Text: HSB00642 Text: HSB00644 Text: HSB00600 - HSB00699 Text: HSB Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. Section 513C.3, subsection 15, Code Supplement 1 2 2003, is amended by adding the following new unnumbered 1 3 paragraph: 1 4 NEW UNNUMBERED PARAGRAPH. For purposes of this subsection, 1 5 an association policy under chapter 514E is not considered 1 6 "qualifying existing coverage" or "qualifying previous 1 7 coverage". 1 8 Sec. 2. Section 513C.7, subsections 1, 2, and 5, Code 1 9 Supplement 2003, are amended by striking the subsections. 1 10 Sec. 3. Section 513C.8, Code 2003, is amended to read as 1 11 follows: 1 12 513C.8 HEALTH BENEFIT PLAN STANDARDS. 1 13 Thecommissionerboard of directors of the Iowa 1 14 comprehensive health insurance association shall adoptby rule1 15 the form and level of coverage of the basic health benefit 1 16 plan and the standard health benefit plan for the guaranteed 1 17 individual market which shall provide benefits substantially 1 18 similar tothose as provided for under chapter 513B with1 19respect to small group coverage, but which shall be1 20appropriately adjusted at least every three years to reflect1 21 the current state of the individual market. 1 22 Sec. 4. Section 513C.10, subsection 1, paragraph a, Code 1 23 Supplement 2003, is amended to read as follows: 1 24 a. All persons that provide health benefit plans in this 1 25 state including insurers providing accident and sickness 1 26 insurance under chapter 509, 514, or 514A, whether on an 1 27 individual or group basis; fraternal benefit societies 1 28 providing hospital, medical, or nursing benefits under chapter 1 29 512B; and health maintenance organizations, organized delivery 1 30 systems,and allother entities providing health insurance or 1 31 health benefits subject to state insurance regulation, and all 1 32 other insurers as designated by the board of directors of the 1 33 Iowa comprehensive health insurance association with the 1 34 approval of the commissioner shall be members of the 1 35 association. 2 1 Sec. 5. Section 513C.10, subsection 4, Code Supplement 2 2 2003, is amended to read as follows: 2 3 4. The board shall develop procedures and assessment 2 4 mechanisms and make assessments and distributions as required 2 5 to equalize the individual carrier and organized delivery 2 6 system gains or losses so that each carrier or organized 2 7 delivery system receives the same ratio of paid claims to 2 8 ninety percent of earned premiums as the aggregate of all 2 9 basic and standard plans insured by all carriers and organized 2 10 delivery systems in the state. 2 11 Sec. 6. Section 514E.1, subsection 2, Code Supplement 2 12 2003, is amended to read as follows: 2 13 2. "Association policy" means an individual or group 2 14 policy issued by the association that provides the coverage 2 15specified in section 514E.4as set forth in the benefit plans 2 16 adopted by the association's board of directors and approved 2 17 by the commissioner. 2 18 Sec. 7. Section 514E.1, subsections 7, 8, 12, and 22, Code 2 19 Supplement 2003, are amended by striking the subsections. 2 20 Sec. 8. Section 514E.1, subsection 13, Code Supplement 2 21 2003, is amended to read as follows: 2 22 13. "Health care services" means services, the coverage of 2 23 which is authorized under chapter 509, chapter 514, chapter 2 24 514A, or chapter 514B aslimited by sections 514E.4 and 514E.52 25 established by the association's board of directors, and 2 26 includes services for the purposes of preventing, alleviating, 2 27 curing, or healing human illness, injury or physical 2 28 disability. 2 29 Sec. 9. Section 514E.2, subsection 1, unnumbered paragraph 2 30 1, Code Supplement 2003, is amended to read as follows: 2 31 The Iowa comprehensive health insurance association is 2 32 established as a nonprofit corporation. The association shall 2 33 assure that health insurance, aslimited by sections 514E.42 34and 514E.5,established by the association's board of 2 35 directors and subject to the approval of the commissioner, is 3 1 made available to each eligible Iowa resident,andeach 3 2 federally eligible individual applying to the association for 3 3 coverage, and each individual who has been confirmed eligible 3 4 under the federal Trade Adjustment Act of 2002, Pub. L. No. 3 5 107-210, as a recipient under that Act by the department of 3 6 workforce development and the federal internal revenue 3 7 service. The association shall also be responsible for 3 8 administering the Iowa individual health benefit reinsurance 3 9 association pursuant to all of the terms and conditions 3 10 contained in chapter 513C. 3 11 Sec. 10. Section 514E.2, subsection 1, paragraph a, Code 3 12 Supplement 2003, is amended to read as follows: 3 13 a. All carriersas defined in section 514E.1, subsection3 143,and all organized delivery systems licensed by the director 3 15 of public health providing health insurance or health care 3 16 services in Iowa and all other insurers designated by the 3 17 association's board of directors and approved by the 3 18 commissioner shall be members of the association. 