Sensible Claims Act (663)

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PASSED by the General Assembly on 9 January 663, 13 AYE, 2 NAY, 0 ABSTAIN
An act to ensure the medical independence of doctors by requiring medical insurance companies to cover medically necessary procedures, tests, medications, and examinations.

Article One: Definitions

1.1 A doctor is defined as any person holding an active and unexpired medical license issued by the relevant Kodiaker authorities.
1.1.1 A primary care doctor is defined as a patient's declared doctor from whom they seek regular and routine medical care.
1.2 A medical insurance company is defined as any corporation that provides medical insurance, as defined in the Medically Necessary Elective Surgery Act. 1.3 Critical care is defined as treatment given to a patient to mitigate the effects of an immediate and significant threat to the patient's survival,

Article Two: Requirements

2.1 A medical insurance company must cover to the minimum rate of sixty percent of any medical procedure, tests, medications, and examinations deemed necessary for the health of the patient by their primary care doctor. In the instance in which a patient is receiving critical care, this coverage will be raised to eighty per cent. An insurance company many not deny any claim made for the reimbursement of procedures, tests, medications, or examinations ordered by the doctor.
2.2 A medical insurance company must provide a reimbursement to a claim made by a patient within sixty (60) calendar days of the claim.
2.3 A medical insurance company may petition the Board of Medical Insurance to approve the denial or partial coverage of a medical procedure on the grounds that the procedure is unnecessary.

Article Three: Board of Medical Insurance

3.1 The Ministry of Health and Education will establish the Board of Medical Insurance, which shall be staffed by doctors and other medical professionals.
3.2 The Board of Medical Insurance shall be empowered to review requests by any insurance company to deny or provide partial coverage for any medical insurance claim made. The Board of Medical Insurance is empowered to approve or deny these requests.
3.3 The Board of Medical INsurance shall be empowered to levy fines against insurance companies for non-compliance with or violation of any of the statues within this act, any act enforcing requirements on insurance companies, or any regluations passed by the Board of Medical Insurance.
3.4 The Board of Medical Insurance shall be provided with five million florins per fiscal quarter.

Tabled by Braughn F. G. Kryos, MGA

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