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Bills and Amendments: General Index     Bill History: General Index

House Amendment 1326

Amendment Text

PAG LIN
  1  1    Amend House File 701 as follows:
  1  2    #1.  Page 1, by inserting after line 7 the
  1  3 following:
  1  4    "Sec.    .  Section 513B.2, subsection 1, Code
  1  5 1997, is amended to read as follows:
  1  6    1.  "Actuarial certification" means a written
  1  7 statement by a member of the American academy of
  1  8 actuaries or other individual acceptable to the
  1  9 commissioner that a small employer carrier is in
  1 10 compliance with the provisions of section 513B.4,
  1 11 based upon the person's examination, including a
  1 12 review of the appropriate records and of the actuarial
  1 13 assumptions and methods utilized by the small employer
  1 14 carrier in establishing premium rates for applicable
  1 15 health benefit plans insurance coverages."
  1 16    #2.  Page 1, by inserting after line 19 the
  1 17 following:
  1 18    "Sec.    .  Section 513B.2, subsection 6, paragraph
  1 19 a, Code 1997, is amended to read as follows:
  1 20    a.  A distinct grouping may only be established by
  1 21 the small employer carrier on the basis that the
  1 22 applicable health benefit plans insurance coverages
  1 23 meet one or more of the following requirements:
  1 24    (1)  The plans coverages are marketed and sold
  1 25 through individuals and organizations which are not
  1 26 participating in the marketing or sales of other
  1 27 distinct groupings of small employers for the small
  1 28 employer carrier.
  1 29    (2)  The plans coverages have been acquired from
  1 30 another small employer carrier as a distinct grouping
  1 31 of plans.
  1 32    (3)  The plans coverages are provided through an
  1 33 association with membership of not less than fifty
  1 34 small employers which has been formed for purposes
  1 35 other than obtaining insurance.
  1 36    Sec.    .  Section 513B.2, subsection 9, Code 1997,
  1 37 is amended to read as follows:
  1 38    9.  "Eligible employee" means an employee who works
  1 39 on a full-time basis and has a normal work week of
  1 40 thirty or more hours.  The term includes a sole
  1 41 proprietor, a partner of a partnership, and an
  1 42 independent contractor, if the sole proprietor,
  1 43 partner, or independent contractor is included as an
  1 44 employee under a health benefit plan health insurance
  1 45 coverage of a small employer, but does not include an
  1 46 employee who works on a part-time, temporary, or
  1 47 substitute basis."
  1 48    #3.  Page 2, lines 32 and 33, by striking the words
  1 49 and figure "paragraph a, Code 1997, is" and inserting
  1 50 the following:  "paragraphs a, b, and c, Code 1997,
  2  1 are".
  2  2    #4.  Page 3, by inserting after line 9 the
  2  3 following:
  2  4    "b.  The individual is employed by an employer that
  2  5 offers multiple health benefit plans insurance
  2  6 coverages and the individual elects a different plan
  2  7 coverage during an open enrollment period.
  2  8    c.  A court has ordered that coverage be provided
  2  9 for a spouse or minor or dependent child under a
  2 10 covered employee's health benefit plan insurance
  2 11 coverage and the request for enrollment is made within
  2 12 thirty days after issuance of the court order."
  2 13    #5.  Page 3, by inserting after line 18 the
  2 14 following:
  2 15    "Sec.    .  Section 513B.2, subsection 13, Code
  2 16 1997, is amended to read as follows:
  2 17    13.  "New business premium rate" means, for each
  2 18 class of business as to a rating period, the lowest
  2 19 premium rate charged or offered by the small employer
  2 20 carrier to small employers with similar case
  2 21 characteristics for newly issued health benefit plans
  2 22 insurance coverages with the same or similar
  2 23 coverage."
  2 24    #6.  Page 4, by inserting after line 22 the
  2 25 following:
  2 26    "c.  For purposes of this subsection, a partnership
  2 27 which establishes and maintains a plan, fund, or
  2 28 program to provide medical care to present or former
  2 29 partners in the partnership or to their dependents
  2 30 directly or through insurance, reimbursement, or other
  2 31 method, which would not be an employee benefit welfare
  2 32 plan but for this paragraph, shall be treated as an
  2 33 employee benefit welfare plan which is a group health
  2 34 plan.
