98RS HB244


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HB 244 (BR 1491) - T. Burch

     AN ACT relating to health insurance and declaring an emergency.
     Create new sections of Subtitle 17A of KRS Chapter 304, the insurance code, to provide that health insurers shall offer individual health insurance coverage or pay an assessment, provide for division of losses in the individual market in accordance with total market share by September 1, 1998, provide for an assessment to reimburse health insurers for net losses, provide for a deferment of the assessment by the Commissioner of Insurance, require health insurers to participate in assessments or forfeit authorization to issue health benefit plans, provide for an exemption from assessment based upon enrollment of an minimum number of nongroup persons, provide for filing net earned premiums, provide for filing a minimum number of nongroup persons covered, provide for deemed compliance if the health insurer has covered at least 40% of the minimum number of nongroup persons by the end of 1998, 75% by 1999, and 100% by 2000; amend definitions in KRS 304.17A-010 of "accountable health plan", "health benefit plan", "health status"; amend KRS 304.17A-070 to delete statement that alliance members may be offered an accountable health plan offered by the state employee benefit fund established under KRS 18A.2281 and provide that the state employee benefit fund shall cease to be offered by the alliance as an accountable health plan to any persons other than state employees and dependents when the alliance can offer at least 2 other health insurance plans to members currently covered under the state employee benefit fund; provide for Health Insurance Advisory Council to evaluate most popular health benefit plans being sold in the Commonwealth; delete mandatory rate hearings for rate increases over medical consumer price index plus 3%; add solvency of insurer and impact of requested rate upon competition to considerations for Department of Insurance approval of rates; provide for new filing of rates after 6 months; provide that rates give to a policy or contract holder shall not change for 12 months; provide for consumer oriented rate filing information; provide that rate filing information is to be considered public record; provide for new definitions under KRS 304.17A-100 of "church plan", '"federally defined eligible individual", "governmental plan", "group health insurance coverage", "health status", "individual health insurance coverage", "premium", and amend definition of "health benefit plan"; provide that persons who are not state employees or dependents of state employees shall not be permitted to renew coverage when at least 2 other individual health insurance options become available; provide that for group and individual health insurance coverage, except for federally defined eligible individuals, preexisting conditions shall not limit coverage beyond 12 months and may only relate to conditions for which medical advice, diagnosis, care or treatment was recommended or received within the 6 month period preceding the effective date of coverage; provide that federally defined eligible individuals shall not be subject to any preexisting conditions provisions; provide for reduction of preexisting conditions period by creditable coverage if the coverage was continuous to 63 days before the effective date of new coverage, and provide for creditable coverage for various health plans; provide that group health insurance coverage preexisting condition period shall not include pregnancy, newborns, or adopted children or children placed for adoption; provide that health benefit plans shall not establish eligibility rules related to health status related factors; provide that individual health insurance policies may use health status as a rating factory; provide that group health insurance policies may use age, gender, occupation or industry, geography, family composition, alliance product, and 10% healthy lifestyle discounts, and health status shall not be used in setting group insurance premiums, and group health benefit plans shall not require individual participants to pay premiums or contributions greater than the premium for similarly situated individuals enrolled in the plan; provide that rating factors based on gender shall be phased out beginning July 15, 1999; provide that insurers issuing individual health insurance policies may utilize health status such that the highest rate factor does not exceed the lowest rate factor by 25%, and the maximum annual increase shall not exceed 10% and shall be based on actual claims experience; provide that insurers give the policyholder or contract holder a table stating the policy rate, identify the source of any rate increase; provide that Commissioner shall study the potential for return to modified community rating and provide a report to the General Assembly by November 1, 1999; direct Commissioner shall provide an annual report to the General Assembly on the state of the health insurance market in Kentucky beginning October 1, 1998 and annually thereafter; provide for implementation of diagnostic risk adjustment mechanism no later than July 15, 1999, and the Department of Insurance shall report to the General Assembly by October 1, 1999, and quarterly thereafter on the implementation of diagnostic risk adjustment mechanism; require 3 standard health benefit plans and allow insurers to offer any other health benefit plans upon filing the plan, rate filings, and consumer comparison sheet; provide for individual health insurance plans to be offered on a guaranteed issue basis to federally defined eligible individuals on a guaranteed issue basis, and provide that an individual who is not a federally defined eligible individual shall be a resident of Kentucky for 12 months prior to the coverage's effective date; provide that group insurance coverage be offerd on a guaranteed issue basis to applicants and must accept every eligible individual and may not place any restriction inconsistent with 42 U.S.C. sec. 300gg-11 on an eligible applicant or dependent; provide for no annual or lifetime limits on standard and non-standard plans; provide for consumer comparison sheet which insurers shall provide to policy or contract holders upon initial enrollment in and renewal of health benefit plans; amend 304.17A-170 to conform; delete association exemption; declaration of emergency.

     Jan 12-introduced in House
     Jan 13-to Health and Welfare (H)

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