[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 1481 Introduced in Senate (IS)]

113th CONGRESS
  1st Session
                                S. 1481

To require issuers of long term care insurance to establish third-party 
                 review processes for disputed claims.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             August 1, 2013

 Ms. Klobuchar introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To require issuers of long term care insurance to establish third-party 
                 review processes for disputed claims.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Long Term Care Insurance Integrity 
Act of 2013''.

SEC. 2. LONG TERM CARE INSURANCE DISPUTE RESOLUTION REVIEW PROCESS.

    (a) 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.
    (b) Requirement.--A claims dispute resolution procedure under 
subsection (a) shall--
            (1) be designed to expeditiously resolve disputes 
        concerning claims under the plan involved;
            (2) 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
            (3) 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.
    (c) 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.
    (d) 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.
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