  2 35    (1)  For purposes of a group health plan, an
  2 36 employer includes the partnership in relation to any
  2 37 partner.
  2 38    (2)  For purposes of a group health plan, the term
  2 39 "participant" also includes both of the following:
  2 40    (a)  An individual who is a partner in relation to
  2 41 a partnership which maintains a group health plan.
  2 42    (b)  An individual who is a self-employed
  2 43 individual in connection with a group health plan
  2 44 maintained by the self-employed individual where one
  2 45 or more employees are participants, if the individual
  2 46 is or may become eligible to receive a benefit under
  2 47 the plan or the individual's beneficiaries may be
  2 48 eligible to receive a benefit."
  2 49    #7.  Page 4, by inserting after line 31 the
  2 50 following:
  3  1    "Sec.    .  Section 513B.3, subsection 3, Code
  3  2 1997, is amended to read as follows:
  3  3    3.  The health benefit plan insurance coverage is
  3  4 treated by the employer or any of the eligible
  3  5 employees or dependents as part of a plan coverage or
  3  6 program for the purposes of section 106, 125, or 162
  3  7 of the Internal Revenue Code as defined in section
  3  8 422.3.
  3  9    Sec.    .  Section 513B.3, subsection 4, paragraphs
  3 10 a and c, Code 1997, are amended to read as follows:
  3 11    a.  Except as provided in paragraph "b", for
  3 12 purposes of this subchapter, carriers that are
  3 13 affiliated companies or that are eligible to file a
  3 14 consolidated tax return shall be treated as one
  3 15 carrier and any restrictions or limitations imposed by
  3 16 this subchapter shall apply as if all health benefit
  3 17 plans insurance coverages delivered or issued for
  3 18 delivery to small employers in this state by such
  3 19 carriers were issued by one carrier.
  3 20    c.  Unless otherwise authorized by the
  3 21 commissioner, a small employer carrier shall not enter
  3 22 into one or more ceding arrangements with respect to
  3 23 health benefit plans insurance coverages delivered or
  3 24 issued for delivery to small employers in this state
  3 25 if the arrangements would result in less than fifty
  3 26 percent of the insurance obligation or risk for such
  3 27 health benefit plans insurance coverages being
  3 28 retained by the ceding carrier.
  3 29    Sec.    .  Section 513B.4, subsection 1, paragraph
  3 30 c, subparagraph (1), Code 1997, is amended to read as
  3 31 follows:
  3 32    (1)  The percentage change in the new business
  3 33 premium rate measured from the first day of the prior
  3 34 rating period to the first day of the new rating
  3 35 period.  In the case of a class of business for which
  3 36 the small employer carrier is not issuing new
  3 37 policies, the small employer carrier shall use the
  3 38 percentage change in the base premium rate, provided
  3 39 that the change does not exceed, on a percentage
  3 40 basis, the change in the new business premium rate for
  3 41 the most similar health benefit plan insurance
  3 42 coverage into which the small employer carrier is
  3 43 actively enrolling new insureds who are small
  3 44 employers.
  3 45    Sec.    .  Section 513B.4, subsection 1, paragraph
  3 46 d, Code 1997, is amended to read as follows:
  3 47    d.  In the case of health benefit plans insurance
  3 48 coverages issued prior to July 1, 1991, a premium rate
  3 49 for a rating period may exceed the ranges described in
  3 50 subsection 1, paragraph "a" or "b", for a period of
  4  1 three years following July 1, 1992.  In such case, the
  4  2 percentage increase in the premium rate charged to a
  4  3 small employer in such a class of business for a new
  4  4 rating period may not exceed the sum of the following:
  4  5    (1)  The percentage change in the new business
  4  6 premium rate measured from the first day of the prior
  4  7 rating period to the first day of the new rating
  4  8 period.  In the case of a class of business for which
  4  9 the small employer carrier is not issuing new
  4 10 policies, the small employer carrier shall use the
  4 11 percentage change in the base premium rate, provided
  4 12 that the change does not exceed, on a percentage
  4 13 basis, the change in the new business premium rate for
  4 14 the most similar health benefit plan insurance
  4 15 coverage into which the small employer carrier is
  4 16 actively enrolling new insureds who are small
  4 17 employers.
