2004 Legislation
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HOUSE BILL NO. 803 – Health insurnce, coverage/eligiblty

HOUSE BILL NO. 803

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Bill Status



H0803......................................................by STATE AFFAIRS
HEALTH INSURANCE - Amends existing law relating to insurance to provide
that the preexisting condition limitation shall not apply to certain
individuals; to further define "eligible individual"; to provide that
certain persons shall be eligible for health benefit plans; and to provide
that certain limitations and requirements shall not apply if such persons
have maintained creditable health insurance coverage for a specified period
of time.
                                                                        
03/02    House intro - 1st rdg - to printing
03/03    Rpt prt - to Bus
03/10    Rpt out - rec d/p - to 2nd rdg
03/11    2nd rdg - to 3rd rdg
03/12    3rd rdg - PASSED - 65-0-5
      AYES -- Andersen, Barraclough, Barrett, Bauer, Bayer, Bedke, Black,
      Block, Boe, Bolz, Bradford, Campbell, Cannon, Clark, Collins, Crow,
      Cuddy, Deal, Denney, Douglas, Eberle, Edmunson, Ellsworth, Eskridge,
      Field(18), Field(23), Gagner, Garrett, Harwood, Jaquet, Jones,
      Kellogg, Kulczyk, Lake, Langford, Langhorst, Martinez, McKague,
      Meyer, Miller, Mitchell, Moyle, Naccarato, Nielsen, Pasley-Stuart,
      Raybould, Ridinger, Ring, Ringo, Roberts, Robison, Rydalch, Sali,
      Sayler, Schaefer, Shepherd, Skippen, Smith(30), Smith(24), Smylie,
      Snodgrass, Trail, Wills, Wood, Mr. Speaker
      NAYS -- None
      Absent and excused -- Bell, Henbest, McGeachin, Shirley, Stevenson
    Floor Sponsor - Collins
    Title apvd - to Senate
03/15    Senate intro - 1st rdg - to Com/HuRes
03/17    Rpt out - rec d/p - to 2nd rdg
03/18    2nd rdg - to 3rd rdg
03/19    3rd rdg - PASSED - 35-0-0
      AYES -- Andreason, Bailey, Brandt, Bunderson, Burkett(Maxand),
      Burtenshaw, Calabretta, Cameron, Compton, Darrington, Davis, Gannon,
      Geddes, Goedde, Hill, Ingram, Kennedy, Keough, Little, Lodge,
      Malepeai, Marley, McKenzie, McWilliams, Noble, Noh, Pearce,
      Richardson, Schroeder, Sorensen, Stegner, Stennett, Sweet, Werk,
      Williams
      NAYS -- None
      Absent and excused -- None
    Floor Sponsor - Cameron
    Title apvd - to House
03/20    To enrol - Rpt enrol - Sp signed - Pres signed
03/22    To Governor
03/24    Governor signed
         Session Law Chapter 332
         Effective: 07/01/04

Bill Text


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-seventh Legislature                 Second Regular Session - 2004
                                                                        
                                                                        
                              IN THE HOUSE OF REPRESENTATIVES
                                                                        
                                     HOUSE BILL NO. 803
                                                                        
                                 BY STATE AFFAIRS COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO INSURANCE; AMENDING SECTION 41-5208, IDAHO CODE, TO  PROVIDE  THAT
  3        THE  PREEXISTING CONDITION LIMITATION SHALL NOT APPLY TO CERTAIN INDIVIDU-
  4        ALS; AMENDING SECTION 41-5501, IDAHO CODE,  TO  FURTHER  DEFINE  "ELIGIBLE
  5        INDIVIDUAL"  AND  TO  MAKE  A  TECHNICAL  CORRECTION; AND AMENDING SECTION
  6        41-5510, IDAHO CODE, TO PROVIDE THAT CERTAIN PERSONS SHALL BE ELIGIBLE FOR
  7        HEALTH BENEFIT PLANS AND TO PROVIDE THAT CERTAIN LIMITATIONS AND  REQUIRE-
  8        MENTS  SHALL  NOT  APPLY IF SUCH PERSONS HAVE MAINTAINED CREDITABLE HEALTH
  9        INSURANCE COVERAGE FOR A SPECIFIED PERIOD OF TIME.
                                                                        
