A BILL TO AMEND CHAPTER 57, TITLE 38 OF THE 1976 CODE, RELATING TO INSURANCE TRADE PRACTICES, BY ADDING SECTION 3857190, TO PROVIDE THAT TERMS AND CONDITIONS OF HEALTH CARE CONTRACTS ISSUED BY HEALTH INSURANCE ISSUERS THAT PROVIDE HEALTH INSURANCE COVERAGE IN THE INDIVIDUAL, SMALL GROUP, OR LARGE GROUP MARKET DO NOT DISCRIMINATE UNREASONABLY AGAINST OR AMONG HEALTH CARE PROVIDERS WILLING AND QUALIFIED TO MEET THE TERMS AND CONDITIONS OF PARTICIPATION ESTABLISHED BY A HEALTH INSURANCE ISSUER AND DO NOT OTHERWISE PROHIBIT OR LIMIT PARTICIPATION BY A PROVIDER WHO IS WILLING TO ACCEPT AN ISSUER’S TERMS AND CONDITIONS FOR PARTICIPATION IN PROVIDING HEALTH CARE SERVICES; BY ADDING SECTION 3871450, TO PROVIDE THAT INDIVIDUAL HEALTH INSURANCE POLICIES OR CERTIFICATES OF COVERAGE MAY PROVIDE FOR WELLNESS CREDITS OR DISCOUNTS AND TO DEFINE WELLNESS CREDITS OR DISCOUNTS; AND BY ADDING SECTION 3871815, TO PROVIDE THAT GROUP HEALTH INSURANCE POLICIES OR CERTIFICATES OF COVERAGE MAY PROVIDE FOR WELLNESS CREDITS OR DISCOUNTS AND TO DEFINE WELLNESS CREDITS OR DISCOUNTS. Be it enacted by the General Assembly of the State of South Carolina: SECTION 1. Chapter 57, Title 38 of the 1976 Code is amended by adding: “Section 3857190. (A) As used in this section:
“Section 3871450. (A) As used in this section: (1) ‘Health insurance coverage’ has the same meaning as provided in Sections 3871670(6) and 3871840(14). (2) ‘Health insurance issuer’ or ‘issuer’ means an entity that provides health insurance coverage in this State as defined in Sections 3871670(7) and 3871840(16). (B)(1) Any rate, rating schedule, or rating manual for an individual health insurance policy or certificate of coverage may provide for wellness credits or discounts. (2) A wellness credit or discount provided by an issuer is presumed to be appropriate if there is a correlation between the reduction in health risk and the amount of the discount or credit offered, unless credible data demonstrates otherwise or unless the wellness credit or discount requires the covered person to incur costs to qualify for the wellness credit or discount that equal or exceed the value of the wellness credit or discount. (3) A wellness credit or discount shall be effective for a covered person on an annual basis, unless a longer period is otherwise provided for in the policy or certificate of coverage. (C) Each health insurance issuer shall include notice of the availability, eligibility criteria, and range of each wellness credit or discount in the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage it provides to covered persons. The notice must provide a plain language description of all available wellness credits or discounts and the terms and conditions of eligibility and participation. The notice must specify what evidence or proof the covered person or applicant must present to obtain and maintain the wellness credit or discount. (D)(1) For purposes of this section, a wellness credit or discount includes: (a) an appropriate refund of premiums paid in the last calendar or policy year; (b) premium discounts; or (c) a reduction or waiver of otherwise applicable copayments or deductibles. (2) A wellness credit or discount may be offered in return for demonstrative maintenance or improvement of the covered person’s health status or enrollment in or adherence to approved programs of health promotion and disease prevention. (E) The director or his designee may at any time request documentation of and actuarial support for wellness credits or discounts and a copy of the notice of availability furnished to