HB748 - HEALTH INSURANCE - Lakin, Scott
HB748 MAKES THE STATE IN COMPLIANCE WITH THE FEDERAL HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996.
Sponsor: Lakin, Scott (33) Effective Date:00/00/00
CoSponsor: LR Number:1318-01
Last Action: 05/14/97 - Placed on the Informal Calendar (H)
HCS HB 748 & 605
Next Hearing:Hearing not scheduled
Calendar:Bill currently not on calendar
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BILL SUMMARIES BILL TEXT FISCAL NOTES
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Available Bill Summaries for HB748
| Committee | Introduced |


Available Bill Text for HB748
| Committee | Introduced |

Available Fiscal Notes for HB748
| House Substitute | House Committee Substitute | Introduced |

BILL SUMMARIES

COMMITTEE

HCS HB 748 & 605 -- HEALTH INSURANCE

SPONSOR:  McLuckie

COMMITTEE ACTION:  Voted "do pass" by the Committee on Consumer
Protection by a vote of 9 to 7.

This substitute makes several changes to health insurance laws
in order to comply with the federal Health Insurance Portability
and Accountability Act.

The substitute:

(1)  Requires group and individual health insurance policies to
be in compliance with the federal Health Insurance Portability
and Accountability Act of 1996 and the Missouri Small Employer
and Individual Health Insurance Availability Act;

(2)  Changes the title from the Small Employer Health Insurance
Availability Act to the Small Employer and Individual Health
Insurance Availability Act;

(3)  Adds the terms bona fide association, bona fide association
plan, church plan, creditable coverage, eligible person, family
composition, governmental plan, group health plan, health
carrier, health status-related factor, individual carrier,
individual health benefit plan, limited benefit health
insurance, medical care, network plan, plan sponsor, preexisting
condition, purchasing alliance, purchasing alliance plan, self--
employed individual, and waiting period to the Small Employer
and Individual Health Insurance Availability Act;

(4)  Deletes the terms actuarial certification, base premium
rate, basic health benefit plan, carrier case characteristics,
class of business, index rate, new business premium rate, plan
of operation, qualifying previous coverage, rating period and
standard health benefit plan from the Small Employer and
Individual Health Insurance Availability Act;

(5)  Adds political subdivisions to the definition of small
employer;

(6)  Changes the definition of small employer from 3 to 25 to 2
to 50 eligible employees;

(7)  Allows an employer to include as an eligible employee a
person who works on a full-time basis with a normal work week of
17.5 to 30 hours;

(8)  Excludes from the definition of a late enrollee a person
who lost health coverage as a result of the cessation of an
employer's contribution, termination of employment, reduction in
hours, involuntary termination of coverage, death of a spouse,
or divorce or legal separation;

(9)  Requires small employer carriers and individual carriers to
provide a description and listing of health benefit plan
information;

(10)  Requires renewal of a small employer health benefit plan
or an individual health benefit plan at the option of the small
employer or individual;

(11)  Requires a small employer carrier or individual carrier to
file with the Department of Insurance any health benefit plan to
be used by the carrier.  A health benefit plan may be used 30
days after the filing unless the department disapproves of its
use;

(12)  Specifies that a small employer health benefit plan cannot
deny, exclude, or limit benefits for a covered individual due to
a preexisting condition for more than 6 months, not 12 months,
following the effective date of coverage or the first day of a
waiting period;

(13)  Limits the minimum participation level required by a small
employer carrier to no greater than 75% of the eligible
employees working for a small employer group with more than 3
employees;

(14)  Specifies that an individual health benefit plan cannot
deny, exclude, or limit benefits due to a preexisting condition
for more than 12 months following the effective date of coverage
and that any preexisting condition exclusion be reduced by the
aggregate of the period of creditable coverage which was
continuous up to 63 days prior to the effective date of new
coverage;

(15)  Allows individual carrier premium rates to be based on
age, sex, and geographical location, but limits the highest rate
charged to not more than 400% of the lowest rate for individuals
with the same benefit levels;

(16)  Allows individual carriers to develop rate schedules for
individuals determined by the carrier to be high risk, but
limits the rate to 135% of the standard rate which would
otherwise be charged;

(17)  Dissolves the Missouri Health Insurance Pool as of
December 31, 1998 and requires the Board of Directors to develop
a mechanism by which current pool enrollees will be equitably
apportioned among individual carriers; and

(18)  Allows the Department of Insurance to require a small
employer carrier or individual carrier to reissue a health
benefit plan if the plan was terminated or not renewed within 6
months prior to July 1, 1997.

This bill contains an emergency clause.

FISCAL NOTE:  Not available at time of printing.

PROPONENTS:  Supporters say that HB 748 will eliminate losing
coverage when changing jobs and limit preexisting conditions
exclusions.  Premiums for basic hospitalization for individuals
often costs more than an average year's salary for someone with
a preexisting condition.  Supporters say that HB 605 will expand
coverage to small employers by defining a small employer as
having 2 to 50 employees, rather than 3 to 25, and this bill
will make health insurance available to everyone.

Testifying for the HB 748 were Representative Lakin; Jay Angoff,
Director of Missouri Department of Insurance; Office of Governor
Carnahan; Debbie Eichelberger, nurse; Dennis Drane; and J. David
Auner, M.D.

Testifying for HB 605 were Representative Auer; Associated
Industries of Missouri; and General American Health Insurance of
St. Louis.

