a person covered 30 under a health care insurance policy eligible for the program. 31 Sec. 21.96.240. Filing requirements. Before offering an incentive program
01 under AS 21.96.220, a health care insurer that offers a health care insurance policy in 02 the group or individual market shall file a description of the program with the director 03 in the manner determined by the director. The director may review the filing to 04 determine whether the incentive program complies with the requirements of 05 AS 21.96.210 - 21.96.300. 06 Sec. 21.96.250. Out-of-network health care providers. If a covered person 07 participates in an incentive program under AS 21.96.220 and elects to receive a health 08 care service under AS 21.96.220(a) from an out-of-network health care provider that 09 results in a savings for the health care insurer, the health care insurer shall apply the 10 amount paid for the health care service toward the cost sharing owed by the covered 11 person as specified in the applicable health care insurance policy as if the health care 12 services were provided by an in-network health care provider. 13 Sec. 21.96.260. Reporting requirements. (a) A health care insurer shall, at the 14 request of the director, annually provide information to the director relating to an 15 incentive program under AS 21.96.220 for the most recent calendar year that includes 16 (1) the total number of incentive payments; 17 (2) information on the use of the incentive program by category of 18 service; 19 (3) the total amount of incentive payments; 20 (4) the average amount of each incentive payment for each category of 21 service; 22 (5) the total savings achieved below the average price of the health 23 care service in each category of service; and 24 (6) the total number and percentage of covered persons who 25 participated in the incentive program. 26 (b) The director shall include the information provided under this section in 27 the director's annual report under AS 21.06.110 and shall submit the annual report to 28 the chairs of the committee in each house of the legislature with jurisdiction over labor 29 and commerce. 30 Sec. 21.96.270. Applicability. (a) Except as provided in (b) of this section, 31 AS 21.96.210 - 21.96.300 apply to a health care insurance policy or contract but do
01 not apply to excepted benefits. 02 (b) AS 21.96.210 - 21.96.300 apply to excepted benefits provided under a 03 dental insurance policy or a vision insurance policy. 04 (c) In this section, "excepted benefits" has the meaning given in AS 21.54.160. 05 Sec. 21.96.300. Definitions. In AS 21.96.210 - 21.96.300, 06 (1) "health care insurance" has the meaning given in AS 21.12.050; 07 (2) "health care insurer" has the meaning given in AS 21.54.500; 08 (3) "health care provider" has the meaning given in AS 18.23.400(n); 09 (4) "health care service" has the meaning given in AS 18.23.400(n); 10 (5) "policy" has the meaning given in AS 21.97.900. 11 * Sec. 5. AS 29.10.200 is amended by adding a new paragraph to read: 12 (68) AS 29.35.142 (disclosure and reporting of health care services and 13 price information). 14 * Sec. 6. AS 29.35 is amended by adding a new section to read: 15 Sec. 29.35.142. Regulation of disclosure and reporting of health care 16 services and price information. (a) The authority to regulate the disclosure or 17 reporting of price information for health care services by health care providers, health 18 care facilities, or health care insurers is reserved to the state, and, except as 19 specifically provided by statute, a municipality may not enact or enforce an ordinance 20 regulating the disclosure or reporting of price information for health care services by 21 health care providers, health care facilities, or health care insurers. 22 (b) This section applies to home rule and general law municipalities. 23 (c) In this section, 24 (1) "health care facility" has the meaning given in AS 18.23.400(n); 25 (2) "health care insurer" has the meaning given in AS 21.54.500; 26 (3) "health care provider" has the meaning given in AS 18.23.400(n); 27 (4) "health care service" has the meaning given in AS 18.23.400(n). 28 * Sec. 7. The uncodified law of the State of Alaska is amended by adding a new section to 29 read: 30 DEPARTMENT OF ADMINISTRATION ANALYSIS; REPORT TO 31 LEGISLATURE. The Department of Administration shall analyze whether the state or
01 employees covered by a group health care insurance policy for a participating governmental 02 unit would benefit if a group health care insurance policy obtained or provided under 03 AS 39.30.090 or 39.30.091 were required to comply with the provisions of AS 21.96.210 - 04 21.96.300, added by sec. 4 of this Act. The Department of Administration shall complete the 05 analysis and compile the information into a report to the legislature, submit the report to the 06 senate secretary and chief clerk of the house of representatives before January 31, 2024, and 07 notify the legislature that the report is available. 08 * Sec. 8. The uncodified law of the State of Alaska is amended by adding a new section to 09 read: 10 TRANSITION: REGULATIONS. The director of the division of insurance may adopt 11 regulations necessary to implement this Act. The regulations take effect under AS 44.62 12 (Administrative Procedure Act), but not before the effective date of the law implemented by 13 the regulation. 14 * Sec. 9. Sections 7 and 8 of this Act take effect immediately under AS 01.10.070(c). 15 * Sec. 10. Except as provided in sec. 9 of this Act, this Act takes effect January 1, 2024.