YES:
MR. SPEAKER:
Your Committee on Insurance, Corporations and Small Business , to which was
referred Senate Bill 462 , has had the same under consideration and begs leave to report
the same back to the House with the recommendation that said bill be amended as follows:
of the association becomes uncertain due to the failure or
refusal of members of the association to meet their financial
obligations as members of the association or due to any other
reason;
this chapter is void and
IC 27-8-10.1
becomes effective.".
means the following services:
(1) If health benefit plan coverage is provided under a
contract with a health maintenance organization, preventive
care.
(2) Inpatient and outpatient hospital and physician care.
(3) Diagnostic laboratory care.
(4) Diagnostic and therapeutic radiological services.
(5) Emergency care.
Sec. 6. As used in this chapter, "church plan" has the meaning
set forth in the federal Employee Retirement Income Security Act
of 1974 (26 U.S.C. 414(e)).
Sec. 7. As used in this chapter, "creditable coverage" has the
meaning set forth in the federal Health Insurance Portability and
Accountability Act of 1996 (26 U.S.C. 9801(c)(1)).
Sec. 8. As used in this chapter, "federally eligible individual"
means an individual:
(1) for whom, as of the date on which the individual seeks
coverage under this chapter, the total period of creditable
coverage is at least eighteen (18) months and whose most
recent prior creditable coverage was under a:
(A) group health plan;
(B) governmental plan; or
(C) church plan;
or health insurance coverage in connection with any of those
plans;
(2) who is not eligible for coverage under:
(A) a group health plan;
(B) Part A or Part B of Title XVIII of the federal Social
Security Act; or
(C) a state plan under Title XIX of the federal Social
Security Act (or any successor program);
and does not have other health insurance coverage;
(3) with respect to whom the individual's most recent
coverage was not terminated for factors relating to
nonpayment of premiums or fraud;
(4) who, if after being offered the option of continuation
coverage under the Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA) (29 U.S.C. 1191b(d)(1)),
or under a similar state program, elected such coverage; and
(5) who, if after electing continuation coverage described in
subdivision (4), has exhausted continuation coverage under
the provision or program.
Sec. 9. As used in this chapter, "governmental plan" means a
plan as defined under the federal Employee Retirement Income
Security Act of 1974 (26 U.S.C. 414(d)) and any plan established or
maintained for its employees by the United States government or
by any agency or instrumentality of the United States government.
Sec. 10. As used in this chapter, "health benefit plan" means
coverage of basic health care services under a:
(1) policy of accident and sickness insurance; or
(2) contract with a health maintenance organization.
Sec. 11. As used in this chapter, "health benefit plan provider"
means:
(1) an accident and sickness insurer; or
(2) a health maintenance organization;
that provides coverage under a health benefit plan.
Sec. 12. As used in this chapter, "health maintenance
organization" has the meaning set forth in
IC 27-13-1-19.
Sec. 13. As used in this chapter, "individual contract" has the
meaning set forth in
IC 27-13-1-21.
Sec. 14. As used in this chapter, "individual health benefit plan"
means a health benefit plan that is:
(1) issued on an individual basis; or
(2) entered into as an individual contract;
and may include coverage of dependents of the individual.
Sec. 15. As used in this chapter, "policy of accident and sickness
insurance" has the meaning set forth in
IC 27-8-5-1
(a).
Sec. 16. As used in this chapter, "qualified individual" means an
individual who meets one (1) of the following criteria:
(1) At the effective date of coverage, the individual is not
eligible for coverage:
(A) under a group health benefit plan that provides
coverage for basic health care services;
(B) under Part A or Part B of Title XVIII of the federal
Social Security Act;
(C) under a state plan under Title XIX of the federal Social
Security Act (or any successor program); or
(D) available through an employer plan that provides
coverage for basic health care services.
(2) The individual is a federally eligible individual.
For purposes of this section, an individual may be a qualified
individual if the individual is eligible for Medicare coverage and is
less than sixty-five (65) years of age.
Sec. 17. As used in this chapter, "standard health benefit plan"
means a health benefit plan that meets the following requirements:
(1) After a deductible, provides coverage for at least eighty
percent (80%) of the cost of the following medically necessary
services:
(A) Basic health care services.
(B) Mental health services.
(C) Services for alcohol and drug abuse.
(D) Dental services.
(E) Vision services.
(F) Long term rehabilitation treatment.
(2) Meets the requirements for an individual:
(A) policy of accident and sickness insurance specified in
IC 27-8-5
; or
(B) contract with a health maintenance organization
specified in IC 27-13.
Sec. 18. (a) A health benefit plan provider that provides
coverage in Indiana under at least one (1) individual health benefit
plan shall actively offer to provide coverage to a qualified
individual under all health benefit plans the health benefit plan
provider actively markets to individuals in Indiana, including at
least:
(1) one (1) basic health benefit plan; and
(2) one (1) standard health benefit plan.
(b) A health benefit plan provider shall provide coverage to a
qualified individual under the health benefit plan for which the
qualified individual applies.
Sec. 19. A health benefit plan provider may not impose a
preexisting condition limitation or exclusion on individual health
benefit plan coverage provided under section 18 of this chapter.
Sec. 20. (a) Premiums for individual basic health benefit plan
coverage provided under section 18 of this chapter may not exceed
one hundred fifty percent (150%) of the average premium charged
by health benefit plan providers for basic health benefit plan
coverage in Indiana during the previous calendar year, as
determined by the department under section 21(a) of this chapter.
(b) Premiums for individual standard health benefit plan
coverage provided under section 18 of this chapter may not exceed
one hundred fifty percent (150%) of the average premium charged
by health benefit plan providers for standard health benefit plan
coverage in Indiana during the previous calendar year, as
determined by the department under section 21(b) of this chapter.
Sec. 21. (a) The department shall calculate and make available
to health benefit plan providers the average premium charged for
basic health benefit plan coverage as reported to the department
under
IC 27-1-22
by the five (5) health benefit plan providers with
the largest premium volume in Indiana during the previous
calendar year.
(b) The department shall calculate and make available to health
benefit plan providers the average premium charged for standard
health benefit plan coverage as reported to the department under
IC 27-1-22
by the five (5) health benefit plan providers with the
largest premium volume in Indiana during the previous calendar
year.
Sec. 22. Coverage for basic health care services provided under
this chapter shall be provided in compliance with the federal
Health Insurance Portability and Accountability Act of 1996
(P.L.104-191).
SECTION 14. [EFFECTIVE JULY 1, 2003] Upon the effective
date of
IC 27-8-10.1
, as added by this act, the legislative services
agency shall prepare legislation for introduction during the next
succeeding regular session of the general assembly to organize and
correct statutes affected by
IC 27-8-10.1
, as added by this act.".
and when so amended that said bill do pass.