1998 Regular Session
By: Representative Holden
House Bill 1331
AN ACT TO CREATE THE "INSURANCE DISCLOSURE ACT OF 1998" TO REQUIRE CERTAIN DISCLOSURES TO INSURED INDIVIDUALS OF THEIR MEDICAL CONDITION AFTER UNDERGOING MEDICAL EXAMINATIONS NECESSARY TO QUALIFY FOR INSURANCE COVERAGE; TO PROVIDE DEFINITIONS; TO PROVIDE PENALTIES FOR VIOLATIONS; TO REQUIRE THAT THE COMMISSIONER OF INSURANCE PRESCRIBE REGULATIONS TO CARRY OUT THE PROVISIONS OF THIS ACT; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. This act may be cited as the "Insurance Disclosure Act of 1998."
SECTION 2. As used in this act:
(a) "Insurer" means any person, reciprocal exchange, interinsurer, Lloyds insurer, fraternal benefit society or other legal entity engaged in the business of insurance, including agents, brokers, adjusters and third party administrators. The term also includes health benefit plans, health carriers and life, disability and property and casualty insurers.
(b) "Health benefit plan" means any public or private entity or program that provides for payments for health care, including:
(i) A group health plan, as defined in Section 2791(a)(1) of the Public Health Service Act (42 USCS 300gg-91(a)(1), Section 733 (a)(1) of the Employee Retirement Income Security Act of 1974 (29 USCS 1191b(a)(1) or Section 5000(b)(1) of the Internal Revenue Code of 1986);
(ii) A multiple employer welfare arrangement, as defined in Section 3(40) of the Employee Retirement Income Security Act (29 USCS 1002(40)) that provides benefits consisting of medical care as defined in Section 733(a)(2) of such act (29 USCS 1191b(a)(2)), including items and services paid for as medical care;
(iii) Any other health insurance arrangement, including any arrangement consisting of a hospital or medical expense incurred policy or certificate, hospital or medical service plan contract or health maintenance organization subscriber contract;
(iv) Workers' compensation or similar insurance to the extent that it relates to workers' compensation medical benefits, as defined in regulations of the Secretary of Health and Human Services;
(v) Automobile medical insurance to the extent that it relates to medial benefits, as defined in the regulations of the Secretary of Health and Human Services; and
(vi) Any other insurance providing for enrollees medical benefits, as defined in regulations of the Secretary of Health and Human Services, in the event of sickness, accident, disability, death or unemployment.
(c) "Health carrier" means a person that contracts or offers to contract on a risk assuming basis to provide, deliver, arrange for, pay for or reimburse any of the cost of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation or any other entity providing a plan of health insurance, health benefits or health services.
(d) "Policy" means a contract of insurance, certificate, indemnity, suretyship or annuity issued, proposed for issuance or intended for issuance by an insurer, including endorsements or riders to an insurance policy or contract.
(e) "Secretary" means the Secretary of Health and Human Services.
SECTION 3. An insurer shall take such actions as are necessary to ensure that, in any case in which a medical examination of an individual is required for initial or continued enrollment under a policy issued by the insurer, and such medical examination is conducted by a person who is in the employ of the insurer or whose services are procured otherwise by the insurer, such individual, or the individual's legal guardian, is provided all medical information obtained from such examination at the same time that such information is made available to the insurer and is encouraged to make such information available to such individual's own physician.
SECTION 4. An individual who believes that he or she has been adversely affected by an act or practice of an insurer in violation of Section 3 of this act may maintain an action against the insurer in a federal or state court of original jurisdiction. Upon proof of such conduct by a preponderance of the evidence, the court may award appropriate relief, including temporary, preliminary and permanent injunctive relief and compensatory and punitive damages, as well as the costs of suit and reasonable fees for the aggrieved individual's attorneys and expert witnesses. With respect to compensatory damages, the aggrieved individual may elect, at any time before the rendering of final judgment, to recover in lieu of actual damages, an award of statutory damages in the amount of Ten Thousand Dollars ($10,000.00) for each violation. It shall be the duty of the courts to advance on the docket and to expedite to the greatest possible extent the disposition of any action for temporary or preliminary injunctive relief considered under this paragraph.
SECTION 5. Nothing in Section 3 of this act shall be construed to alter or relieve any insurer from the obligation to comply with any law with respect to insurers, policies and health benefit plans, except to the extent that such law is inconsistent with any provision of Section 3 of this act.
SECTION 6. The Commissioner of Insurance shall prescribe regulations to carry out the provisions of Sections 2 through 5 of this act.
SECTION 7. This act shall take effect and be in force from and after July 1, 1998.