Bill No.: SF0062 Drafter: JHR

 

LSO No.: 09LSO-0358 Effective Date: 7/1/2009

 

Enrolled Act No.: SEA0034

 

Chapter No.: 105

 

Prime Sponsor: Senator Ross

 

Catch Title: Discretionary Clause Prohibition Act.

 

Subject: Creates the Discretionary Clause Prohibition Act.

 

 

Summary/Major Elements:

         This Bill:

o       Creates the Discretionary Clause Prohibition Act;

 

o       Prohibits any group health insurance policy, contract, certificate or agreement not subject to the Employee Retirement Income Security Act (ERISA) that is issued in this State from containing a discretionary clause that allows the insurer to decide or interpret the benefits that are due under a health insurance policy it has issued;

 

o       Requires any group health insurance policy, contract, certificate or agreement subject to ERISA that is issued in this State with a discretionary clause to contain an appropriate disclosure of the clause;

 

o       Provides that any group health insurance policy, contract, certificate or agreement subject to ERISA that is issued in this State with a discretionary clause to contain a provision entitling any person denied benefits to have the determination reviewed de novo in any court with jurisdiction;

 

o       Provides purposes and intent of the Act;

o       Provides definitions;

 

o       Provides penalties for violations of the Act.

 

Comments:

Popular name: Discretionary Clause Prohibition Act