furnished for each group of 51 or more covered employees,
members or enrollees, not including dependents.
(c) Claims experience data defined.--For purposes of this
chapter, claims experience data includes, for at least the last
two policy years, if applicable, separated by policy year, the
aggregated dollar value of each of the following:
(1) Earned premiums.
(2) Total incurred claims, including paid, reserved and
incurred but not reserved claims, inclusive of high amount
claims, pooled claims, capitated expenses and noncapitated
expenses.
(3) Any amounts incurred in excess of the individual
pooling or stop-loss point applicable to the group.
(4) Any amounts under a provider reimbursement
methodology other than fee for service that were allocated to
the group or otherwise accounted for in rating the group's
policy.
(d) Fee permitted.--An insurer may charge a fee for
providing the claims experience data to a group policyholder.
The fee shall be:
(1) Reasonable.
(2) Not unfairly discriminatory.
(3) In accord with a schedule or methodology filed with
the department at least 30 days prior to use, which schedule
shall become effective unless disapproved by the department
prior to use.
(e) Privacy protection.--In providing claims experience data
to a group policyholder under this chapter, an insurer shall
adhere to all Federal and State laws regarding disclosure of
protected health or personal information.
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