Health-care Cost-sharing Consumer Protections
The bill defines a "health-care cost-sharing arrangement" as a health care sharing ministry or medical cost-sharing community that collects money from its members on a regular basis, at levels established by the arrangement, for purposes of sharing, covering, or defraying the medical costs of its members. A health-care cost-sharing arrangement is required to:
- Report specified information to the commissioner of insurance (commissioner) regarding its operations, financial statements, membership, and medical bills submitted, paid, and denied in Colorado;
- Provide certain written disclosures to potential and renewing members, post the disclosures on its website, if the arrangement has a website, and include the disclosures in its marketing materials;
- Provide specified written statements about arrangement finances and guidelines about arrangement procedures to members; and
- Respond to requests for payment of medical expenses from members or health-care providers within a period specified by the commissioner by rule.
An insurance broker that offers a health-care cost-sharing arrangement in this state is required to provide written or electronic disclosures about the product to prospective members before selling the arrangement to the person.
The commissioner is authorized to:
- Adopt rules to implement the data reporting, disclosure, and response time requirements;
- Impose fines for failure to comply with the requirements and prohibitions specified in the bill;
- Issue an emergency, ex parte cease-and-desist order against a person the commissioner believes to be violating the bill if it appears to the commissioner that the alleged conduct is fraudulent, creates an immediate danger to public safety, or is causing or is reasonably expected to cause significant, imminent, and irreparable public injury; and
- Impose a civil penalty, order restitution, or both, against a person that violates an ex parte cease-and-desist order.
A person is prohibited from making, issuing, circulating, or causing to be made, issued, or circulated any statement or publication that misrepresents the medical cost-sharing benefits, advantages, conditions, or terms of any health-care cost-sharing arrangement.
(Note: This summary applies to this bill as introduced.)