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S.F. No. 0062 |
Discretionary Clause Prohibition Act. |
Sponsored By: Senator(s) Ross, Hastert and Sessions and Representative(s) Berger and Petersen
AN ACT relating to insurance; creating the Discretionary Clause Prohibition Act; providing definitions; specifying the purpose and intent of the act; prohibiting discretionary clauses in specified health insurance contracts; requiring disclosure and additional provisions in insurance contracts covered by the federal Employee Retirement Income Security Act; providing penalties for violations of the act; providing for severability; and providing for an effective date.
1/5/2009 Bill Number Assigned
1/13/2009 S Received for Introduction
1/13/2009 S Introduced and Referred to S01
1/26/2009 S01 Recommended Amend and Do Pass
ROLL CALL
Ayes: Senator(s) Decaria, Perkins, Ross and Sessions
Excused: Senator(s) Burns
Ayes 4 Nays 0 Excused 1 Absent 0 Conflicts 0
1/26/2009 S Placed on General File
SF0062SS001/ADOPTED
Page 3-lines 1 through 5 Delete and renumber.
Page 3-line 7 Delete "(iii)" insert "(ii)".
Page 3-line 11 Delete "(iv)" insert "(iii)".
Page 3-line 18 Delete "cooperation" insert "corporation".
Page 3-line 22 Delete "(v)" insert "(iv)".
Page 4-line 1 Delete "(vi)" insert "(v)". ROSS,CHAIRMAN
SF0062SW001/ADOPTED
Page 2-line 15 After "carrier" insert "." and delete balance of line.
Page 2-line 16 Delete. ROSS
SF0062SW002/ADOPTED
Page 1-line 4 Delete "and disability".
Page 1-line 5 Delete "income protection".
Page 4-line 6 Delete "(a)".
Page 4-lines 15 through 20 Delete. ROSS
1/26/2009 S Passed CoW
1/27/2009 S Passed 2nd Reading
1/28/2009 S Passed 3rd Reading
ROLL CALL
Ayes: Senator(s) Anderson, J., Burns, Cooper, Decaria, Dockstader, Esquibel, F., Hastert, Hines, Hunnicutt, Jennings, Johnson, Landen, Larson, Martin, Massie, Meier, Nicholas, Perkins, Peterson, Ross, Schiffer, Scott, Sessions, Townsend, Vasey and Von Flatern
Nays: Senator(s) Bebout, Case, Coe and Geis
Ayes 26 Nays 4 Excused 0 Absent 0 Conflicts 0
1/30/2009 H Received for Introduction
2/5/2009 H Introduced and Referred to H01
2/13/2009 H01 Recommended Amend and Do Pass
ROLL CALL
Ayes: Representative(s) Bagby, Barbuto, Cannady, Gingery, Mercer, Quarberg and Throne
Nays: Representative(s) Patton and Peasley
Ayes 7 Nays 2 Excused 0 Absent 0 Conflicts 0
2/13/2009 H Placed on General File
SF0062HS001/ADOPTED (TO ENGROSSED COPY)
Page 2-line 8 Delete "and disability income protection coverage". GINGERY, CHAIRMAN
2/17/2009 H Passed CoW
2/18/2009 H Passed 2nd Reading
SF0062H3001/ADOPTED (TO ENGROSSED COPY)
Page 1-line 4 After "in" insert "specified"; after ";" insert "requiring disclosure and additional provisions in insurance contracts covered by the federal Employee Retirement Income Security Act;".
Page 2-line 8 Before "are" insert "not subject to the federal Employee Retirement Income Security Act".
Page 2-line 12 After "due." Insert "This act is also intended to assure that health insurance benefits contracts subject to the federal Employee Retirement Income Security Act which contain a discretionary clause provide appropriate disclosure of the clause and additional provisions to assure a fair determination of contract benefits.".
Page 4-line 1 Before "No" insert "(a)".
Page 4-line 8 After "." insert "This subsection shall not apply to a policy, contract, certificate or agreement subject to and meeting the requirements of subsections (b) and (c) of this section.".
