HOUSE BILL No. 4756


     June 3, 1999, Introduced by Rep. Richner and referred to the Committee on Family and
Civil Law.


        A bill to amend 1984 PA 218, entitled

   "Third party administrator act,"

   by amending section 34 (MCL 550.934) and by adding section 35.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1         Sec. 34.  (1) A TPA shall provide for the confidentiality of

 2    personal data identifying an individual covered by a plan.  A TPA

 3    shall not disclose records containing personal information that

 4    may be associated with an identifiable individual covered by a

 5    plan to a person other than the individual to whom the informa-

 6    tion pertains.  Except as is necessary to comply with a court

 7    order, an administrator shall not disclose personal data concern-

 8    ing a covered individual without the prior consent of the covered

 9    individual.  If the individual covered by a plan has authorized

10    the release of information to a third person, the third person




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 1    shall not release that information unless the individual executes

 2    in writing another consent authorizing the additional release.

 3         (2) Subsection (1)  shall  DOES not 
             be construed to  apply

 4    to information disclosed for any of the following reasons:

 5         (a) For claims adjudication.

 6         (b) For claims verification.

 7         (c) For other proper plan administration.

 8         (d) For an audit conducted pursuant to ERISA.

 9         (e) To an insurer for the purchase of excess loss insurance

10    and for claims under the excess loss insurance.  However, an

11    insurer obtaining information under this subdivision  shall
             be 

12    IS subject to the requirements of subsection (1).

13         (f) To the plan or a fiduciary of the plan.

14         (g) To the commissioner.  However, information obtained by

15    the commissioner under this subdivision  shall be 
             IS exempt from

16    disclosure under the freedom of information act,  Act No.
             442 of

17     the Public Acts of 1976, being sections 15.231 to 15.246 of
                       the

18     Michigan Compiled Laws  1976 PA 442, MCL 15.231 TO
                       15.246.

19         (H) AS REQUIRED BY SECTION 35.

20         (I)  (h)  As required by law.

21         SEC. 35.  A THIRD PARTY ADMINISTRATOR SHALL FURNISH TO ANY

22    PERSON PAYING FOR A BENEFIT PLAN EITHER DIRECTLY OR INDIRECTLY,

23    WITHIN 30 DAYS AFTER RECEIVING A WRITTEN REQUEST THEREFORE AND

24    UPON PAYMENT OF A REASONABLE CHARGE, ALL OF THE FOLLOWING INFOR-

25    MATION FOR THE BENEFIT PLAN FOR THE IMMEDIATELY PRECEDING

26    12-MONTH PERIOD:





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 1         (A) TOTAL NUMBER OF INDIVIDUALS COVERED.

 2         (B) TOTAL NUMBER OF CLAIMS PAID.

 3         (C) TOTAL NUMBER OF CLAIMS PENDING.

 4         (D) TOTAL NUMBER OF CLAIMS EXCEEDING $50,000.00 AND THE

 5    AMOUNT OF EACH OF THOSE CLAIMS.  INFORMATION UNDER THIS SUBDIVI-

 6    SION SHALL NOT DISCLOSE PERSONAL DATA THAT MAY REVEAL THE IDEN-

 7    TITY OF A COVERED INDIVIDUAL.

 8         (E) CLAIMS EXPERIENCE DATA BY COVERAGE COMPONENT.

 9         (F) ALL PERTINENT INFORMATION THAT IS NECESSARY FOR THE

10    PERSON TO OBTAIN COMPETITIVE BIDS FOR OTHER THIRD PARTY ADMINIS-

11    TRATOR SERVICES OR OTHER HEALTH CARE COVERAGE.


































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