 10    Be It Enacted by the Legislature of the State of Idaho:
                                                                        
 11        SECTION 1.  That Section 41-5208, Idaho Code, be, and the same  is  hereby
 12    amended to read as follows:
                                                                        
 13        41-5208.  AVAILABILITY OF COVERAGE --  PREEXISTING CONDITIONS -- PORTABIL-
 14    ITY.
 15        (1)  (a) Every individual carrier shall, as a condition of offering health
 16        benefit  plans in this state to individuals, actively offer health benefit
 17        plans to individuals, including the individual basic health benefit  plan,
 18        the individual standard health benefit plan, the individual catastrophic A
 19        health benefit plan and the individual catastrophic B health benefit plan.
 20        (b)  An individual carrier shall issue an individual basic, standard, cat-
 21        astrophic A or catastrophic B health benefit plan to any eligible individ-
 22        ual  that  applies  for  such plan and agrees to make the required premium
 23        payments and to satisfy the other reasonable provisions of the health ben-
 24        efit plan not inconsistent with the provisions of this chapter.
 25        (2)  (a) An individual carrier shall file with the director, in  a  format
 26        and  manner  prescribed  by  the  director,  the basic, standard and cata-
 27        strophic health benefit plans to be used by the carrier. A health  benefit
 28        plan  filed pursuant to the provisions of this paragraph may be used by an
 29        individual carrier beginning thirty (30) days after it is filed unless the
 30        director disapproves its use.
 31        (b)  The director at any time may, after providing notice and an  opportu-
 32        nity for a hearing to the individual carrier, disapprove the continued use
 33        by an individual carrier of a basic, standard, or catastrophic health ben-
 34        efit  plan  on the grounds that the plan does not meet the requirements of
 35        this chapter.
 36        (3)  Health benefit plans covering individuals shall comply with the  fol-
 37    lowing provisions:
 38        (a)  A health benefit plan shall not deny, exclude or limit benefits for a
 39        covered  individual  for  covered  expenses incurred more than twelve (12)
 40        months following the effective date of the individual's coverage due to  a
 41        preexisting  condition. A health benefit plan shall not define a preexist-
 42        ing condition more restrictively than:
 43             (i)   A condition that would have caused an ordinarily prudent person
                                                                        
                                           2
                                                                        
  1             to seek medical advice, diagnosis, care or treatment during  the  six
  2             (6) months immediately preceding the effective date of coverage;
  3             (ii)  A condition for which medical advice, diagnosis, care or treat-
  4             ment  was  recommended  or received during the six (6) months immedi-
  5             ately preceding the effective date of coverage; or
  6             (iii) A pregnancy existing on the effective date of coverage.
  7        (b)  A health benefit plan shall waive any time  period  applicable  to  a
  8        preexisting  condition exclusion or limitation period with respect to par-
  9        ticular  services for the period of time an individual was previously cov-
 10        ered by qualifying previous coverage to the extent such previous  coverage
 11        provided  benefits with respect to such services, provided that the quali-
 12        fying previous coverage was continuous to a date not more than sixty-three
 13        (63) days prior to the effective date of the new coverage.
 14        (c)  An individual carrier shall not modify a basic,  standard,  or  cata-
 15        strophic  health benefit plan with respect to an individual or any depend-
 16        ent through riders, endorsements, or otherwise,  to  restrict  or  exclude
 17        coverage  for  certain diseases or medical conditions otherwise covered by
 18        the health benefit plan.
 19        (d)  In the case of an individual who  is  eligible  for  the  credit  for
 20        health  insurance  costs  under section 35 of the Internal Revenue Code of
 21        1986, the preexisting condition limitation shall not  apply  only  if  the
 22        individual  maintained  creditable health insurance coverage for an aggre-
 23        gate period of three (3) months as of the date  on  which  the  individual
 24        seeks  to  enroll  in  pool  coverage,  not counting any period prior to a
 25        sixty-three (63) day break in coverage.
 26        (4)  (a) An individual carrier shall not be required to offer coverage  or
 27        accept  applications  pursuant to the provisions of subsection (1) of this
 28        section in the case of the following:
 29             (i)   To an individual, where the individual is not residing  in  the
 30             carrier's established geographic service area;
 31             (ii)  Within  an area where the individual carrier reasonably antici-
 32             pates, and demonstrates to the satisfaction of the director, that  it
 33             will  not have the capacity within its established geographic service
 34             area to deliver service adequately  to  individuals  because  of  its
 35             obligations to existing groups or individuals.
 36        (b)  An individual carrier that cannot offer coverage pursuant to the pro-
 37        visions of subsection (4)(a)(ii) of this section may not offer coverage in
 38        the  applicable area to new employer groups with more than fifty (50) eli-
 39        gible employees or to any small employer  groups  or  to  any  individuals
 40        until  the  later  of  one  hundred  eighty (180) days following each such
 41        refusal or the date on which the carrier notifies the director that it has
 42        regained capacity to deliver services to individuals and groups.
 43        (5)  An individual carrier shall not be required to  provide  coverage  to
 44    individuals  pursuant  to the provisions of subsection (1) of this section for
 45    any period of time for which the director determines that requiring the accep-
 46    tance of individuals in accordance with the provisions of  subsection  (1)  of
 47    this section would place the individual carrier in a financially impaired con-
 48    dition.
                                                                        
