Amendment H-1112 to HF 467
Relating to primary health benefit plans, claims for reimbursement, and explanation of benefits
Adopted · March 21, 2023
Filed March 14, 2023 in the House by
What it changes
AI summary This amendment adds a rule that healthcare providers must submit claims to a person's primary insurance plan before sending them to any other insurance plan. It also changes the deadline for sending an explanation of benefits from twenty days to thirty days.1
Read the amendment’s wording
- Page 1, before line 1 by inserting: “Section
- NEW SECTION . 147.164 Health benefit plans —— claims.
- As used in this section, unless the context otherwise requires: a. “Covered person” means the same as defined in section 514J.102. b. “Health benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. c. “Health care professional” means a physician or other health care practitioner licensed, accredited, registered, or certified to perform specified health care services consistent with state law. d. “Health care services” means the same as defined in section 514J.102. e. “Personal representative” means the same as described in 45 C.F.R. §164.502(g).
- A health care professional who provides health care services to a covered person shall submit a claim for reimbursement to the primary health benefit plan designated by the covered person or the covered person’s personal representative prior to submitting a claim for reimbursement to any other health benefit plan designated by the covered person or the covered person’s personal representative.”
- Page 1, after line 16 by inserting: “e. “Personal representative” means the same as described in 45 C.F.R. §164.502(g).”
- Page 1, line 17, after “If” by inserting “a covered person, a covered person’s personal representative, or”
- Page 1, line 18, by striking “requests” and inserting “request”
- Page 1, line 21, by striking “twenty” and inserting “thirty”
- Title page, by striking lines 1 through 2 and inserting “An Act relating to primary health benefit plans, claims for reimbursement, and explanation of benefits.”
- By renumbering as necessary.