Bill 4011

                    Current Status

Bill Number:               4011
Ratification Number:       727
Act Number                 622
Introducing Body:          House
Subject:                   Return of surplus premiums

(A622, R727, H4011)

AN ACT TO AMEND SECTIONS 38-33-20, 38-33-130, AND 38-39-90, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO INSURANCE, SO AS TO INCREASE THE AMOUNT OF SURPLUS OVER THE AMOUNT DUE TO AN INSURED IN A RETURN OF PREMIUM WHICH IS NOT REQUIRED TO BE RETURNED FROM ONE DOLLAR TO THREE DOLLARS, TO DEFINE "COPAYMENT" OR "DEDUCTIBLE" IN REGARD TO HEALTH CARE SERVICES, AND TO EMPOWER THE CHIEF INSURANCE COMMISSIONER TO APPROVE PROVIDER'S AGREEMENTS WITH HEALTH MAINTENANCE ORGANIZATIONS.

Be it enacted by the General Assembly of the State of South Carolina:

Return of surplus premiums

SECTION 1. Section 38-39-90(f) of the 1976 Code is amended to read:

"(f) If the crediting of return premiums to the account of the insured results in a surplus over the amount due from the insured, the premium service company shall hold the surplus in a fiduciary capacity and promptly refund the excess to the insured. No refund is required if it amounts to less than three dollars."

Definitions

SECTION 2. Section 38-33-20 of the 1976 Code is amended by adding a new item (10) to read:

"(10) 'Copayment' or 'deductible' means the amount specified in the evidence of coverage that the enrollee shall pay directly to the provider for covered health care services, which may be stated in either specific dollar amounts or as a percentage of the provider's usual or customary charge."

Provider's agreements with health maintenance organizations

SECTION 3. Section 38-33-130(B) of the 1976 Code is amended to read:

"(B) Each health maintenance organization shall require every provider who participates in the health maintenance organization and furnishes health care services to the health maintenance organization's enrollees to execute an agreement not to bill the enrollee or otherwise hold the enrollee financially responsible for services rendered. The provider's agreement must be given on forms prescribed or approved by the commissioner, shall extend to all services furnished to the enrollee during the time he was enrolled in the health maintenance organization, and shall apply even where the provider has not been paid by the health maintenance organization."

Time effective

SECTION 4. This act takes effect upon approval by the Governor.