 49        SECTION  2.  That  Section 41-5501, Idaho Code, be, and the same is hereby
 50    amended to read as follows:
                                                                        
 51        41-5501.  DEFINITIONS. As used in this chapter:
 52        (1)  "Agent" means a producer as defined  in  section  41-1003(98),  Idaho
 53    Code.
                                                                        
                                           3
                                                                        
  1        (2)  "Board"  means the board of directors of the Idaho high risk individ-
  2    ual reinsurance pool established in this chapter and the Idaho small  employer
  3    reinsurance program established in section 41-4711, Idaho Code.
  4        (3)  "Carrier"  means  any  entity that provides, or is authorized to pro-
  5    vide, health insurance in this state. For purposes of  this  chapter,  carrier
  6    includes  an insurance company, any other entity providing reinsurance includ-
  7    ing excess or stop loss coverage, a hospital or professional service  corpora-
  8    tion,  a  fraternal  benefit  society, a managed care organization, any entity
  9    providing health insurance coverage or benefits to residents of this state  as
 10    certificate  holders  under a group policy issued or delivered outside of this
 11    state, and any other entity providing a plan of  health  insurance  or  health
 12    benefits subject to state insurance regulation.
 13        (4)  "Dependent" means a spouse, an unmarried child under the age of nine-
 14    teen  (19)  years, an unmarried child who is a full-time student under the age
 15    of twenty-three (23) years and who is financially dependent upon  the  parent,
 16    and  an  unmarried child of any age who is medically certified as disabled and
 17    dependent upon the parent.
 18        (5)  "Director" means the director of the department of insurance  of  the
 19    state of Idaho.
 20        (6)  "Eligible individual" means:
 21        (a)  Aan  Idaho  resident individual or dependent of an Idaho resident who
 22        is under the age of sixty-five (65) years, is not  eligible  for  coverage
 23        under  a  group health plan, part A or part B of title XVIII of the social
 24        security act (medicare), or a state plan under title XIX (medicaid) or any
 25        successor program, and who does not have other health insurance  coverage;
 26        or
 27        (b)  An individual who is legally domiciled in Idaho on the date of appli-
 28        cation  to  the  pool  and is eligible for the credit for health insurance
 29        costs under section 35 of the Internal  Revenue  Code  of  1986.  Coverage
 30        under  a  basic, standard, catastrophic A or catastrophic B health benefit
 31        plan shall not be available to any individual who is covered  under  other
 32        health  insurance  coverage. For purposes of this chapter, to be eligible,
 33        an individual must also meet the requirements of  section  41-5510,  Idaho
 34        Code.
 35        (7)  "Health benefit plan" means any hospital or medical policy or certif-
 36    icate,  any subscriber contract provided by a hospital or professional service
 37    corporation, or health maintenance organization  subscriber  contract.  Health
 38    benefit  plan  does not include policies or certificates of insurance for spe-
 39    cific disease, hospital confinement indemnity, accident-only, credit,  dental,
 40    vision,  medicare  supplement, long-term care, or disability income insurance,
 41    student health benefits only, coverage issued as  a  supplement  to  liability
 42    insurance, worker's compensation or similar insurance, automobile medical pay-
 43    ment  insurance,  or  nonrenewable  short-term coverage issued for a period of
 44    twelve (12) months or less.
 45        (8)  "Individual basic health benefit plan" means a lower cost health ben-
 46    efit plan developed pursuant to section 41-5511, Idaho Code.
 47        (9)  "Individual carrier" means a carrier that offers health benefit plans
 48    covering eligible individuals and their dependents.
 49        (10) "Individual catastrophic A health benefit plan" means a higher  limit
 50    health benefit plan developed pursuant to section 41-5511, Idaho Code.
 51        (11) "Individual  catastrophic B health benefit plan" means a health bene-
 52    fit plan offering limits higher than a  catastrophic  A  health  benefit  plan
 53    developed pursuant to section 41-5511, Idaho Code.
 54        (12) "Individual standard health benefit plan" means a health benefit plan
 55    developed pursuant to section 41-5511, Idaho Code.
                                                                        
