Vote Smart's Synopsis:

Vote to pass a bill that establishes privacy rights for people receiving sensitive health care services, such as gender-affirming care.

Highlights:

• Defines “sensitive services” as all health care services related to mental or behavioral health, sexual and reproductive health, sexually transmitted infections, substance use disorder, gender-affirming care, and intimate partner violence, obtained by a patient of any age at or above the minimum age specified for consenting to the service (Sec. 5.ac).

• Authorizes a health care service plan to mandate that a confidential communications request contain a statement that the request pertains to either medical information related to the receipt of sensitive services or that disclosure of all or part of the medical information could endanger the subscriber or enrollee. The health care service plan will not require an explanation as to the basis for a subscriber’s or enrollee’s statement that disclosure could endanger the subscriber or enrollee (Sec. 2-3).

• Prohibits a health care service plan from mandating a protected individual to obtain the policyholder, primary subscriber, or other enrollee’s authorization to receive sensitive services or to submit a claim for sensitive services if the protected individual has the right to consent to care (Sec. 3.a-1).

• Specifies communications subject to this paragraph will include the following written, verbal, or electronic communications related to the receipt of sensitive services (Sec. 3.c):

• Bills and attempts to collect payment;

• A notice of adverse benefits determinations;

• An explanation of benefits notice;

• A health care service plan’s request for additional information regarding a claim;

• A notice of a contested claim;

• The name and address of a provider, description of services provided, and other information related to a visit; and

• Any written, oral, or electronic communication from a health care service plan that contains protected health information.

• Classifies an “Individual” as any natural person who is any of the following (Sec. 5.i):

• In the case of property or casualty insurance, is a past, present, or proposed named insured or certificate holder;

• In the case of life or disability insurance, is a past, present, or proposed principal insured or certificate holder;

• Is a past, present, or proposed policy owner;

• Is a past or present applicant;

• Is a past or present claimant; or

• Derived, derives or is proposed to derive insurance coverage under an insurance policy or certificate subject to this act.

• Authorizes a provider of health care to make arrangements with the insured for the payment of benefit-cost sharing and communicate that arrangement with the insurer (Sec. 6.b).

• Prohibits a health insurer from requiring a protected individual to obtain the policyholder’s authorization to receive sensitive services or to submit a claim for sensitive services if the protected individual has the right to consent to care (Sec. 7.a-1).

• Requires a confidential communications request to be implemented by the health insurer within 7 calendar days of the receipt of electronic transmission, telephonic request, or request submitted through the health insurer’s internet website, or within 14 calendar days of receipt by first-class mail. The health insurer shall acknowledge receipt of the confidential communications request and advise the insured of the status of implementation of the request if an insured contacts the insurer (Sec. 7-5).

Full Bill Text