OPPONENTS:  Those who oppose the bill say that they prefer
minimum compliance with Kennedy-Kassebaum to sweeping reform.

They maintain that guaranteed issue will be a problem for some
in the insurance industry, especially in rural areas where there
may only be one health insurance carrier to write policies.
They oppose adjusted community rating.

Testifying against HB 748 were State Farm Insurance Company; and
Associated Industries of Missouri.

Testifying against HB 605 were State Farm Insurance Company; and
Golden Rule Insurance Company.

Donna Schlosser, Research Analyst


INTRODUCED

HB 748 -- Health Insurance Portability and Accountability Act

Sponsor:  Lakin

This bill makes several changes to health insurance laws.

The bill:

(1)  Requires individual or group health insurance policies to
be in compliance with the federal Health Insurance Portability
and Accountability Act of 1996 and the Missouri Small Employer
and Individual Health Insurance Availability Act;

(2)  Changes the title from the Small Employer Health Insurance
Availability Act to the Small Employer and Individual Health
Insurance Availability Act;

(3)  Adds the terms adjusted community rating, bona fide
association, bona fide association plan, church plan, creditable
coverage, eligible person, family composition, governmental
plan, group health plan, health carrier, health status related
factor, individual carrier, individual health benefit plan,
individual reinsuring carrier, individual risk assuming carrier,
limited benefit health insurance, medical care, network plan,
plan sponsor, preexisting condition, purchasing alliance,
purchasing alliance plan, reinsuring carrier, risk adjustment
mechanism, risk assuming carrier, self-employed individual, and
waiting period to the Small Employer and Individual Health
Insurance Availability Act;

(4)  Deletes the terms base premium rate, carrier, case
characteristics, class of business, index rate, new business
premium rate, and qualifying previous coverage from the Small
Employer and Individual Health Insurance Availability Act;

(5)  Adds political subdivisions to the definition of small
employer;

(6)  Changes the number of eligible employees to be defined as a
small employer from 3 to 25 to 2 to 50;

(7)  Allows an employer to include as an eligible employee a
person who works on a full-time basis with a normal work week of
17.5 to 30 hours;

(8)  Excludes from the definition of a late enrollee a person
who lost health coverage as a result of the cessation of an
employer's contribution, termination, reduction in hours,
involuntary termination, or death of a spouse or divorce or
legal separation;

(9)  Applies the provisions of the Small Employer and Individual
Health Insurance Availability Act concerning individual health
benefit plans to professional association health benefit plans
and trust health benefit plans;

(10) Requires premium rates to be based on an adjusted community
rate with variance only for geographic area, family composition,
and age;

(11) Requires a small employer carrier and individual carrier to
provide a description and listing of health benefit plan
information;

(12) Requires the renewal of a small employer health benefit
plan or an individual health benefit plan at the option of the
small employer or individual;

(13) Requires a small employer carrier or individual carrier to
file with the Department of Insurance any basic health benefit
plan or standard health benefit plan to be used by the carrier.
A health benefit plan may be used 30 days after the filing
unless the Department of Insurance disapproves of its use;

(14) Specifies that a small employer health benefit plan cannot
deny, exclude, or limit benefits for a covered individual for
losses incurred more than 6 months, not 12 months, following the
effective date of coverage or the first day of a waiting period
due to a preexisting condition;

(15) Limits the minimum participation level required by a small
employer carrier to no greater than 75 percent of the eligible
employees working for a small employer group with more than 3
employees;

(16) Specifies that an individual health benefit plan can not
deny, exclude, or limit benefits for losses incurred more than
12 months following the effective date of coverage due to a
preexisting condition;

(17) Requires that each small employer carrier or individual
carrier apply with the Department of Insurance to operate as a
risk assuming carrier or a reinsuring carrier;

(18) Changes the title from the Missouri Small Employer Health
Reinsurance Program to the Missouri Small Employer and
Individual Health Reinsurance Program;

(19) Requires that within 60 days of July 1, 1997, each small
employer carrier and individual carrier must file with the
Department of Insurance the net health insurance premium derived
from health benefit plans delivered or issued for delivery in
1996;

(20) Limits a health benefit plan carrier's liability under the
Missouri Small Employer and Individual Health Reinsurance
Program to $10,000 rather than $25,000 each year;

(21) Establishes the premium rates for the Missouri Small
Employer and Individual Health Reinsurance Program at 1.5 times
the base reinsurance premium rate for an entire small employer
group, 5 times the base reinsurance premium rate for an eligible
employee or dependent, and 1.5 times the base reinsurance
premium rate for an individual with an individual health benefit
plan;

(22) Stipulates that any net loss from reinsuring an eligible
person in the Missouri Small Employer and Individual Health
Reinsurance Program will be recovered by an assessment on all
health benefit plan carriers, stop less coverage providers, and
Taft-Hartley health plan providers.  Individual risk assuming
carriers are exempt from this assessment;

(23) Requires the board governing the Missouri Small Employer
and Individual Health Reinsurance Program and the 9 member, not
7 member, Health Benefit Plan Committee to report every 3 years
to the Department of Insurance on the effectiveness of the Small
Employer and Individual Health Insurance Availability Act; and

(24) Allows the Department of Insurance to require a small
employer carrier or individual carrier to reissue a health
benefit plan if the plan was terminated or not renewed within 6
months prior to January 1, 1998.

This bill contains an emergency clause.


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Last Updated August 11, 1997 at 4:19 pm