Credit Covered Person Expenses Insurer Insolvency

For individual health benefit plans, if a covered person has paid any out-of-pocket expenses and the individual's health insurance carrier (carrier) exits the health insurance market and can no longer provide health insurance benefits to the individual, the act requires the individual's new carrier to credit all of the out-of-pocket expenses paid by the individual in accordance with the original health benefit plan in the given plan year to the new health benefit plan if the individual enrolls in the new health benefit plan in the established special enrollment period. The new carrier may file a claim for the amount of any claims liability that results from the new costs to the carrier; except that a claim may not be filed with the estate of the new carrier if the new carrier has otherwise recouped its costs for out-of-pocket expenses credited to covered persons. The act grants an exception for carriers from crediting the out-of-pocket expenses if doing so would make the carrier insolvent.

The act grants rule-making authority to the commissioner of insurance.

APPROVED by Governor June 3, 2024

EFFECTIVE January 1, 2025
(Note: This summary applies to this bill as enacted.)