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
Iowa General Assembly
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