Text: S03026 Text: S03028 Text: S03000 - S03099 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Amend Senate File 84 as follows: 1 2 #1. Page 2, line 5, by inserting after the word 1 3 "regulation." the following: ""Carrier" does not 1 4 include an organized delivery system." 1 5 #2. Page 4, lines 7 and 8, by striking the words 1 6 "or other objective". 1 7 #3. Page 5, by striking lines 18 through 20. 1 8 #4. Page 5, line 25, by striking the letter "f." 1 9 and inserting the following: "e." 1 10 #5. Page 5, line 29, by striking the letter "g." 1 11 and inserting the following: "f." 1 12 #6. Page 6, line 5, by striking the letter ""f"" 1 13 and inserting the following: ""e"". 1 14 #7. By striking page 13, line 15, through page 17, 1 15 line 4, and inserting the following: 1 16 "a. Four members shall be representatives of the 1 17 four largest domestic carriers of individual health 1 18 insurance in the state as of the calendar year ending 1 19 December 31, 1994. 1 20 b. Three members shall be representatives of the 1 21 three largest carriers of health insurance in the 1 22 state, excluding medicare supplement coverage 1 23 premiums, which are not otherwise represented. In the 1 24 event a carrier to be represented pursuant to this 1 25 paragraph does not appoint a representative, the board 1 26 member shall be a representative of the next largest 1 27 carrier which satisfies the criteria. 1 28 After an initial term, board members shall be 1 29 nominated and elected by the members of the 1 30 association. 1 31 Members of the board may be reimbursed from the 1 32 funds of the association for expenses incurred by them 1 33 as members, but shall not otherwise be compensated by 1 34 the association for their services. 1 35 3. The association shall submit to the 1 36 commissioner a plan of operation for the association 1 37 and any amendments to the association's articles of 1 38 incorporation necessary and appropriate to assure the 1 39 fair, reasonable, and equitable administration of the 1 40 association. The plan shall provide for the sharing 1 41 of losses related to basic and standard plans, if any, 1 42 on an equitable and proportional basis among the 1 43 members of the association. If the association fails 1 44 to submit a suitable plan of operation within one 1 45 hundred eighty days after the appointment of the board 1 46 of directors, the commissioner shall adopt rules 1 47 necessary to implement this section. The rules shall 1 48 continue in force until modified by the commissioner 1 49 or superseded by a plan submitted by the association 1 50 and approved by the commissioner. In addition to 2 1 other requirements, the plan of operation shall 2 2 provide for all of the following: 2 3 a. The handling and accounting of assets and funds 2 4 of the association. 2 5 b. The amount of and method for reimbursing the 2 6 expenses of board members. 2 7 c. Regular times and places for meetings of the 2 8 board of directors. 2 9 d. Records to be kept relating to all financial 2 10 transactions, and annual fiscal reporting to the 2 11 commissioner. 2 12 e. Procedures for selecting the board of 2 13 directors. 2 14 f. Additional provisions necessary or proper for 2 15 the execution of the powers and duties of the 2 16 association. 2 17 4. The plan of operation may provide that the 2 18 powers and duties of the association may be delegated 2 19 to a person who will perform functions similar to 2 20 those of the association. A delegation under this 2 21 section takes effect only upon the approval of the 2 22 board of directors. 2 23 5. The association has the general powers and 2 24 authority enumerated by this section and executed in 2 25 accordance with the plan of operation approved by the 2 26 commissioner under subsection 3. In addition, the 2 27 association may do any of the following: 2 28 a. Enter into contracts as necessary or proper to 2 29 administer this chapter. 2 30 b. Sue or be sued, including taking any legal 2 31 action necessary or proper for recovery of any 2 32 assessments for, on behalf of, or against members of 2 33 the association or other participating persons. 2 34 c. Appoint from among members appropriate legal, 2 35 actuarial, and other committees as necessary to 2 36 provide technical assistance in the operation of the 2 37 association, including the hiring of independent 2 38 consultants as necessary. 2 39 d. Perform any other functions within the 2 40 authority of the association. 2 41 6. Rates for basic and standard coverages as 2 42 provided in this chapter shall be determined by each 2 43 carrier or organized delivery system as the average of 2 44 the lowest rate available for issuance by that carrier 2 45 or organized delivery system adjusted for rating 2 46 characteristics and benefits and the maximum rate 2 47 allowable by law after adjustments for rate 2 48 characteristics and benefits. 