AN ACT relating to health insurance, making an appropriation therefor, and declaring an emergency.
     Create new sections of Subtitle 17A of KRS Chapter 304 on health insurance to require guarantee issue for small groups; require group plans to comply with federal law on pre-existing conditions; prohibit use of pre-existing conditions exclusions for eligible individuals under federal law; restrict individual plans for individuals who are not eligible individuals to pre-existing condition provision in federal law for small groups; provide for guaranteed renewal of all health insurance policies with exceptions; require the commissioner to define one standard plan by December 31, 1997 for use in the individual and small group markets; require individual and small group insurers to offer the standard plan; permit insurers to offer other plans; require applicants in the individual and small group markets be given a benefits comparison of the standard plan to the plan being offered to the applicant; permit insurers that on or after July 15, 1995, sold standard plans and then stopped doing business in the state to return to the state without penalty; amend KRS 304.17A-095 to require a copy of rate filings be submitted to the Attorney General; delete the requirement of a mandatory rate hearing if premium increase exceeds increase in consumer price index; require a hearing upon written request of the Attorney General; permit immediate use of rates if filing includes a minimum loss ratio guarantee of 65 percent for individuals and groups of 2 to 10 and 70 percent for groups of 11 to 50; create a new section of Subtitle 17A of KRS Chapter 304 to establish health insurance rating methodology for individuals, small groups, associations, and alliances; provide that premium rates for individuals with similar case characteristics for same coverage cannot vary from the index rate by more than 35 percent of the index rate; provide rating methodology for percentage increase in premium rates charged to an individual for a new rating period; provide rating methodology for plans issued to high risk individuals from July 15, 1995 until the effective date of this Act; provide that premium rates for small group and association members with similar case characteristics for the similar coverage cannot vary from the index rate by more than 25 percent of the index rate; provide rating methodology for percentage increase in premium rates charged to small groups and association members for a new rating period; prohibit use of case characteristics other than age, gender, occupation or industry, geographic area, family composition, and group size without prior approval of the commissioner; provide that the ratio of the highest rate factor to the lowest rate factor within a class of business cannot exceed 5 to 1; provide that the index rate for any class of business cannot exceed the index rate for any other class of business in that market segment by more than 20 percent; allow commissioner to approve additional classes of business; prohibit rate adjustments for claims experience, health status, and duration of coverage for an individual group member or his dependents; create a new section of Subtitle 17A of KRS Chapter 304 to create a rating methodology for employer-organized association health plans; prohibit the Kentucky Health Purchasing Alliance from issuing or renewing any business after January 1, 1998; require commissioner to assist Alliance members with finding coverage in the private market; prohibit a health insurer from discriminating against any provider who is willing to meet the terms and conditions for participation in the plan; establish the Kentucky Comprehensive Health Insurance Plan; require the Governor to appoint a six-member board for the plan and require the commissioner to serve as chair of the board; require all health insurers to participate in the plan; require the plan to issue policies no later than 6 months after the effective date of the Act; require policies to be guaranteed issue to eligible individuals; provide that eligible individuals under federal law are eligible for the plan and other individuals must be a resident of the state for 12 months and be rejected by two insurers or offered coverage by two insurers at a premium higher than the plan premium or have a high-cost condition; require the commissioner to establish a list of high-cost conditions; limit lifetime benefits under plan coverage to $1,000,000; require the board to establish and annually update provider reimbursement rates and prohibit board from authorizing contracts that allow health care providers to bill insureds for plan services in excess of that amount; require the board to select an insurer to administer the plan; require the plan to offer three health benefit plans; provide that rates for plan coverage for previously insured individuals cannot exceed 135 percent of individual standard risk rate and 150 percent for persons without previous coverage; establish the Kentucky Comprehensive Health Insurance Plan Fund in the State Treasury; require premium taxes in excess of those collected in 1997 to be remitted to the board; amend KRS 304.17A-130 to establish a risk adjustment process to collect and distribute funds from insurers to equalize risks between insurers and the Kentucky Comprehensive Health Insurance Plan; prohibit non-state employee small groups from renewing coverage under the state self-insured plan; allow non-state employee individuals to renew coverage under the state self-insured plan; permit renewal of plans under the state buy-in program at specified rates; require the Department of Personnel to establish a fund separate from the state employee benefit fund for persons covered under the state self-insured fund who are not state employees; require insurers to disclose certain information to enrollees; require managed care plans to provide telephone access, reasonable standards for waiting times for appointments, coverage for emergency room screening and stabilization without prior authorization, and a policy for termination of providers; prohibit providers from being penalized for disclosure of certain information; require plans to have drug utilization review; require a denial letter be sent to enrollee within 20 days of denial of coverage for experimental services; require plans to appoint a physician as medical director; establish a patient's right of privacy; require employer-organized associations to obtain a certificate of filing to self-insure; require all health insurers and employer-organized associations that self insure that write health insurance to submit certain data, to the Department of Insurance; require the sponsor of a bill or amendment that contains a mandate health benefit to submit to the standing committee a financial impact statement; amend KRS 304.14-130, 304.18-050, 304.14-120, 304.38-050, 304.38-200, 304.17A-080, 304.17A-145, 304.17A-150, 304.17A-170 and 216.2923 to conform; repeal KRS 304.17A-090 on the effective date of this Act; repeal effective January 1, 1999 the following statutes: KRS 304.17A-010, 304.17A-020, 304.17A-030, 304.17A-040, 304.17A-050, 304.17A-060, 304.17A-070, 304.17A-100, 304.17A-110, 304.17A-120, and 304.17A-160; appropriate $5 million per fiscal year for fiscal year 1997-98 and direct Governor to include same amount in his budget recommendation for fiscal years 1998-99 and 1999-2000; EMERGENCY.

     Sep 30-introduced in House; to Appropriations and Revenue (H); posting waived