  4 18    (2)  Any adjustment due to change in coverage or
  4 19 change in the case characteristics of the small
  4 20 employer as determined from the small employer
  4 21 carrier's rate manual for the class of business.
  4 22    Sec.    .  Section 513B.4, subsection 3, unnumbered
  4 23 paragraph 3, Code 1997, is amended to read as follows:
  4 24    Rating factors shall produce premiums for identical
  4 25 groups which differ only by amounts attributable to
  4 26 plan coverage design and do not reflect differences
  4 27 due to the nature of the groups assumed to select
  4 28 particular health benefit plans.  A small employer
  4 29 carrier shall treat all health benefit plans insurance
  4 30 coverages issued or renewed in the same calendar month
  4 31 as having the same rating period.
  4 32    Sec.    .  Section 513B.4, subsection 4, Code 1997,
  4 33 is amended to read as follows:
  4 34    4.  For purposes of this section, a health benefit
  4 35 plan insurance coverage that contains a restricted
  4 36 network provision shall not be considered similar
  4 37 coverage to a health benefit plan insurance coverage
  4 38 that does not contain such a provision, if the
  4 39 restriction of benefits to network providers results
  4 40 in substantial differences in claims costs.
  4 41    Sec.    .  Section 513B.4A, Code 1997, is amended
  4 42 to read as follows:
  4 43    513B.4A  EXEMPTION FROM PREMIUM RATE RESTRICTIONS.
  4 44    A Taft-Hartley trust or a carrier with the written
  4 45 authorization of such a trust may make a written
  4 46 request to the commissioner for an exemption from the
  4 47 application of any provisions of section 513B.4 with
  4 48 respect to a health benefit plan health insurance
  4 49 coverage provided to such a trust.  The commissioner
  4 50 may grant an exemption if the commissioner finds that
  5  1 application of section 513B.4 with respect to the
  5  2 trust would have a substantial adverse effect on the
  5  3 participants and beneficiaries of such trust, and
  5  4 would require significant modifications to one or more
  5  5 collective bargaining arrangements under which the
  5  6 trust is established or maintained.  An exemption
  5  7 granted under this section shall not apply to an
  5  8 individual if the individual participates in a trust
  5  9 as an associate member of an employee organization."
  5 10    #8.  Page 7, by inserting after line 19 the
  5 11 following:
  5 12    "Sec.    .  Section 513B.6, unnumbered paragraph 1,
  5 13 Code 1997, is amended to read as follows:
  5 14    A small employer carrier or organized delivery
  5 15 system shall make reasonable disclosure in
  5 16 solicitation and sales materials provided to small
  5 17 employers of all of the following:
  5 18    Sec.    .  Section 513B.6, subsection 2, Code 1997,
  5 19 is amended to read as follows:
  5 20    2.  The provisions concerning the small employer
  5 21 carrier's or organized delivery system's right to
  5 22 change premium rates and factors, including case
  5 23 characteristics, which affect changes in premium
  5 24 rates.
  5 25    Sec.    .  Section 513B.7, Code 1997, is amended to
  5 26 read as follows:
  5 27    513B.7  MAINTENANCE OF RECORDS.
  5 28    1.  A small employer carrier or organized delivery
  5 29 system shall maintain at its principal place of
  5 30 business a complete and detailed description of its
  5 31 rating practices and renewal underwriting practices,
  5 32 including information and documentation which
  5 33 demonstrate that its rating methods and practices are
  5 34 based upon commonly accepted actuarial assumptions and
  5 35 are in accordance with sound actuarial principles.
  5 36    2.  A small employer carrier or organized delivery
  5 37 system shall file each March 1 with the commissioner
  5 38 or director an actuarial certification that the small
  5 39 employer carrier or organized delivery system is in
  5 40 compliance with this section and that the rating
  5 41 methods of the small employer carrier or organized
  5 42 delivery system are actuarially sound.  A copy of the
  5 43 certification shall be retained by the small employer
  5 44 carrier or organized delivery system at its principal
  5 45 place of business.
