HB 1152 -- Insurance Deductibles and Copayments

Sponsor:  Crump

The bill requires health insurers and similar entities
(insurers) to base calculations of deductibles, co-payments,
coinsurance, and charges applied to the policy limit on the
usual and reasonable provider's fee or a negotiated fee. If a
negotiated fee is used, then the fee must be: payment in full,
agreed to in writing, and less than the usual fee. An insurer is
prohibited from including amounts paid to providers for referral
rates, quality standards, or cost-effectiveness measures as part
of the provider's fee.

If there is a reduction in the actual reimbursement amount for a
claim, the insurer is required to recalculate the insured costs
and charges applied to the policy limit. The insurer must refund
any excess costs to the insured within 30 days.

The bill has an emergency clause and applies to policies issued
or renewed after July 1, 1996.