Current Status Bill Number:933 Type of Legislation:General Bill GB Introducing Body:Senate Introduced Date:19960109 Primary Sponsor:Rose All Sponsors:Rose Drafted Document Number:RES9785.MTR Residing Body:Senate Current Committee:Banking and Insurance Committee 02 SBI Subject:Health Services, Governor's Committee on; medical claims
Body Date Action Description Com Leg Involved
______ ________ _______________________________________ _______ ____________
Senate 19960109 Introduced, read first time, 02 SBI
referred to Committee
Senate 19951010 Prefiled, referred to Committee 02 SBI
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TO AMEND SECTION 38-71-1420 OF THE CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO THE GOVERNOR'S COMMITTEE ON BASIC HEALTH SERVICES, SO AS TO PROVIDE THAT THE BASIC AND STANDARD PLANS FOR THE LEVEL OF COVERAGE RECOMMENDED BY THE COMMITTEE MUST REQUIRE INSURERS TO PAY MEDICAL COST CLAIMS FOR CLAIMS MADE ON A SMALL EMPLOYER HEALTH INSURANCE GROUP HEALTH PLAN AT THE SAME LEVEL OF REIMBURSEMENT AS ALL OTHER HEALTH INSURANCE PLANS ISSUED BY THE INSURER.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Section 38-71-1420(B) of the 1976 Code is amended to read:
"(B) The committee shall recommend benefit levels, cost-sharing levels, exclusions, and limitations for the basic health insurance plan and the standard health insurance plan. The committee shall specifically recommend which, if any, mandated coverages of health care services or health care providers should be included in the basic and standard health insurance plans and shall recommend as well whether the plans should be exempt from any other statutory provisions otherwise applicable to group health insurance policies. Section 38-71-200 is applicable to the basic and standard health insurance plans and is not subject to exemption. The committee also shall design a basic health insurance plan and a standard health insurance plan which contain benefit and cost-sharing levels that are consistent with the basic method of operation and the benefit plans of health maintenance organizations, including any restrictions imposed by federal law.
(1) The plans recommended by the committee may include cost containment features such as:
(a) utilization review of health care services, including review of medical necessity of hospital and physician services;
(b) case management;
(c) selective contracting with hospitals, physicians, and other health care providers;
(d) reasonable benefit differentials applicable to providers that participate or do not participate in arrangements using restricted network provisions; and
(e) other managed care provisions.
Notwithstanding any other provision of this article, a basic or standard health insurance plan submitted to the commissioner by the committee must require all insurers providing coverage pursuant to a small employer health insurance group health plan to pay all medical claims filed against such plans at the same level of reimbursement as all other health insurance plans issued by the insurer.
(2) The committee shall submit the health insurance plans described in paragraphs subsections (A) and (B) to the commissioner for approval by January 1, 1995. If, for any reason, the committee does not provide the commissioner with a recommendation as to the form and level of coverages to be made available pursuant to this article, the board shall make such recommendation to the commissioner. If, subsequent to the approval of the benefit levels of the basic and standard health insurance plans, amendments to the plans become necessary, the board shall make such recommendations to the commissioner for his approval."
SECTION 2. This act takes effect upon approval by the Governor.