  5 46    3.  A small employer carrier or organized delivery
  5 47 system shall make the information and documentation
  5 48 described in subsection 1 available to the
  5 49 commissioner or organized delivery system upon
  5 50 request.  The information is not a public record or
  6  1 otherwise subject to disclosure under chapter 22, and
  6  2 is considered proprietary and trade secret information
  6  3 and is not subject to disclosure by the commissioner
  6  4 or director to persons outside of the division or
  6  5 department except as agreed to by the small employer
  6  6 carrier or organized delivery system or as ordered by
  6  7 a court of competent jurisdiction."
  6  8    #9.  Page 7, by striking lines 21 and 22 and
  6  9 inserting the following:
  6 10    "A carrier or organized delivery system offering
  6 11 group health insurance coverage".
  6 12    #10.  Page 7, line 25, by striking the word "plan"
  6 13 and inserting the following:  "coverage".
  6 14    #11.  Page 8, by striking line 3, and inserting the
  6 15 following:
  6 16    "2.  Subsection 1 does not require".
  6 17    #12.  Page 8, line 5, by striking the words "plan
  6 18 or".
  6 19    #13.  Page 8, line 6, by striking the words "plan
  6 20 or".
  6 21    #14.  Page 8, line 9, by striking the words "plan
  6 22 or".
  6 23    #15.  Page 8, by striking lines 10 and 11 and
  6 24 inserting the following:
  6 25    "3.  Rules for eligibility to enroll under group
  6 26 health insurance coverage include rules defining".
  6 27    #16.  Page 8, by striking lines 13 and 14 and
  6 28 inserting the following:
  6 29    "4.  a.  A carrier or organized delivery system
  6 30 offering health insurance coverage".
  6 31    #17.  Page 8, line 16, by striking the word "plan"
  6 32 and inserting the following:  "coverage".
  6 33    #18.  Page 8, line 18, by striking the word "plan"
  6 34 and inserting the following:  "coverage".
  6 35    #19.  Page 8, line 21, by striking the word "plan"
  6 36 and inserting the following:  "coverage".
  6 37    #20.  Page 8, by striking line 25 and inserting the
  6 38 following:  "for health insurance coverage."
  6 39    #21.  Page 9, line 6, by striking the words "group
  6 40 health plan" and inserting the following:  "health
  6 41 insurance coverage".
  6 42    #22.  Page 9, line 20, by striking the words ", if
  6 43 required,".
  6 44    #23.  Page 10, line 4, by striking the words ", if
  6 45 required,".
  6 46    #24.  Page 10, lines 17 and 18, by striking the
  6 47 words "in connection with group health plans".
  6 48    #25.  Page 10, line 19, by striking the words
  6 49 "group health plans" and inserting the following:
  6 50 "health insurance coverages".
  7  1    #26.  Page 10, lines 31 and 32, by striking the
  7  2 words "in connection with a group health plan".
  7  3    #27.  Page 11, line 12, by inserting after the word
  7  4 "carrier" the following:  "or organized delivery
  7  5 system".
  7  6    #28.  Page 12, line 8, by striking the words "group
  7  7 health plan and a".
  7  8    #29.  Page 15, by inserting after line 19 the
  7  9 following:
  7 10    "Sec.    .  Section 513B.11, subsection 2, Code
  7 11 1997, is amended to read as follows:
  7 12    2.  A reinsuring carrier that applies and is
  7 13 approved to operate as a risk-assuming carrier shall
  7 14 not be permitted to continue to reinsure any health
  7 15 benefit plan insurance coverage with the program.  The
  7 16 carrier shall pay a prorated assessment based upon
  7 17 business issued as a reinsuring carrier for any
  7 18 portion of the year that the business was reinsured.
  7 19    Sec.    .  Section 513B.13, subsection 7,
  7 20 unnumbered paragraph 1, Code 1997, is amended to read
  7 21 as follows:
  7 22    The same general powers and authority granted under
  7 23 the laws of this state to insurance companies and
  7 24 health maintenance organizations licensed to transact
  7 25 business in this state may be exercised by the board
  7 26 under the program, except the power to issue health
  7 27 benefit plans insurance coverages directly to either
  7 28 groups or individuals.  Additionally, the board is
  7 29 granted the specific authority to do all or any of the
  7 30 following:
  7 31    Sec.    .  Section 513B.13, subsection 7, paragraph
  7 32 d, Code 1997, is amended to read as follows:
  7 33    d.  Define the health benefit plans insurance
  7 34 coverages for which reinsurance will be provided, and
  7 35 issue reinsurance policies, pursuant to this
  7 36 subchapter.
