2005 Legislation
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HOUSE BILL NO. 111 – Individl high risk insurnc/eligible


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Bill Status

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.
      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

Bill Text

  ]]]]              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
  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;
  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 / Fiscal Impact

                     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


Name:     Joan Krosch
Agency:   Insurance, Dept. of
Phone:    334-4300

STATEMENT OF PURPOSE/FISCAL NOTE                        H 111