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OLR Bill Analysis
sHB 6389 (as amended by House "A")*
AN ACT CONCERNING EXPLANATIONS OF BENEFITS.
SUMMARY
This bill requires certain health insurance carriers and their third-
party administrators (TPAs) to (1) provide an explanation of benefits
(EOBs) to covered individuals for benefits they receive and (2) allow
covered individuals, who may legally consent to receive covered
medical services, to make a specific written selection about whether
and how to receive the EOBs (see BACKGROUND) . The bill requires
health insurance carriers and TPAs to disclose EOB delivery options to
covered individuals.
It prohibits a health insurance carrier from requiring a covered
individual to waive his or her right to limit disclosure under the bill as
a precondition to issuing, delivering, renewing, amending, or
continuing a policy. The bill specifies that it does not limit a covered
individual’s or policy holder’s ability to request an adverse
determination review.
The bill applies to insurers, health care centers (i.e., HMOs), hospital
and medical service corporations, fraternal benefit societies, and any
other entity that delivers, issues, renews, amends, or continues a health
insurance policy in Connecticut (i.e., “health insurance carriers”) that
cover (1) basic hospital expenses; (2) basic medical-surgical expenses;
(3) major medical expenses; or (4) hospital or medical services,
including those provided under an HMO plan. It also applies to TPAs
providing services to these health insurance carriers.
It also makes conforming and technical changes.
*House Amendment “A” eliminates the electronic EOB delivery
option for covered individuals and instead specifies that EOBs may be 2021HB-06389-R010633-BA.docx
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made available electronically, and if so, requires that individuals be
notified electronically of their availability.
EFFECTIVE DATE: January 1, 2023
EXPLANATION OF BENEF ITS (EOBs)
Delivery Method
The bill requires health insurance carriers and TPAs to issue EOBs
to consumers, but it also allows covered individuals who may legally
consent to receiving covered services to (1) specify how EOBs are
delivered or (2) opt out of receiving them entirely.
Health insurance carriers and TPAs must allow a legally consenting
consumer who is a covered individual to specify in writing that EOBs
must be delivered solely to him or her by:
1. mailing it to his or her address or any other specified address or
2. making it available electronically and notifying him or her
electronically of its availability, including by e-mail or other
electronic means, in compliance with certain federal privacy
laws (e.g., through a patient portal).
Under the bill, the consumer’s choice remains valid until he or she
specifies another method in writing to the carrier. The health insurance
carrier or TPA must comply with a consumer’s written request for a
specific delivery method within three business days after receiving it.
Additionally, it must provide written confirmation of receipt and, if
contacted by the consumer, advise on the status of his or her selection.
Opting Out
Covered individuals who can legally consent to benefits may
specify, in writing, that the health insurance carrier or TPA not issue
an EOB. In such a case, the carrier or TPA cannot require the covered
individual to explain this decision unless required by law or pursuant
to a court order.
Disclosures 2021HB-06389-R010633-BA.docx
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Additionally, the bill requires health insurance carriers and TPAs to
make available to consumers a statement disclosing that any covered
individual who can legally consent to receiving covered benefits may
specify that the carrier (1) not issue EOBs concerning him or her or (2)
issue them only to the consumer using the method he or she chooses.
The statement must be in an easily readable, accessible, and
understandable format and include a space for the consumer to
provide a mailing or email address.
Under the bill, the disclosure statement described above must be
included in the benefits information that carriers must provide upon
enrollment and that both carriers and the Connecticut Health
Insurance Exchange (Access Health CT) must make available on their
websites.
The bill also requires health carriers and TPAs to disclose to
insureds that they may (1) submit EOB delivery method requests or (2)
request that EOBs not be delivered at all. This disclosure must be in
plain language and displayed or printed clearly and conspicuously in
all coverage documents, privacy communications, EOBs, and Internet
websites the health carrier makes available to Connecticut consumers.
BACKGROUND
Medical Consent
Generally, adults may legally consent to medical procedures. By
law, a minor may legally receive certain medical examinations or
treatment without his or her parent’s consent, including sexually
transmitted disease testing (CGS § 19a-216); alcohol or drug
dependence treatment (CGS § 17a-688); and, in certain cases, HIV
testing (CGS § 19a-592).
Related Bill
sHB 6461 (§ 6) (File 264), favorably reported by Higher Education
and Employment Advancement Committee, contains the same
provisions as the underlying bill.
COMMITTEE ACTION 2021HB-06389-R010633-BA.docx
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Insurance and Real Estate Committee
Joint Favorable
Yea 15 Nay 3 (03/22/2021)