                                           4
                                                                        
  1        (13) "Plan"  or  "pool  plan"  means the individual basic, standard, cata-
  2    strophic A or catastrophic B plan established  pursuant  to  section  41-5511,
  3    Idaho Code.
  4        (14) "Plan  of  operation"  means  the plan of operation of the individual
  5    high risk reinsurance pool established pursuant to this chapter.
  6        (15) "Pool" means the Idaho high risk reinsurance pool.
  7        (16) "Premium" means all moneys paid by an individual and eligible depend-
  8    ents as a condition of receiving coverage from a carrier, including  any  fees
  9    or other contributions associated with the health benefit plan.
 10        (17) "Qualifying  previous  coverage"  and  "qualifying existing coverage"
 11    mean benefits or coverage provided under:
 12        (a)  Medicare  or  medicaid,  civilian  health  and  medical  program  for
 13        uniformed services (CHAMPUS), the Indian health service program,  a  state
 14        health benefit risk pool, or any other similar publicly sponsored program;
 15        or
 16        (b)  Any  group  or  individual  health insurance policy or health benefit
 17        arrangement whether or not subject to the state insurance laws,  including
 18        coverage provided by a managed care organization, hospital or professional
 19        service  corporation,  or a fraternal benefit society, that provides bene-
 20        fits similar to or exceeding benefits provided under the basic health ben-
 21        efit plan.
 22        (18) "Reinsurance premium" means the premium set by the board pursuant  to
 23    section  41-5506,  Idaho  Code,  to  be paid by a reinsuring carrier for plans
 24    issued under the pool.
 25        (19) "Reinsuring carrier" means a carrier participating in the  individual
 26    high risk reinsurance pool established by this chapter.
 27        (20) "Restricted  network provision" means any provision of a health bene-
 28    fit plan that conditions the payment of benefits, in whole or in part, on  the
 29    use  of health care providers that have entered into a contractual arrangement
 30    with the carrier to provide health care services to covered individuals.
                                                                        
