House File 790 - Enrolled

PAG LIN



  1  1                                             HOUSE FILE 790
  1  2
  1  3                             AN ACT
  1  4 ALLOWING CERTAIN ASSOCIATION GROUP HEALTH CARE PLANS AND
  1  5    WELLNESS INITIATIVES, AND PROVIDING AN EFFECTIVE DATE.
  1  6
  1  7 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
  1  8
  1  9                           DIVISION I
  1 10               ASSOCIATION GROUP HEALTH CARE PLANS
  1 11    Section 1.  Section 509.1, Code 2007, is amended by adding
  1 12 the following new subsection:
  1 13    NEW SUBSECTION.  7A.  A policy of group health insurance
  1 14 coverage, as defined in section 513B.2, issued by a small
  1 15 employer carrier, as defined in section 513B.2, to a bona fide
  1 16 association, subject to the following requirements:
  1 17    a.  The policy provides group health insurance coverage to
  1 18 eligible employees of members of a bona fide association that
  1 19 are small employers as defined in section 513B.2, and to the
  1 20 spouses and dependents of such employees.
  1 21    b.  The policy is issued to a bona fide association.  For
  1 22 the purposes of this subsection, a bona fide association is an
  1 23 association which meets all of the following requirements:
  1 24    (1)  The association is a trade, industry, or professional
  1 25 association which is organized in good faith as a nonprofit
  1 26 corporation under chapter 504 for purposes other than
  1 27 obtaining insurance and has been in existence and actively
  1 28 maintained for at least five continuous years at the time the
  1 29 policy is issued.
  1 30    (2)  The association does not condition membership in the
  1 31 association on the health status of employees of its members
  1 32 or the health status of the spouses and dependents of such
  1 33 employees.
  1 34    (3)  Group health insurance coverage offered by the
  1 35 association is available to all eligible employees of its
  2  1 members that are small employers as defined in section 513B.2
  2  2 who choose to participate in the health insurance coverage
  2  3 offered, and to the spouses and dependents of such employees,
  2  4 regardless of the health status of such employees or their
  2  5 spouses and dependents.
  2  6    (4)  Group health insurance coverage offered by the
  2  7 association is available only to persons who are eligible
  2  8 employees of a small employer as defined in section 513B.2
  2  9 that is a member of the association, or to the spouses or
  2 10 dependents of such employees.
  2 11    Sec. 2.  Section 509.1, subsection 8, unnumbered paragraph
  2 12 1, Code 2007, is amended to read as follows:
  2 13    A policy issued to a resident of this state under a group
  2 14 life, accident, or health insurance policy issued to a group
  2 15 other than one described in subsections 1 through 7 7A,
  2 16 subject to the following requirements:
  2 17    Sec. 3.  Section 513B.2, subsection 6, paragraph a,
  2 18 subparagraph (3), Code 2007, is amended by striking the
  2 19 subparagraph and inserting in lieu thereof the following:
  2 20    (3)  The coverages are provided by a policy of group health
  2 21 insurance coverage through a bona fide association as provided
  2 22 in section 509.1, subsection 7A, which meets the requirements
  2 23 for a class of business under section 513B.4.  A small
  2 24 employer carrier may condition coverages under such a policy
  2 25 of group health insurance coverage on any of the following
  2 26 requirements:
  2 27    (a)  Minimum levels of participation by employees of each
  2 28 member of a bona fide association that offers the coverage to
  2 29 its employees.
  2 30    (b)  Minimum levels of contribution by each member of a
  2 31 bona fide association that offers the coverage to its
  2 32 employees.
  2 33    (c)  A specified policy term, subject to annual premium
  2 34 rate adjustments as permitted by section 513B.4.