3 19 Sec. 11. Section 514E.2, subsection 6, Code Supplement 3 20 2003, is amended by striking the subsection and inserting in 3 21 lieu thereof the following: 3 22 6. Rates for coverages issued by the association shall 3 23 reflect rating characteristics used in the individual 3 24 insurance market. The rates for a given classification shall 3 25 not be more than one hundred fifty percent of the average 3 26 premium or payment rate for the classification charged by the 3 27 five carriers with the largest health insurance premium or 3 28 payment volume in the state during the preceding calendar 3 29 year. In determining the average rate of the five largest 3 30 carriers, the rates or payments charged by the carriers shall 3 31 be actuarially adjusted to determine the rate or payment that 3 32 would have been charged for benefits similar to those issued 3 33 by the association. 3 34 Sec. 12. Section 514E.2, subsection 13, Code Supplement 3 35 2003, is amended by striking the subsection and inserting the 4 1 following: 4 2 13. An insurer may offset an assessment made pursuant to 4 3 this chapter against its premium tax liability pursuant to 4 4 chapter 432 to the extent of twenty percent of the amount of 4 5 the assessment for each of the five calendar years following 4 6 the year in which the assessment was paid. If an insurer 4 7 ceases doing business, all uncredited assessments may be 4 8 credited against its premium tax liability for the year it 4 9 ceases doing business. 4 10 Sec. 13. Section 514E.4, Code 2003, is amended by striking 4 11 the section and inserting in lieu thereof the following: 4 12 514E.4 ASSOCIATION POLICY – COVERAGE AND BENEFIT 4 13 REQUIREMENTS – DEDUCTIBLES – COINSURANCE. 4 14 The association policy shall pay for medically necessary 4 15 eligible health care services as established in the benefit 4 16 plans adopted by the association's board of directors and 4 17 approved by the commissioner. The plans shall provide 4 18 benefits, deductibles, and coinsurance that reflect the 4 19 current state of the individual insurance market. The board 4 20 may modify the benefits provided under the plans to reflect 4 21 the current state of the individual insurance market with the 4 22 approval of the commissioner. 4 23 Sec. 14. Section 514E.7, subsection 1, Code 2003, is 4 24 amended by adding the following new unnumbered paragraph: 4 25 NEW UNNUMBERED PARAGRAPH. The association shall rescind 4 26 coverage for an individual who no longer resides in the state. 4 27 Sec. 15. Section 514E.7, subsection 4, paragraph b, Code 4 28 2003, is amended by adding the following new subparagraph: 4 29 NEW SUBPARAGRAPH. (4) In the case of an individual 4 30 transferring to an association policy from a basic or standard 4 31 health benefit plan under chapter 513C beginning on or after 4 32 January 1, 2005. 4 33 Sec. 16. Section 514E.7, subsection 5, Code 2003, is 4 34 amended by adding the following new paragraph: 4 35 NEW PARAGRAPH. f. The individual is eligible for Medicare 5 1 based upon age. 5 2 Sec. 17. Section 514E.8, subsection 1, Code 2003, is 5 3 amended to read as follows: 5 4 1. An association policy shall contain provisions under 5 5 which the association is obligated to renew the contract until 5 6 the day on which the individualin whose name the contract is5 7issued firstbecomes eligible for Medicare coverage, except5 8that in a family policy covering both husband and wife, the5 9age of the younger spouse shall be used as the basis for5 10meeting the durational requirements of this subsection.5 11However, when the individual in whose name the contract is5 12issued becomes eligible for Medicare coverage, the person5 13shall be eligible for the Medicare supplement plan offered by5 14the associationbased on age. 5 15 Sec. 18. Section 514E.11, Code 2003, is amended to read as 5 16 follows: 5 17 514E.11 NOTICE OF ASSOCIATION POLICY. 5 18 Every carrier, including a health maintenance organization 5 19 subject to chapter 514B and an organized delivery system, 5 20 authorized to provide health care insurance or coverage for 5 21 health care services in Iowa, shall provide a notice of the 5 22 availability of coverage by the association to any person who 5 23 receives a rejection of coverage for health insurance or 5 24 health care services, or a notice to any person who is5 25informed that a rate for health insurance or coverage for5 26health care services will exceed the rate of an association5 27policy,and that the person is eligible to apply for health 5 28 insurance provided by the association. Application for the 5 29 health insurance shall be on forms prescribed by the 5 30 association's board of directors and made available to the 5 31 carriers and organized delivery systems and other entities 5 32 providing health care insurance or coverage for health care 5 33 services regulated by the commissioner. 