  7 37    Sec.    .  Section 513B.13, subsection 8, paragraph
  7 38 b, Code 1997, is amended to read as follows:
  7 39    b.  A small employer carrier may reinsure an entire
  7 40 employer group within sixty days of the commencement
  7 41 of the group's coverage under a health benefit plan
  7 42 health insurance coverage.
  7 43    Sec.    .  Section 513B.13, subsection 9, paragraph
  7 44 a, Code 1997, is amended to read as follows:
  7 45    a.  The board, as part of the plan of operation,
  7 46 shall establish a methodology for determining premium
  7 47 rates to be charged by the program for reinsuring
  7 48 small employers and individuals pursuant to this
  7 49 section.  The methodology shall include a system for
  7 50 classification of small employers that reflects the
  8  1 types of case characteristics commonly used by small
  8  2 employer carriers in the state.  The methodology shall
  8  3 provide for the development of base reinsurance
  8  4 premium rates, which shall be multiplied by the
  8  5 factors set forth in paragraph "b" to determine the
  8  6 premium rates for the program.  The base reinsurance
  8  7 premium rates shall be established by the board,
  8  8 subject to the approval of the commissioner, and shall
  8  9 be set at levels which reasonably approximate gross
  8 10 premiums charged to small employers by small employer
  8 11 carriers for health benefit plans insurance coverages
  8 12 with benefits similar to the standard health benefit
  8 13 plan.
  8 14    Sec.    .  Section 513B.13, subsection 10, Code
  8 15 1997, is amended to read as follows:
  8 16    10.  If a health benefit plan health insurance
  8 17 coverage for a small employer is entirely or partially
  8 18 reinsured with the program, the premium charged to the
  8 19 small employer for any rating period for the coverage
  8 20 issued shall meet the requirements relating to premium
  8 21 rates set forth in section 513B.4.
  8 22    Sec.    .  Section 513B.13, subsection 11,
  8 23 paragraph b, subparagraphs (1), (2), and (3), Code
  8 24 1997, are amended to read as follows:
  8 25    (1)  The board shall establish, as part of the plan
  8 26 of operation, a formula by which to make assessments
  8 27 against reinsuring carriers.  The assessment formula
  8 28 shall be based on both of the following:
  8 29    (a)  Each reinsuring carrier's share of the total
  8 30 premiums earned in the preceding calendar year from
  8 31 health benefit plans insurance coverages delivered or
  8 32 issued for delivery to small employers in this state
  8 33 by reinsuring carriers.
  8 34    (b)  Each reinsuring carrier's share of the
  8 35 premiums earned in the preceding calendar year from
  8 36 newly issued health benefit plans insurance coverages
  8 37 delivered or issued for delivery during such calendar
  8 38 year to small employers in this state by reinsuring
  8 39 carriers.
  8 40    (2)  The formula established pursuant to
  8 41 subparagraph (1) shall not result in any reinsuring
  8 42 carrier having an assessment share that is less than
  8 43 fifty percent nor more than one hundred fifty percent
  8 44 of an amount which is based on the proportion of the
  8 45 reinsuring carrier's total premiums earned in the
  8 46 preceding calendar year from health benefit plans
  8 47 insurance coverages delivered or issued for delivery
  8 48 to small employers in this state by reinsuring
  8 49 carriers to total premiums earned in the preceding
  8 50 calendar year from health benefit plans insurance
  9  1 coverages delivered or issued for delivery to small
  9  2 employers in this state by all reinsuring carriers.
  9  3    (3)  The board, with approval of the commissioner,
  9  4 may change the assessment formula established pursuant
  9  5 to subparagraph (1) from time to time as appropriate.
  9  6 The board may provide for the shares of the assessment
  9  7 base attributable to premiums from all health benefit
  9  8 plans insurance coverages and to premiums from newly
  9  9 issued health benefit plans insurance coverages to
  9 10 vary during a transition period.
