View Bill Status
View Bill Text
View Statement of Purpose / Fiscal Impact
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 - 2005IN 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