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A265, R311, S1104
STATUS INFORMATION
General Bill
Sponsors: Senator McConnell
Document Path: l:\s-jud\bills\mcconnell\jud0050.pgb.doc
Companion/Similar bill(s): 5036
Introduced in the Senate on February 14, 2008
Introduced in the House on April 24, 2008
Passed by the General Assembly on May 28, 2008
Governor's Action: June 4, 2008, Signed
Summary: Insurance policies
HISTORY OF LEGISLATIVE ACTIONS
Date Body Action Description with journal page number
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2/14/2008 Senate Introduced and read first time SJ-28
2/14/2008 Senate Referred to Committee on Banking and Insurance SJ-28
3/4/2008 Senate Committee report: Favorable with amendment Banking and
Insurance SJ-13
3/5/2008 Scrivener's error corrected
4/22/2008 Senate Committee Amendment Amended and Adopted SJ-17
4/22/2008 Senate Read second time SJ-17
4/23/2008 Senate Read third time and sent to House SJ-32
4/23/2008 Scrivener's error corrected
4/24/2008 House Introduced and read first time HJ-14
4/24/2008 House Referred to Committee on Labor, Commerce and Industry
HJ-14
5/21/2008 House Committee report: Favorable Labor, Commerce and Industry
HJ-4
5/27/2008 House Read second time HJ-15
5/28/2008 House Read third time and enrolled HJ-22
5/29/2008 Ratified R 311
6/4/2008 Signed By Governor
6/11/2008 Copies available
6/11/2008 Effective date 06/04/08
6/13/2008 Act No. 265
View the latest legislative information at the LPITS web site
VERSIONS OF THIS BILL
2/14/2008
3/4/2008
3/5/2008
4/22/2008
4/23/2008
4/23/2008-A
5/21/2008
(A265, R311, S1104)
AN ACT TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-242 SO AS TO PROVIDE THAT WHEN USED IN INDIVIDUAL OR GROUP SPECIFIED DISEASE INSURANCE POLICIES, AND UNLESS OTHERWISE DEFINED IN THE POLICY, THE TERMS "ACTUAL CHARGE", "ACTUAL CHARGES", "ACTUAL FEE", OR "ACTUAL FEES" MEANS THE AMOUNT THE HEALTH CARE PROVIDER AGREED TO ACCEPT OR IS OBLIGATED BY LAW TO ACCEPT AS PAYMENT FOR GOODS OR SERVICES PROVIDED AND TO REQUIRE THAT NO INSURER OR ISSUER OF ANY INDIVIDUAL OR GROUP SPECIFIED DISEASE INSURANCE POLICY PAY ANY CLAIM OR BENEFIT UNDER THE APPLICABLE POLICY IN AN AMOUNT IN EXCESS OF THE ACTUAL CHARGE, ACTUAL CHARGES, ACTUAL FEE, OR ACTUAL FEES.
Be it enacted by the General Assembly of the State of South Carolina:
Specified disease insurance policies and payment of claims and benefits
SECTION 1. Chapter 71, Title 38 of the 1976 Code is amended by adding:
"Section 38-71-242. (A)(1) When used in any individual or group specified disease insurance policy in connection with the benefits payable for goods or services provided by any health care provider or other designated person or entity, the terms 'actual charge', 'actual charges', 'actual fee', or 'actual fees' shall mean the amount that the health care provider or other designated person or entity:
(a) agreed to accept, pursuant to a network or other agreement with a health insurer, third-party administrator, or other third-party payor, as payment in full for the goods or services provided to the insured;
(b) agreed or is obligated by operation of law to accept as payment in full for the goods or services provided to the insured pursuant to a provider, participation agreement, or supplier agreement under Medicare, Medicaid, or any other government administered health care program, where the insured is covered or reimbursed by such program; or
(c) if both subitems (a) and (b) of this subsection apply, the lowest amount determined under these two subitems; and
(2) must include any applicable deductibles, coinsurance requirements, or co-pay requirements applicable to the insured under any government administered health care program or any private primary health insurance coverage for the health care provider's goods or services provided to the insured.
(B) This section applies to any individual or group specified disease insurance policy issued to any resident of this State that contains the terms 'actual charge', 'actual charges', 'actual fee', or 'actual fees' and does not contain an express definition for the terms 'actual charge', 'actual charges', 'actual fee', or 'actual fees'.
(C) Notwithstanding any other provision of law, after the effective date of this section, an insurer or issuer of any individual or group specified disease insurance policy shall not pay any claim or benefits based upon an actual charge, actual charges, actual fee, or actual fees under the applicable policy in an amount in excess of the 'actual charge', 'actual charges', 'actual fee', or 'actual fees' as defined in this section."
Severability clause
SECTION 2. If any section, subsection, item, subitem, paragraph, subparagraph, sentence, clause, phrase, or word of this act is for any reason held to be unconstitutional or invalid, such holding shall not affect the constitutionality or validity of the remaining portions of this act, the General Assembly hereby declaring that it would have passed this chapter, and each and every section, subsection, item, subitem, paragraph, subparagraph, sentence, clause, phrase, and word thereof, irrespective of the fact that any one or more other sections, subsections, paragraphs, subparagraphs, sentences, clauses, phrases, or words hereof may be declared to be unconstitutional, invalid, or otherwise ineffective.
Time effective
SECTION 3. This act takes effect upon approval by the Governor.
Ratified the 29th day of May, 2008.
Approved the 4th day of June, 2008.
This web page was last updated on Monday, October 10, 2011 at 1:31 P.M.