Group Insurance Commission

Section 5: GIC Wellness Program

Requires the Group Insurance Commission to develop a wellness program for enrollees and to offer reductions in premiums or co-payments, or other incentives to encourage enrollees to comply with the wellness program goals. After 1 year of implementation, the GIC must issue a report to the legislature noting collective data, including level of participation and health services participants received and the savings incurred as a result of the program.

Section 37: Establishes Conditions For Health Insurance Carrier Accreditation and Provider Credentialing

The Bureau of Managed Care within the Division of Insurance (DOI) is directed to require, as a condition of accreditation, that carriers adopt uniform standards and methodologies for credentialing health care providers. Also, any carrier that contracts with a third party administrator must ensure that the third party complies with the standards. By way of background, the Bureau of Managed Care within DOI determines standards and procedures for accreditation of health insurance carriers. The Bureau must consult with the Division of Health Care Finance and Policy, the Department of Public Health, the Group Insurance Commission, the Centers for Medicare and Medicaid Services, and each health insurance carrier to develop the standards.

Section 59: Recognizes Special Needs of Children

Directs relevant policymaking agencies to consider the special needs of children and pediatric patients when developing and utilizing data standards, quality measurement systems, wellness initiatives, or making comparisons of costs and prices. Policymakers may require that comparative data and reports related to pediatric patients and providers be segregated from adult patients and providers.