2 49 7. Following the close of each calendar year, the 2 50 association, in conjunction with the commissioner, 3 1 shall require each carrier or organized delivery 3 2 system to report the amount of earned premiums and the 3 3 associated paid losses for all basic and standard 3 4 plans issued by the carrier or organized delivery 3 5 system. The reporting of these amounts must be 3 6 certified by an officer of the carrier or organized 3 7 delivery system. 3 8 8. The board shall develop procedures and make 3 9 assessments and distributions as required to equalize 3 10 the individual carrier and organized delivery system 3 11 gains or losses so that each carrier or organized 3 12 delivery system receives the same ratio of paid claims 3 13 to ninety percent of earned premiums as the aggregate 3 14 of all basic and standard plans insured by all 3 15 carriers and organized delivery systems in the state. 3 16 9. If the statewide aggregate ratio of paid claims 3 17 to ninety percent of earned premiums is greater than 3 18 one, the dollar difference between ninety percent of 3 19 earned premiums and the paid claims shall represent an 3 20 assessable loss. 3 21 10. The assessable loss plus necessary operating 3 22 expenses for the association, plus any additional 3 23 expenses as provided by law, shall be assessed by the 3 24 association to all members in proportion to their 3 25 respective shares of total health insurance premiums 3 26 or payments for subscriber contracts received in Iowa 3 27 during the second preceding calendar year, or with 3 28 paid losses in the year, coinciding with or ending 3 29 during the calendar year, or on any other equitable 3 30 basis as provided in the plan of operation. In 3 31 sharing losses, the association may abate or defer any 3 32 part of the assessment of a member, if, in the opinion 3 33 of the board, payment of the assessment would endanger 3 34 the ability of the member to fulfill its contractual 3 35 obligations. The association may also provide for an 3 36 initial or interim assessment against the members of 3 37 the association to meet the operating expenses of the 3 38 association until the next calendar year is completed. 3 39 11. The board shall develop procedures for 3 40 distributing the assessable loss assessments to each 3 41 carrier and organized delivery system in proportion to 3 42 the carrier's and organized delivery system's 3 43 respective share of premium for basic and standard 3 44 plans to the statewide total premium for all basic and 3 45 standard plans. 3 46 12. The board shall ensure that procedures for 3 47 collecting and distributing assessments are as 3 48 efficient as possible for carriers and organized 3 49 delivery systems. The board may establish procedures 3 50 which combine, or offset, the assessment from, and the 4 1 distribution due to, a carrier or organized delivery 4 2 system. 4 3 13. A carrier or an organized delivery system may 4 4 petition the association board to seek remedy from 4 5 writing a significantly disproportionate share of 4 6 basic and standard policies in relation to total 4 7 premiums written in this state for health benefit 4 8 plans. Upon a finding that a carrier or organized 4 9 delivery system has written a disproportionate share, 4 10 the board may agree to compensate the carrier or 4 11 organized delivery system either by paying to the 4 12 carrier or organized delivery system an additional fee 4 13 not to exceed two percent of earned premiums from 4 14 basic and standard policies for that carrier or 4 15 organized delivery system or by petitioning the 4 16 commissioner or director, as appropriate for remedy. 4 17 14. a. The commissioner, upon a finding that the 4 18 acceptance of the offer of basic and standard coverage 4 19 by individuals pursuant to this chapter would place 4 20 the carrier in a financially impaired condition, shall 4 21 not require the carrier to offer coverage or accept 4 22 applications for any period of time the financial 4 23 impairment is deemed to exist. 4 24 b. The director, upon a finding that the 4 25 acceptance of the offer of basic and standard coverage 4 26 by individuals pursuant to this chapter would place 4 27 the organized delivery system in a financially 4 28 impaired condition, shall not required the organized 4 29 delivery system to offer coverage or accept 4 30 applications for any period of time the financial 4 31 impairment is deemed to exist." 4 32 #8. Title page, by striking lines 1 through 3 and 4 33 inserting the following: "An Act relating to 4 34 individual health insurance and individual health 4 35 benefit plan reforms." 4 36 #9. By renumbering and relettering as necessary. 4 37 4 38 4 39 4 40 TOM VILSACK 4 41 SF 84.202 76 4 42 mj/jj
Text: S03026 Text: S03028 Text: S03000 - S03099 Text: S Index Bills and Amendments: General Index Bill History: General Index
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