The second bill: an employer right to its own claims data

I lied to you yesterday. I said we wrote a bill in NABIP’s Employer Working Group. We wrote two.

In most states, an employer has no guaranteed right to its own claims data.

Texas is a rare exception. There, a carrier has to hand it over when the employer asks, and that right has been on the books for years.

Here’s the catch. Even where the right exists, it’s only as good as what shows up. Plenty of employers ask and get back a thin summary that answers nothing. Technically the carrier complied. Practically you still can’t tell what your plan paid, to whom, or whether it was right, which is the whole reason you wanted it.

So we wrote the Employer-Level Access to Reporting & Analytics Act, the ELARA Act. It guarantees the right where states don’t have one, and it defines the file you get so the right actually means something: a standardized claims report, field by field, including the high-cost claims driving your renewal, not a summary on the carrier’s terms. We built the standard off the file spec 32BJ’s health fund uses to pull real, auditable data from its administrator.
A carrier gets 30 days to produce it.
You can’t manage a plan you’re not allowed to see.

If you’re at NABIP’s national convention this weekend, come find me. I’m happy to walk you through the bill.