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H0111...........................................................by BUSINESS
INDIVIDUAL HIGH RISK INSURANCE - Amends existing law relating to the Idaho
Individual High Risk Reinsurance Pool to revise eligibility provisions for
coverage under the pool plan.
02/04 House intro - 1st rdg - to printing
02/07 Rpt prt - to Bus
02/16 Rpt out - rec d/p - to 2nd rdg
02/17 2nd rdg - to 3rd rdg
02/22 3rd rdg - PASSED - 68-0-2
AYES -- Anderson, Andrus, Barraclough, Barrett, Bastian, Bayer, Bell,
Bilbao, Black, Block, Boe, Bolz, Bradford, Cannon, Chadderdon, Clark,
Collins, Crow, Deal, Denney, Ellsworth, Eskridge, Field(18),
Field(23), Garrett, Hart, Harwood, Henbest, Henderson, Jaquet, Jones,
Kemp, Lake, LeFavour, Loertscher, Martinez, Mathews, McGeachin,
McKague, Miller, Mitchell, Moyle, Nielsen, Nonini, Pasley-Stuart,
Pence, Raybould, Ring, Ringo, Roberts, Rusche, Rydalch, Sali, Sayler,
Schaefer, Shepherd(2), Shepherd(8), Shirley, Skippen, Smith(30),
Smith(24), Smylie, Snodgrass, Stevenson, Trail, Wills, Wood, Mr.
Speaker
NAYS -- None
Absent and excused -- Bedke, Edmunson
Floor Sponsor - Nonini
Title apvd - to Senate
02/23 Senate intro - 1st rdg - to Com/HuRes
03/04 Rpt out - rec d/p - to 2nd rdg
03/07 2nd rdg - to 3rd rdg
03/11 3rd rdg - PASSED - 32-0-2, 1 vacancy
AYES -- Andreason, Brandt, Broadsword, Bunderson, Burkett,
Burtenshaw, Cameron, Coiner, Compton, Corder, Darrington, Davis,
Gannon, Geddes, Goedde, Jorgenson, Kelly, Keough, Langhorst, Little,
Lodge, Malepeai, Marley, McGee, McKenzie, Pearce, Richardson,
Schroeder, Stegner, Stennett, Werk, Williams
NAYS -- None
Absent and excused -- Hill, Sweet, (District 21 seat vacant)
Floor Sponsor - Werk
Title apvd - to House
03/14 To enrol
03/15 Rpt enrol - Sp signed
03/16 Pres signed
03/17 To Governor
03/21 Governor signed
Session Law Chapter 71
Effective: 07/01/05
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature First Regular Session - 2005
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 111
BY BUSINESS COMMITTEE
1 AN ACT
2 RELATING TO THE IDAHO INDIVIDUAL HIGH RISK REINSURANCE POOL; AMENDING SECTION
3 41-5510, IDAHO CODE, TO REVISE ELIGIBILITY PROVISIONS FOR COVERAGE UNDER
4 THE POOL PLAN.
5 Be It Enacted by the Legislature of the State of Idaho:
6 SECTION 1. That Section 41-5510, Idaho Code, be, and the same is hereby
7 amended to read as follows:
8 41-5510. ELIGIBILITY. (1) Any individual eligible person, who is and con-
9 tinues to be a resident shall be eligible for coverage under an individual
10 basic, standard, catastrophic A or catastrophic B health benefit plan if evi-
11 dence is provided that:
12 (a) Such person has been rejected by one (1) individual carrier on the
13 basis of health status or claims experience; or
14 (b) An individual carrier refuses to issue a health benefit plan provid-
15 ing coverage substantially similar to coverage offered under an equivalent
16 pool plan except at a rate exceeding the rate for the pool plan; or
17 (c) Such person is a federally eligible individual; or
18 (d) Such person is legally domiciled in Idaho on the date of application
19 to the pool and is eligible for the credit for health insurance costs
20 under section 35 of the Internal Revenue Code of 1986. In addition, if
21 such person maintained creditable health insurance coverage for an aggre-
22 gate period of three (3) months as of the date on which the individual
23 seeks to enroll in pool coverage, not counting any period prior to a
24 sixty-three (63) day break in coverage:
25 (i) The preexisting condition limitation set forth in section
26 41-5208, Idaho Code, shall not apply; and
27 (ii) The requirement for exhaustion of any available coverage under
28 title X of the consolidated omnibus budget reconciliation act of
29 1986, public law 99-272 (COBRA) or state continuation benefits is
30 waived.
