February 15, 2005, Introduced by Reps. Vander Veen, Gosselin, Taub and Drolet and referred to the Committee on Education.
A bill to amend 1984 PA 218, entitled
"Third party administrator act,"
by amending section 34 (MCL 550.934) and by adding section 31.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 31. (1) If the sponsor of a benefit plan is a public
school employer, the service contract for the plan shall provide
that claims history under the contract shall be made available upon
request to the public school employer.
(2) Claims history to be provided under subsection (1) shall
include all of the following information for the benefit plan on a
school district basis for the immediately preceding 12-month
period:
(a) Total number of individuals covered.
(b) Total number of claims paid.
(c) Total number of claims pending and the total dollar amount
of those claims.
(d) Claims experience data by coverage component.
(e) Any other health claims data necessary for the public
school employer to obtain competitive bids for other third party
administrator services or other health care coverage.
(3) Information under subsection (2) shall not disclose
personal data that may reveal the identity of a covered individual.
(4) As used in this section:
(a) "Public school employer" means that term as defined in
section 1 of 1947 PA 336, MCL 423.201.
(b) "School district" means an intermediate school district,
local act school district, public school academy, or school
district as those terms are defined in sections 4, 5, and 6 of the
revised school code, 1976 PA 451, MCL 380.4, 380.5, and 380.6.
Sec. 34. (1) A TPA shall provide for the confidentiality of
personal data identifying an individual covered by a plan. A TPA
shall not disclose records containing personal information that may
be associated with an identifiable individual covered by a plan to
a person other than the individual to whom the information
pertains. Except as is necessary to comply with a court order, an
administrator shall not disclose personal data concerning a covered
individual without the prior consent of the covered individual. If
the individual covered by a plan has authorized the release of
information to a third person, the third person shall not release
that information unless the individual executes in writing another
consent authorizing the additional release.
(2)
Subsection (1) shall does not be construed to apply to
information disclosed for any of the following reasons:
(a) For claims adjudication.
(b) For claims verification.
(c) For other proper plan administration.
(d) For an audit conducted pursuant to ERISA.
(e) To an insurer for the purchase of excess loss insurance
and for claims under the excess loss insurance. However, an insurer
obtaining
information under this subdivision shall be is
subject
to the requirements of subsection (1).
(f) To the plan or a fiduciary of the plan.
(g) To the commissioner. However, information obtained by the
commissioner
under this subdivision shall be is exempt from
disclosure
under the freedom of information act, Act No. 442 of
the
Public Acts of 1976, being sections 15.231 to 15.246 of the
Michigan
Compiled Laws 1976 PA 442, MCL 15.231 to 15.246.
(h) As required by section 31.
(i) (h)
As required by law.