Health care coverage: report of claim information.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law, the federal Health Insurance Portability and Accountability Act of 1996, establishes certain requirements relating to the provision of health insurance and the protection of privacy of individually identifiable health information. The act authorizes group health plans to permit health insurance issuers, as defined, to disclose protected health information to plan sponsors if specified requirements are met. This bill would, on and after July 1, 2011, require a health care service plan or health insurer that receives a written request for a written report of claim information from the group subscriber or group policyholder of a group health care service plan contract or health insurance policy issued by the plan or insurer, as specified, to provide that report to the subscriber or policyholder no later than 30 days after receipt of the request. The bill would require the report to be provided in a specified manner and to include specified information after removing any individually identifiable information, as defined. The bill would prohibit the health care service plan or health insurer from disclosing any information protected under federal or state law. The bill would make a plan or insurer that fails to comply with these requirements subject to administrative penalties assessed by the departments.