At the request of an insured person or subscriber, can an insurer provide the insured or subscriber with a benefit form other than by sending it to the home address of the insured person or subscriber? B. The explanation of benefits specifies and unambiguously the services to be paid under the contract. Finally, the EOU requirements set out in Section 3234 and this circular do not apply to Family Health Plus, Medicaid or Child Health Plus, as notices to members are already required by federal regulations for these government programs. Insurers are informed by the Ministry of Health of the content of declaratory decisions against members of these schemes. C. The Board may make regulations to establish (i) standards for the accuracy and clarity of the information contained in an explanation of benefits and (ii) other methods for providing an explanation of services that (a) a subscriber who is legally authorized to consent to the care of a covered person or beneficiary; (b) a covered person or beneficiary; who is legally entitled to consent to the care of that covered person or beneficiary, (b) allow a covered person or legally authorized recipient to consent to the care of that covered person or recipient, or (c) another party that has the exclusive legal authority to consent to the care of the covered person or recipient in order to obtain the explanation of benefits by another method; provided that each of these alternative methods complies with the provisions of Article 45 C.F.R. § 164.522 concerning the right to request the confidentiality of protected health information. (a) Every insurer, including health maintenance organizations carrying on business under the Public Health Act or forty-three of this chapter, and any other entity acting under the forty-three of this chapter, must provide the insured or subscriber with a declaration of benefits in response to the submission of a claim under a policy or certificate covering Provide hospital or medical expenses. including policies and certificates that offer nursing home costs or home care costs.

Section 3234 of the New York Insurance Act provides in the relevant part that any insurer, including an HMO, is required to provide its policyholder or subscriber with an EOU unit in response to a claim filed under a policy that provides for hospitalization or medical expense benefits. An exception to the requirement that an EOU be issued under section 3234 is where the service is provided by a participating provider and the full refund of the application, with the exception of a co-payment normally paid to the provider at the time of the service, is paid directly to the participating provider. D. The term “statement of rights”, as used in this section, includes any form provided by an insurer, health care plan or health maintenance organization that explains the amounts covered by a policy or plan or indicates the amounts payable by an insured person to a health care provider. One. Any insurer that issues accident and health insurance, a company that issues subscription contracts and each health care organization must submit a declaration of benefits for approval. These benefit explanation forms are subject to the requirements of § 38.2-316 or § 38.2-4306. Both sections require the insurer to provide the insured or subscriber with a form explaining the benefits. It does not need to be sent to the home address of the insured or subscriber. Thus, the insurer would comply with the law if, at the request of the insured or subscriber, it made other arrangements to provide the insured or subscriber with the benefit declaration form.

There is a similar provision regarding Medicare supplemental and health insurance applications or certificates with limited benefits, which are primarily intended to supplement Medicare benefits. N.Y. Ins. Law § 3235 (McKinney 2000). Yes. N.Y. Ins. Law §§ 3234, 3235 (McKinney 2000) does not require the insurer to send the declaration of benefit form to the home address of the insured or subscriber. For more information, contact supervising attorney Joan Siegel in the New York office. The purpose of this circular is to outline some of the cases identified in the Business Conduct Reviews, where an insurer is required to issue an EOU to an insured or policyholder under section 3234 of the Insurance Act. These cases include: It is not necessary to issue an export unit to an insured or policyholder in the following circumstances: Please note that the ministry is of the view that transferring risk to a third party, such as an independent practice association (AAC), requires the insurer to provide an export unit unit to the insured or policyholder. if required by law, do not repeal.

All insurers authorized to purchase accident and health insurance in the State of New York (commercial insurers), Article 43 Health Care Companies and Organizations In all cases where an EOU unit is to be issued to the insured or subscriber, it must contain at least all the information required under Section 3234(b) of the Insurance Act.