SB 315 North Carolina Senate · 2025-2026 Session

More Transparency/Efficiency in Utiliz. Rev.

SB 315 improves transparency and efficiency in insurance reviews of medical services by setting strict timeframes for insurers to make decisions. For urgent care, insurers must decide within 24 hours; for non-urgent care, within three business days after receiving all necessary information. The bill also requires insurers to clearly explain review processes in patient handbooks, on websites, and on membership cards, and to notify both patients and providers of outcomes. Additionally, it mandates that appeal reviews be conducted by qualified medical professionals without conflicts of interest, ensuring fairer assessments of coverage disputes.

Issues: ✓ Healthcare

Bill status in committee 1 of 4 stages cleared

Introduction

Mar 2025

Committee Review

Floor Vote

Governor

Introduced Mar 17, 2025 Last action Mar 18, 2025

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What changed between versions

Filed → Edition 1 · 4 edits

MODERATE

The bill underwent minor formatting and organizational changes during its transition from filing to the first edition. The primary substantive change involves clarifying the insurer's disclosure requirements for utilization review procedures, specifically adding a new subsection requiring these procedures to be included in coverage certificates and member handbooks. A few administrative details were also updated, including the bill number, reference document ID, and referral information.

Scope change

The bill's scope remains focused on increasing transparency and efficiency in utilization review for health care services. No changes were made to the bill's overall applicability or the populations it affects.

REQUIREMENT

Added specific language requiring insurers to disclose utilization review procedures in their certificate of coverage and member handbook, making these requirements more explicit.

TECHNICAL

Removed the reference to document ID 'DRS45172-MR-110' and replaced it with 'S315-v-1', updating the bill's internal tracking information.

Added a new subsection (1) under the disclosure requirements, specifying that utilization review procedures must be included in coverage and member handbooks.

Updated the bill's header information, including the filing date and session details, to reflect the first edition status.

Floor votes

How they voted

No floor votes recorded yet.

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Mar 18, 2025

Committee

Ref to Health Care. If fav, re-ref to Rules and Operations of the Senate

upper

Mar 17, 2025

Introduced

Filed

upper

2 primary · 16 co-sponsors