  2 35    Sec. 4.  Section 513B.2, subsection 6, paragraph a, Code
  3  1 2007, is amended by adding the following new subparagraph:
  3  2    NEW SUBPARAGRAPH.  (4)  The coverages are provided by a
  3  3 policy of group health insurance coverage through two or more
  3  4 bona fide associations as provided in section 509.1,
  3  5 subsection 7A, which a small employer carrier has aggregated
  3  6 as a distinct grouping that meets the requirements for a class
  3  7 of business under section 513B.4.  After a distinct grouping
  3  8 of bona fide associations is established as a class of
  3  9 business, the small group carrier shall not remove a bona fide
  3 10 association from the class based on the claims experience of
  3 11 that association.  A small employer carrier may condition
  3 12 coverages under such a policy of group health insurance
  3 13 coverage on any of the following requirements:
  3 14    (a)  Minimum levels of participation by employees of each
  3 15 member of a bona fide association in the class that offers the
  3 16 coverage to its employees.
  3 17    (b)  Minimum levels of contribution by each member of a
  3 18 bona fide association in the class that offers the coverage to
  3 19 its employees.
  3 20    (c)  A specified policy term, subject to annual premium
  3 21 rate adjustments as permitted by section 513B.4.
  3 22    Sec. 5.  Section 513B.2, subsection 6, paragraph b, Code
  3 23 2007, is amended to read as follows:
  3 24    b.  A small employer carrier may establish no more than two
  3 25 additional groupings under each of the subparagraphs in
  3 26 paragraph "a" on the basis of underwriting criteria which are
  3 27 expected to produce substantial variation in the health care
  3 28 costs.
  3 29                           DIVISION II
  3 30                      WELLNESS INITIATIVES
  3 31    Sec. 6.  Section 513B.4, Code 2007, is amended by adding
  3 32 the following new subsection:
  3 33    NEW SUBSECTION.  6.  Notwithstanding subsection 4, a small
  3 34 employer carrier may offer to transfer a small employer into a
  3 35 different class of business with a lower index rate based upon
  4  1 claims experience, implementation of managed care or wellness
  4  2 programs, or health status improvement of the small employer
  4  3 since issue.
  4  4    Sec. 7.  NEW SECTION.  513B.4B  SMALL EMPLOYER INCENTIVES
  4  5 == SUSPENSION OR MODIFICATION OF PREMIUM RATE RESTRICTIONS.
  4  6    1.  In order to encourage voluntary participation in
  4  7 wellness or disease management programs, a small employer
  4  8 carrier may offer premium credits or discounts to a small
  4  9 employer for the benefit of eligible employees of that small
  4 10 employer who participate in such a program.  An employee shall
  4 11 not be penalized in any way for not participating in such a
  4 12 program.
  4 13    2.  The commissioner shall adopt, by rule or order,
  4 14 provisions allowing suspension or modification of premium rate
  4 15 restrictions to enable a small employer carrier to provide
  4 16 premium credits or discounts to a small employer based on
  4 17 measurable reductions in costs of that small employer,
  4 18 including but not limited to tobacco use cessation,
  4 19 participation in established wellness or disease management
  4 20 programs, and economies of acquisition or administration.
  4 21                          DIVISION III
  4 22                         EFFECTIVE DATE
  4 23    Sec. 8.  EFFECTIVE DATE.  This Act, being deemed of
  4 24 immediate importance, takes effect upon enactment.
  4 25
  4 26
  4 27                                                             
  4 28                               PATRICK J. MURPHY
  4 29                               Speaker of the House
  4 30
  4 31
  4 32                                                             
  4 33                               JOHN P. KIBBIE
  4 34                               President of the Senate
  4 35
  5  1    I hereby certify that this bill originated in the House and
  5  2 is known as House File 790, Eighty=second General Assembly.
  5  3
  5  4
  5  5                                                             
  5  6                               MARK BRANDSGARD
  5  7                               Chief Clerk of the House
  5  8 Approved                , 2007
  5  9
  5 10
  5 11                            
  5 12 CHESTER J. CULVER
  5 13 Governor