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