Section 1 Short title
This Act may be cited as the “Long Term Care Insurance Integrity Act of 2013”.
Long Term Care Insurance Integrity Act of 2013
A BILL
To require issuers of long term care insurance to establish third-party review processes for disputed claims.
Sec. 2 Long term care insurance dispute resolution review process
In general— Notwithstanding any other provision of law, an insurance issuer that offers a long term care insurance plan shall develop and implement claims dispute resolution procedures that comply with the requirements of this section that shall be applicable to such plan.
Requirement— A claims dispute resolution procedure under subsection (a) shall—
be designed to expeditiously resolve disputes concerning claims under the plan involved;
with respect to such disputes, provide for the application of one or more alternative means of dispute resolution involving independent third-party review under appropriate circumstances by entities that are mutually acceptable to the issuer and the enrollee involved, with the decision of such reviewer being binding on the issuer; and
ensure that an enrollee is eligible to obtain claims review only to the extent and in the manner provided for in the applicable insurance contract.
Appeals— An enrollee may appeal the decision of an independent reviewer under subsection (b)(2) to an appropriate State court as provided for under State law.
Rule of construction— Nothing in this section shall be construed to provide authority for an independent third-party reviewer under subsection (b)(2) to modify the terms of any long term care insurance contract.