MR. PRESIDENT:
I move
that Engrossed House Bill 1004 be amended to read as follows:
amount of that difference.".
Page 124, between lines 13 and 14, begin a new paragraph block
indented and insert:
to submit suitable amendments to the plan, the commissioner shall
adopt rules under IC 4-22-2 necessary or advisable to implement this
section. These rules are effective until modified by the commissioner
or superseded by a plan submitted by the association and approved by
the commissioner. The plan of operation must:
(1) establish procedures for the handling and accounting of assets
and money of the association;
(2) establish the amount and method of reimbursing members of
the board;
(3) establish regular times and places for meetings of the board of
directors;
(4) establish procedures for records to be kept of all financial
transactions, and for the annual fiscal reporting to the
commissioner;
(5) establish procedures whereby selections for the board of
directors will be made and submitted to the commissioner for
approval;
(6) contain additional provisions necessary or proper for the
execution of the powers and duties of the association; and
(7) establish procedures for the periodic advertising of the general
availability of the health insurance coverages from the
association.
(d) The plan of operation may provide that any of the powers and
duties of the association be delegated to a person who will perform
functions similar to those of this association. A delegation under this
section takes effect only with the approval of both the board of
directors and the commissioner. The commissioner may not approve a
delegation unless the protections afforded to the insured are
substantially equivalent to or greater than those provided under this
chapter.
(e) The association has the general powers and authority enumerated
by this subsection in accordance with the plan of operation approved
by the commissioner under subsection (c). The association has the
general powers and authority granted under the laws of Indiana to
carriers licensed to transact the kinds of health care services or health
insurance described in section 1 of this chapter and also has the
specific authority to do the following:
(1) Enter into contracts as are necessary or proper to carry out this
chapter, subject to the approval of the commissioner.
(2) Sue or be sued, including taking any legal actions necessary
or proper for recovery of any assessments for, on behalf of, or
against participating carriers.
(3) Take legal action necessary to avoid the payment of improper
claims against the association or the coverage provided by or
through the association.
(4) Establish a medical review committee to determine the
reasonably appropriate level and extent of health care services in
each instance.
(5) Establish appropriate rates, scales of rates, rate classifications
and rating adjustments, such rates not to be unreasonable in
relation to the coverage provided and the reasonable operational
expenses of the association.
(6) Pool risks among members.
(7) Issue policies of insurance on an indemnity or provision of
service basis providing the coverage required by this chapter.
(8) Administer separate pools, separate accounts, or other plans
or arrangements considered appropriate for separate members or
groups of members.
(9) Operate and administer any combination of plans, pools, or
other mechanisms considered appropriate to best accomplish the
fair and equitable operation of the association.
(10) Appoint from among members appropriate legal, actuarial,
and other committees as necessary to provide technical assistance
in the operation of the association, policy and other contract
design, and any other function within the authority of the
association.
(11) Hire an independent consultant.
(12) Develop a method of advising applicants of the availability
of other coverages outside the association and may promulgate a
list of health conditions the existence of which would deem an
applicant eligible without demonstrating a rejection of coverage
by one (1) carrier.
(13) Provide for the use of managed care plans for insureds,
including the use of:
(A) health maintenance organizations; and
(B) preferred provider plans.
(14) Solicit bids directly from providers for coverage under this
chapter.
(f) Rates for coverages issued by the association may not be
unreasonable in relation to the benefits provided, the risk experience,
and the reasonable expenses of providing the coverage. Separate scales
of premium rates based on age apply for individual risks. Premium
rates must take into consideration the extra morbidity and
administration expenses, if any, for risks insured in the association. The
rates for a given classification may not be more than one hundred fifty
percent (150%) of the average premium rate for that class charged by
the five (5) carriers with the largest premium volume in the state during
the preceding calendar year. In determining the average rate of the five
(5) largest carriers, the rates charged by the carriers shall be actuarially
adjusted to determine the rate that would have been charged for
benefits identical to those issued by the association. All rates adopted
by the association must be submitted to the commissioner for approval.
(g) Following the close of the association's fiscal year, the
association shall determine:
association if that applicant is accepted.
(m) The association and the premium collected by the association
shall be exempt from the premium tax, the gross income tax, the
adjusted gross income tax, supplemental corporate net income, or any
combination of these, or similar taxes upon revenues or income that
may be imposed by the state.
(n) Members who after July 1, 1983, during any calendar year, have
paid one (1) or more assessments levied under this chapter may either:
(1) take a credit against premium taxes, gross income taxes,
adjusted gross income taxes, supplemental corporate net income
taxes, or any combination of these, or similar taxes upon revenues
or income of member insurers that may be imposed by the state,
up to the amount of the taxes due for each calendar year in which
the assessments were paid and for succeeding years until the
aggregate of those assessments have been offset by either credits
against those taxes or refunds from the association; or
(2) any member insurer may include in the rates for premiums
charged for insurance policies to which this chapter applies
amounts sufficient to recoup a sum equal to the amounts paid to
the association by the member less any amounts returned to the
member insurer by the association, and the rates shall not be
deemed excessive by virtue of including an amount reasonably
calculated to recoup assessments paid by the member.
(o) The association shall provide for the option of monthly
collection of premiums.