Payment deadlines
- Electronic claims
- 15 business days (statute makes no format distinction)
- Paper claims
- 15 business days (statute makes no format distinction)
After receiving a health insurance proof of loss form, the insurer has fifteen business days to pay the claim or the portion that is not contested, deny the claim, or make an initial request for additional information. A second fifteen-business-day window then runs from receipt of the information initially requested, and that one allows only payment or denial — no further information requests. If the claim is contested, the insured or the insured's assignee must be notified in writing of the reasons, and that notice does not stop the insurer denying later on other grounds. The section draws no distinction by submission format.