Page 4-after line 8 Insert:
"(b) Any group policy, contract, certificate or agreement subject to the federal Employee Retirement Income Security Act and offered or issued in this state by a health carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services and which contains a provision purporting to reserve discretion to the health carrier to interpret the terms of the contract or to provide standards of interpretation or review shall contain the following language highlighted in bold in not less than twelve (12) point type:
This benefit plan contains a discretionary clause. Determinations made by (insurer name) pursuant to the discretionary clause do not prohibit or prevent a claimant from seeking judicial review in court of (insurer name's) decisions. By including this discretionary clause (insurer's name) agrees to allow a court to review its determinations anew when a claimant seeks judicial review of (insurer name's) determinations of eligibility of benefits, the payment of benefits or interpretations of the terms and conditions applicable to the benefit plan.
(c) Any group policy, contract, certificate or agreement containing a discretionary clause as authorized in subsection (b) of this section shall contain a provision entitling any person denied benefits in whole or in part to have the determination reviewed de novo in any court with jurisdiction.". SIMPSON
SF0062H3002/FAILED (TO ENGROSSED COPY)
Delete the Simpson third reading amendment (SF0002H3001/AE) entirely and further amend as follows:
Page 1-line 4 After "in" insert "specified"; after ";" insert "requiring disclosure in insurance contracts covered by the federal Employee Retirement Income Security Act;".
Page 2-line 8 After "coverage" insert "not subject to the federal Employee Retirement Income Security Act".
Page 2-line 12 After "due." Insert "This act is also intended to assure that health insurance benefits contracts subject to the federal Employee Retirement Income Security Act which contain a discretionary clause provide appropriate disclosure of the clause.".
Page 4-line 8 After "." insert "This subsection shall not apply to a policy, contract, certificate or agreement subject to and meeting the requirements of subsection (b) of this section.".
Page 4-after line 8 Insert:
"(b) Any group policy, contract, certificate or agreement subject to the federal Employee Retirement Income Security Act and offered or issued in this state by a health carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services and which contains a provision purporting to reserve discretion to the health carrier to interpret the terms of the contract or to provide standards of interpretation or review shall contain the following language highlighted in bold in not less than twelve (12) point type:
This benefit plan contains a discretionary clause. Determinations made by (insurer name) pursuant to the discretionary clause do not prohibit or prevent a claimant from seeking judicial review in federal court of (insurer name's) decisions. The reservation of discretion made under this provision only establishes the scope of review that a federal court will apply when a claimant seeks judicial review of (insurer name's) determinations of eligibility of benefits, the payment of benefits or interpretations of the terms and conditions applicable to the benefit plan. (Insurer name) is an insurance company that provides insurance to this employer benefit plan and the federal court will determine the level of discretion that it will accord (insurer name's) determinations.". PATTON
2/19/2009 H Passed 3rd Reading
ROLL CALL
Ayes: Representative(s) Anderson, R., Bagby, Barbuto, Berger, Blake, Brown, Buchanan, Cannady, Carson, Childers, Cohee, Connolly, Craft, Davison, Diercks, Edmonds, Esquibel, K., Gilmore, Gingery, Goggles, Hales, Hammons, Harshman, Harvey, Illoway, Jaggi, Jorgensen, Lubnau, McKim, McOmie, Meyer, Millin, Moniz, Pedersen, Petersen, Philp, Roscoe, Semlek, Shepperson, Simpson, Teeters, Thompson, Throne, Wallis, Zwonitzer, Dn. and Zwonitzer, Dv.
Nays: Representative(s) Brechtel, Hallinan, Landon, Madden, Mercer, Miller, Patton, Peasley, Quarberg, Steward and Stubson
Excused: Representative(s) Byrd and Lockhart
Conflicts: Representative(s) Bonner
Ayes 46 Nays 11 Excused 2 Absent 0 Conflicts 1
2/19/2009 S Received for Concurrence
2/24/2009 S Did Concur
ROLL CALL
Ayes: Senator(s) Anderson, J., Burns, Case, Coe, Cooper, Decaria, Dockstader, Esquibel, F., Geis, Hastert, Hines, Hunnicutt, Jennings, Johnson, Landen, Larson, Martin, Massie, Nicholas, Perkins, Peterson, Ross, Schiffer, Sessions, Townsend, Vasey and Von Flatern
Nays: Senator(s) Bebout, Meier and Scott
Ayes 27 Nays 3 Excused 0 Absent 0 Conflicts 0
2/24/2009 Assigned Number SEA No. 0034
2/24/2009 S President Signed SEA No. 0034
2/26/2009 H Speaker Signed SEA No. 0034
3/2/2009 Governor Signed SEA No. 0034
Chapter No. 105 Session Laws of Wyoming 2009.