145th GENERAL ASSEMBLY

FISCAL NOTE

Bill: HOUSE BILL NO. 367

sponsor: Representative D. Short

DESCRIPTION: AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO UNFAIR ACTS IN THE BUSINESS OF INSURANCE.

Assumptions:

1. Effective upon signature of Governor.

2. This Act requires a health insurer, health service corporation, or health maintenance organization who denies coverage for a procedure or test as medically unnecessary to reimburse an insured for all expenses, including out-of-pocket expenses, including but not limited to deductibles, co-pays, and coinsurance, if the insured pays for the procedure or test and the procedure or test is proven to be medically necessary.

3. The insurer shall also be responsible for any damages sustained by the insured due to delay in obtaining the procedure or test resulting from the insurer’s unreasonable denial of such coverage.

4. The outcome and determination of punitive damages could only be determined by a court of law.

5. As a self-insured insurance plan, the state is not required to adopt this mandate. However, should the State Employees Benefit Committee (SEBC) choose to participate, estimates of the cost by the statewide benefits office are indeterminable but assumed to be significant.

Cost:

FY2011 Indeterminable.

FY2012 Indeterminable.

FY2013 Indeterminable.

Office of Controller General (Amounts are shown in whole dollars)

May 05, 2010

EJB:CGO

3631450007