 31        SECTION 3.  That Section 41-5510, Idaho Code, be, and the same  is  hereby
 32    amended to read as follows:
                                                                        
 33        41-5510.  ELIGIBILITY. (1) Any individual eligible person, who is and con-
 34    tinues  to  be  a  resident shall be eligible for coverage under an individual
 35    basic, standard, catastrophic A or catastrophic B health benefit plan if  evi-
 36    dence is provided that:
 37        (a)  Such  person  has  been rejected by one (1) individual carrier on the
 38        basis of health status or claims experience; or
 39        (b)  An individual carrier refuses to issue a health benefit plan  provid-
 40        ing coverage substantially similar to coverage offered under an equivalent
 41        pool plan except at a rate exceeding the rate for the pool plan; or
 42        (c)  Such  person is legally domiciled in Idaho on the date of application
 43        to the pool and is eligible for the  credit  for  health  insurance  costs
 44        under  section  35  of  the Internal Revenue Code of 1986. In addition, if
 45        such person maintained creditable health insurance coverage for an  aggre-
 46        gate  period  of  three  (3) months as of the date on which the individual
 47        seeks to enroll in pool coverage, not  counting  any  period  prior  to  a
 48        sixty-three (63) day break in coverage:
 49             (i)   The  preexisting  condition  limitation  set  forth  in section
 50             41-5208, Idaho Code, shall not apply; and
 51             (ii)  The requirement for exhaustion of any available COBRA or  state
 52             continuation benefits is waived.
 53        (2)  A  rejection  or refusal by a carrier offering only stop loss, excess
                                                                        
                                           5
                                                                        
  1    of loss or reinsurance coverage with respect to an applicant under  subsection
  2    (1)  of  this section shall not constitute sufficient evidence for purposes of
  3    subsection (1) of this section.
  4        (3)  Each resident dependent of a person  who  is  eligible  for  coverage
  5    under the pool shall also be eligible for coverage under the pool.
  6        (4)  A person shall not be eligible for coverage under a pool plan if:
  7        (a)  The  person  has  or  obtains health insurance coverage substantially
  8        similar to or more comprehensive than a pool plan, or would be eligible to
  9        have coverage if the person elected to obtain it;
 10        (b)  The person is determined to be  eligible  for  health  care  benefits
 11        under medicaid;
 12        (c)  The person has previously terminated pool plan coverage unless twelve
 13        (12)  months  have  lapsed  since such termination; provided however, that
 14        this provision shall not apply with respect to an applicant who is a  fed-
 15        erally defined eligible individual;
 16        (d)  The person is an inmate or resident of a state or other public insti-
 17        tution,  or a state, local or private correctional facility; provided how-
 18        ever, that this provision shall not apply with respect to an applicant who
 19        is a federally defined eligible individual.
 20        (5)  Coverage shall cease:
 21        (a)  On the first day of the month following  the  date  a  person  is  no
 22        longer a resident of this state;
 23        (b)  On  the  first  day of the month following the date a person requests
 24        coverage to end;
 25        (c)  Upon the death of the covered person;
 26        (d)  At the option of the board, thirty (30) days after the plan makes any
 27        inquiry concerning the person's eligibility or place of residence to which
 28        the person does not reply.
 29        (6)  A person who ceases to meet the eligibility requirements of this sec-
 30    tion may be terminated on the first day of the month following the  date  when
 31    the individual becomes ineligible.

Statement of Purpose / Fiscal Impact



                       STATEMENT OF PURPOSE
                             RS 13738

The Federal Trade Act of 2002 includes provisions to help certain
categories of individuals who have lost their jobs purchase
health insurance.  Under the federal act, persons participating
in the Trade Adjustment Assistance Program or receiving payments
from the Pension Benefit Guaranty Corporation are eligible for a
federal tax credit that is equal to 65 percent of the premium 
cost of a state qualified health insurance plan.  To be a
qualified health insurance plan for purpose of the act, the plan
must meet certain minimum federal requirements.  Currently, there
are no qualified plans in Idaho, and individuals who would
otherwise qualify for the federal tax credit are unable to take
advantage of the credit.  The amendments made by this bill will
allow the Idaho Individual High Risk Reinsurance Pool plans to be
designated as state qualified health benefit plans for purposes
of the Trade Act of 2002.


                          FISCAL IMPACT

The Individual High Risk Reinsurance Pool receives a statutorily
set percentage of premium tax receipts.  The changes made by this
bill will not change that percentage and, therefore, this bill
will have no fiscal impact on the general fund.






Contact
Name: Rep. W.W."Bill" Deal 
Phone: 332-1000




STATEMENT OF PURPOSE/FISCAL NOTE                   H 803