31 (2) A rejection or refusal by a carrier offering only stop loss, excess
32 of loss or reinsurance coverage with respect to an applicant under subsection
33 (1) of this section shall not constitute sufficient evidence for purposes of
34 subsection (1) of this section.
35 (3) Each resident dependent of a person who is eligible for coverage
36 under the pool shall also be eligible for coverage under the pool.
37 (4) A person shall not be eligible for coverage under a pool plan if:
38 (a) The person is not a federally eligible individual and has or obtains
39 health insurance coverage substantially similar to or more comprehensive
40 than a pool plan, or would be eligible to have such coverage at a rate not
41 exceeding the rate for the pool plan if the person elected to obtain it;
42 (b) The person is determined to be eligible for health care benefits
43 under medicaid;
2
1 (c) The person has previously terminated pool plan coverage unless twelve
2 (12) months have lapsed since such termination; provided however, that
3 this provision shall not apply with respect to an applicant who is a fed-
4 erally eligible individual;
5 (d) The person is an inmate or resident of a state or other public insti-
6 tution, or a state, local or private correctional facility; provided how-
7 ever, that this provision shall not apply with respect to an applicant who
8 is a federally eligible individual.
9 (5) Notwithstanding any other provision of this chapter, eligibility for
10 continuation of coverage under COBRA shall not render a person ineligible for
11 coverage under a pool plan.
12 (6) Coverage shall cease:
13 (a) On the first day of the month following the date a person is no
14 longer a resident of this state;
15 (b) On the first day of the month following the date a person requests
16 coverage to end;
17 (c) Upon the death of the covered person;
18 (d) At the option of the board, thirty (30) days after the plan makes any
19 inquiry concerning the person's eligibility or place of residence to which
20 the person does not reply.
21 (67) A person who ceases to meet the eligibility requirements of this
22 section may be terminated on the first day of the month following the date
23 when the individual becomes ineligible.
STATEMENT OF PURPOSE
RS 14415C1
In 2000, legislation was enacted creating a "high risk pool" to
reinsure individual health plans to be made available to Idahoans who
might otherwise not be insurable due to their health status. This
proposal makes two changes to Idaho Code 41-5510, which defines who
is eligible for the high risk pool plans. The first change is to
clarify that "federally eligible individuals" qualify for coverage
under high-risk pool plans without regard to whether they are eligible
for coverage under other types of health insurance products. A
federally eligible individual is any person who meets eligibility
criteria set forth in the federal Health Insurance Portability and
Accountability Act of 1996 ("HIPAA"). Federal law requires that
federally eligible individuals have guaranteed access to individual
health plans regardless of a person's health status or availability of
other coverage. The proposed amendment clarifies that Idaho's high-
risk pool meets federal requirements for guaranteed access by allowing
federally eligible individuals access to high-risk pool plans without
regard to whether other coverage may be available to them.
The second change made by this proposed amendment is to allow persons
access to high-risk pool plans even if they are eligible for
continuation of group health coverage under COBRA. COBRA is a federal
law that allows persons to continue coverage under their group health
plan for a period of time after they leave employment. Persons who
elect coverage under COBRA, however, are responsible for paying the
full cost of the coverage, including the portion normally paid by the
employer. Because group plans generally offer richer benefits than
individual plans, the cost of paying for coverage under COBRA may be
more than the former employee can afford, and more than the cost of
purchasing an individual health plan. Under the current law, however,
a person who is eligible for continuation of coverage under COBRA is
not eligible for an individual high-risk pool plan. This means that
persons may have to go without health insurance coverage if they cannot
afford continuation of group coverage under COBRA and they do not
qualify for a regular individual health insurance plan. The proposed
amendment will address this problem by allowing COBRA eligible persons
access to individual high-risk pool plans.
FISCAL NOTE
None.
CONTACT
Name: Joan Krosch
Agency: Insurance, Dept. of
Phone: 334-4300
STATEMENT OF PURPOSE/FISCAL NOTE H 111