  9 11    Sec.    .  Section 513B.13, subsection 11,
  9 12 paragraph c, subparagraph (3), Code 1997, is amended
  9 13 to read as follows:
  9 14    (3)  For any calendar year, the amount specified in
  9 15 this subparagraph is five percent of total premiums
  9 16 earned in the previous year from health benefit plans
  9 17 insurance coverages delivered or issued for delivery
  9 18 to small employers in this state by reinsuring
  9 19 carriers.
  9 20    Sec.    .  Section 513B.15, Code 1997, is amended
  9 21 to read as follows:
  9 22    513B.15  PERIODIC MARKET EVALUATION.
  9 23    The board shall study and report at least every
  9 24 three years to the commissioner on the effectiveness
  9 25 of this subchapter.  The report shall analyze the
  9 26 effectiveness of the subchapter in promoting rate
  9 27 stability, product availability, and coverage
  9 28 affordability.  The report may contain recommendations
  9 29 for actions to improve the overall effectiveness,
  9 30 efficiency, and fairness of the small group health
  9 31 insurance marketplace.  The report shall address
  9 32 whether carriers and producers are fairly and actively
  9 33 marketing or issuing health benefit plans insurance
  9 34 coverages to small employers in fulfillment of the
  9 35 purposes of this subchapter.  The report may contain
  9 36 recommendations for market conduct or other regulatory
  9 37 standards or action."
  9 38    #30.  Page 15, by inserting after line 25 the
  9 39 following:
  9 40    "Sec.    .  Section 513B.17A, Code 1997, is amended
  9 41 to read as follows:
  9 42    513B.17A  RESTORATION OF TERMINATED COVERAGE.
  9 43    The commissioner may adopt rules to require small
  9 44 employer carriers, as a condition of transacting
  9 45 business with small employers in this state after July
  9 46 1, 1993, to reissue a health benefit plan health
  9 47 insurance coverage to any small employer whose health
  9 48 benefit plan insurance coverage is terminated or not
  9 49 renewed by a carrier after January 1, 1993, unless the
  9 50 carrier's termination is pursuant to section 513B.5.
 10  1 The commissioner may prescribe such terms for the
 10  2 reissuance of coverage as the commissioner finds are
 10  3 reasonable and necessary to provide continuity of
 10  4 coverage to such employers."
 10  5    #31.  Page 18, by inserting after line 6 the
 10  6 following:
 10  7    "6.  A carrier or organized delivery system
 10  8 offering coverage through a bona fide association is
 10  9 not required to renew a continue in force coverage or
 10 10 to accept applications from an individual through an
 10 11 association if the membership of the individual in the
 10 12 association on which the basis of coverage is provided
 10 13 ceases, but only if the coverage is not offered or
 10 14 terminated under this paragraph uniformly without
 10 15 regard to health status-related factors of a covered
 10 16 individual."
 10 17    #32.  Page 19, line 11, by striking the words "as
 10 18 the same" and inserting the following:  "the same as".
 10 19    #33.  Page 20, line 3, by striking the words "any
 10 20 of".
 10 21    #34.  Page 21, line 35, by striking the words "in
 10 22 the".
 10 23    #35.  Page 22, line 1, by striking the words
 10 24 "individual market".
 10 25    #36.  Page 22, line 3, by striking the words
 10 26 "Individual health" and inserting the following:
 10 27 "Health".
 10 28    #37.  Page 22, line 19, by striking the words
 10 29 "Individual health" and inserting the following:
 10 30 "Health".
 10 31    #38.  Page 22, line 26, by striking the words
 10 32 "Individual health" and inserting the following:
 10 33 "Health".
 10 34    #39.  Page 22, line 32, by striking the words
 10 35 "Individual health" and inserting the following:
 10 36 "Health".
 10 37    #40.  Page 23, by inserting after line 33 the
 10 38 following:
 10 39    "Sec.    .  Section 514E.2, subsection 2,
 10 40 unnumbered paragraph 1, Code 1997, is amended to read
 10 41 as follows:
 10 42    The board of directors of the association shall
 10 43 consist of four members selected by the members of the
 10 44 association, two of whom shall be representatives from
 10 45 corporations operating pursuant to chapter 514 on July
 10 46 1, 1989, or any successors in interest, and two of
 10 47 whom shall be representatives of organized delivery
 10 48 systems or insurers providing coverage pursuant to
 10 49 chapter 509 or 514A; four public members selected by
 10 50 the governor; the commissioner or the commissioner's
 11  1 designee from the division of insurance; and two
 11  2 members of the general assembly, one of whom shall be
 11  3 appointed by the speaker of the house and one of whom
 11  4 shall be appointed by the president of the senate,
 11  5 after consultation with the majority leader and the
 11  6 minority leader of the senate, who shall be ex officio
 11  7 and nonvoting members.  The composition of the board
 11  8 of directors shall be in compliance with sections
 11  9 69.16 and 69.16A.  The governor's appointees shall be
 11 10 chosen from a broad cross-section of the residents of
 11 11 this state.