5 34 Sec. 19. Sections 514E.5 and 514E.6, Code 2003, are 5 35 repealed. 6 1 Sec. 20. EFFECTIVE DATE. The sections of this Act 6 2 amending section 513C.7 and section 514E.2, subsection 13, and 6 3 repealing sections 514E.5 and 514E.6 take effect January 1, 6 4 2005. 6 5 EXPLANATION 6 6 This bill contains provisions related to issues considered 6 7 by the individual health insurance task force, created 6 8 pursuant to House File 647, as passed during the 2003 session 6 9 of the general assembly. The provisions relate to individual 6 10 health insurance market reforms under Code chapter 513C and 6 11 the Iowa comprehensive health insurance association (ICHA) 6 12 governed under Code chapter 514E and address program 6 13 eligibility, benefit design, rate structures, program 6 14 administration, and funding of assessments. 6 15 Regarding program eligibility, the bill modifies Code 6 16 section 513C.3 by specifying that an association policy under 6 17 Code chapter 514E is not considered "qualifying existing 6 18 coverage" or "qualifying previous coverage". Certain 6 19 subsections of Code section 513C.7 regarding basic and 6 20 standard health plans are stricken effective January 1, 2005. 6 21 The bill amends Code section 513C.8 to provide that the 6 22 board of directors of the Iowa comprehensive health insurance 6 23 association, instead of the commissioner, shall adopt forms 6 24 and levels of coverage of basic and standard individual health 6 25 benefit plans for the guaranteed individual market that are 6 26 substantially similar to the current state of the individual 6 27 market. 6 28 The bill amends Code section 513C.10, subsection 1, 6 29 paragraph "a", to provide that all insurers, as designated by 6 30 the board of directors of the Iowa comprehensive health 6 31 insurance association with the approval of the commissioner, 6 32 shall be included as members of the Iowa individual health 6 33 benefit reinsurance association. 6 34 The bill amends Code section 513C.10, subsection 4, to 6 35 provide that the Iowa individual health benefit reinsurance 7 1 association shall develop not only procedures but assessment 7 2 mechanisms to make assessments and distributions as required 7 3 to equalize individual carrier and organized delivery system 7 4 gains or losses. 7 5 The bill amends Code section 514E.7 to limit eligible 7 6 participants to residents, and, due to recommending the sunset 7 7 of basic and standard plans beginning January 1, 2005, to 7 8 allow new participants in the ICHA plan to transfer from a 7 9 basic and standard plan without a limitation on preexisting 7 10 conditions. Code section 514E.11, regarding notification of 7 11 potential eligibility for ICHA, is also modified. The bill 7 12 also modifies Code section 514E.2 related to the federal Trade 7 13 Adjustment Act, Pub. L. No. 107-210, because the ICHA is the 7 14 mechanism designated by the governor pursuant to the trade 7 15 Act. 7 16 Code section 514E.4 is amended relating to the payment of 7 17 medically necessary health care services. The bill also 7 18 addresses the provision of benefits, deductibles, and 7 19 coinsurance reflective of current individual insurance market 7 20 conditions in that Code section. The ICHA board is authorized 7 21 to make benefit changes from time to time to remain current 7 22 with market conditions. Code sections 514E.5 and 514E.6, 7 23 containing lists of excluded expenses and benefit limitations, 7 24 are repealed effective January 1, 2005. Corresponding changes 7 25 are made to delete unused definitions from Code section 7 26 514E.1. Changes are also made to Code section 513C.8 to 7 27 remove an outdated reference to Code chapter 513B, and to Code 7 28 sections 514E.7 and 514E.8 to coordinate that Code language 7 29 with Medicare requirements. 7 30 Regarding rate structures, Code section 514E.2 is amended 7 31 to allow for adjustments in ICHA rates to reflect rating 7 32 characteristics in the marketplace and is amended to allow an 7 33 insurer to offset an assessment made under Code chapter 514E 7 34 against its premium tax liability pursuant to Code chapter 7 35 432. The amendment to Code section 514E.2, subsection 13, 8 1 allowing the offset, takes effect on January 1, 2005. 8 2 With regard to program administration, basic and standard 8 3 plan offerings are eliminated over time, which the bill 8 4 implements through the amendments to Code section 513C.4 and 8 5 repeals of Code sections 513C.5 and 513C.6, effective January 8 6 1, 2005. 8 7 With the exception of those specific provisions noted above 8 8 that take effect on January 1, 2005, the remainder of the bill 8 9 takes effect July 1, 2004. 8 10 LSB 5318DP 80 8 11 av/sh/8
Text: HSB00642 Text: HSB00644 Text: HSB00600 - HSB00699 Text: HSB Index Bills and Amendments: General Index Bill History: General Index
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