 11 12    Sec.    .  Section 514E.2, subsection 3, paragraph
 11 13 f, Code 1997, is amended by striking the paragraph.
 11 14    Sec.    .  Section 514E.2, subsection 7, Code 1997,
 11 15 is amended to read as follows:
 11 16    7.  Following the close of each calendar year, the
 11 17 association shall determine the net premiums and
 11 18 payments, the expenses of administration, and the
 11 19 incurred losses of the association for the year.  The
 11 20 association shall certify the amount of any net loss
 11 21 for the preceding calendar year to the commissioner of
 11 22 insurance and director of revenue and finance who
 11 23 shall make payment to the association according to
 11 24 procedures established under subsection 3, paragraph
 11 25 "f".  Any remaining loss, after payment to the
 11 26 association from the health insurance trust fund,
 11 27 shall be assessed by the association to all members in
 11 28 proportion to their respective shares of total health
 11 29 insurance premiums or payments for subscriber
 11 30 contracts received in Iowa during the second preceding
 11 31 calendar year, or with paid losses in the year,
 11 32 coinciding with or ending during the calendar year or
 11 33 on any other equitable basis as provided in the plan
 11 34 of operation.  In sharing losses, the association may
 11 35 abate or defer in any part the assessment of a member,
 11 36 if, in the opinion of the board, payment of the
 11 37 assessment would endanger the ability of the member to
 11 38 fulfill its contractual obligations.  The association
 11 39 may also provide for an initial or interim assessment
 11 40 against members of the association if necessary to
 11 41 assure the financial capability of the association to
 11 42 meet the incurred or estimated claims expenses or
 11 43 operating expenses of the association until the next
 11 44 calendar year is completed.  Net gains, if any, must
 11 45 be held at interest to offset future losses or
 11 46 allocated to reduce future premiums."
 11 47    #41.  Page 23, by inserting after line 35 the
 11 48 following:
 11 49    "Sec.    .  Section 514E.5, subsection 2, Code
 11 50 1997, is amended to read as follows:
 12  1    2.  Services and charges made for benefits provided
 12  2 under the laws of the United States, including
 12  3 excluding Medicare and Medicaid, military service-
 12  4 connected disabilities, but including medical services
 12  5 provided for members of the armed forces and their
 12  6 dependents or for employees of the armed forces of the
 12  7 United States, and medical services financed on behalf
 12  8 of all citizens by the United States.
 12  9    However, the association policy shall pay benefits
 12 10 as a primary payer in any case where benefit coverage
 12 11 provided under the laws of the United States,
 12 12 including Medicare and Medicaid, or under the laws of
 12 13 this state is, by rule or statute, secondary to all
 12 14 other coverages."
 12 15    #42.  Page 24, line 19, by inserting after the word
 12 16 "carrier" the following:  "or organized delivery
 12 17 system".
 12 18    #43.  Page 24, line 20, by inserting after the word
 12 19 "carrier" the following:  "or organized delivery
 12 20 system".
 12 21    #44.  Page 24, line 24, by inserting after the word
 12 22 "carrier" the following:  "or organized delivery
 12 23 system".
 12 24    #45.  Page 27, by inserting after line 9 the
 12 25 following:
 12 26    "Sec.    .  Section 514E.3, Code 1997, is
 12 27 repealed."
 12 28    #46.  By renumbering as necessary.  
 12 29 
 12 30 
 12 31                               
 12 32 DIX of Butler
 12 33 HF 701.202 77
 12 34 mj/jj/28
     

Text: H01325                            Text: H01327
Text: H01300 - H01399                   Text: H Index
Bills and Amendments: General Index     Bill History: General Index

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