Introduced Version
HOUSE BILL No. 1041
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 27-8-13.5; IC 27-13.
Synopsis: Health benefit mandates. Allows, under certain
circumstances, an accident and sickness insurer or a health
maintenance organization to provide a policy or contract without
complying with all health benefit mandates. Requires insurers and
health maintenance organizations to report specified information
concerning the policies and contracts to the department of insurance.
Requires the department to report to the legislative council.
Effective: July 1, 2006.
Torr
January 4, 2006, read first time and referred to Committee on Insurance.
Introduced
Second Regular Session 114th General Assembly (2006)
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HOUSE BILL No. 1041
A BILL FOR AN ACT to amend the Indiana Code concerning
insurance.
Be it enacted by the General Assembly of the State of Indiana:
SOURCE: IC 27-8-13.5; (06)IN1041.1.1. -->
SECTION 1. IC 27-8-13.5 IS ADDED TO THE INDIANA CODE
AS A
NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2006]:
Chapter 13.5. Health Benefit Mandate Option
Sec. 1. As used in this chapter, "health benefit mandate" means
any of the following requirements for coverage in, or an offering
of coverage that must be made in connection with the purchase of,
a policy of accident and sickness insurance, to the extent that the
coverage is not required under federal law:
(1) Newborn coverage under IC 27-8-5.6.
(2) Breast cancer screening related coverage under
IC 27-8-14.
(3) Morbid obesity related coverage under IC 27-8-14.1.
(4) Pervasive developmental disorder related coverage under
IC 27-8-14.2.
(5) Diabetes related coverage under IC 27-8-14.5.
(6) Prostate cancer testing related coverage under
IC 27-8-14.7.
(7) Colorectal cancer testing related coverage under
IC 27-8-14.8.
(8) Off label drug treatment coverage under IC 27-8-20.
(9) Minimum maternity related benefits under IC 27-8-24.
(10) Inherited metabolic disease related coverage under
IC 27-8-24.1.
(11) Mastectomy related coverage under IC 27-8-5-26.
(12) Mental illness related coverage under IC 27-8-5-15.6.
(13) Dental anesthesia related coverage under IC 27-8-5-27.
(14) Adopted child coverage under IC 27-8-5-21.
Sec. 2. As used in this chapter, "insurer" refers to an insurer (as
defined in IC 27-1-2-3(x)) that issues or delivers a policy of
accident and sickness insurance.
Sec. 3. As used in this chapter, "policy of accident and sickness
insurance" has the meaning set forth in IC 27-8-5-1.
Sec. 4. As used in this chapter, "prospective purchaser" means
an:
(1) individual who requests coverage under a policy of
accident and sickness insurance that is issued on an individual
basis; or
(2) employer that:
(A) employs not more than fifty (50) employees, a majority
of whom were not offered coverage for health care services
(as defined in IC 27-13-1-18) by:
(i) the employer; or
(ii) a parent, a subsidiary, or an affiliate of the employer;
during the preceding calendar year; and
(B) requests coverage for the employer's employees under
a policy of accident and sickness insurance that is issued on
a group basis.
Sec. 5. Notwithstanding any other law, an insurer may offer to
a prospective purchaser a policy of accident and sickness insurance
without complying with all health benefit mandates if:
(1) when the offer is made, the insurer provides a list of the
health benefit mandates with which the offer does not comply;
and
(2) the policy offered includes the following:
(A) Newborn coverage required under IC 27-8-5.6.
(B) Diabetes related coverage required under IC 27-8-14.5.
(C) If the prospective purchaser is described in section 4(2)
of this chapter:
(i) breast cancer screening related coverage required
under IC 27-8-14;
(ii) prostate cancer testing related coverage required
under IC 27-8-14.7; and
(iii) colorectal cancer testing related coverage required
under IC 27-8-14.8.
(D) Adopted child coverage required under IC 27-8-5-21.
(E) Minimum maternity related benefits of examination
and testing of the newborn child required under
IC 27-8-24-4(a)(2) and IC 27-8-24-4(a)(3).
Sec. 6. An insurer that offers to a prospective purchaser a policy
of accident and sickness insurance described in section 5 of this
chapter shall also offer to the prospective purchaser a policy of
accident and sickness insurance in compliance with all health
benefit mandates.
Sec. 7. An insurer that issues or delivers a policy of accident and
sickness insurance described in section 5 of this chapter shall
provide to an individual insured under the policy of accident and
sickness insurance a written disclosure that:
(1) acknowledges that the policy of accident and sickness
insurance is not issued in compliance with all health benefit
mandates; and
(2) lists in summary form the health benefits:
(A) to which a health benefit mandate applies; and
(B) for which coverage is provided in the policy of accident
and sickness insurance.
SOURCE: IC 27-13-1-17.6; (06)IN1041.1.2. -->
SECTION 2. IC 27-13-1-17.6 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2006]: Sec. 17.6. "Health benefit mandate"
means any of the following requirements for coverage in, or an
offering of coverage that must be made in connection with the
purchase of, an individual contract or a group contract, to the
extent that the coverage is not required under federal law:
(1) Newborn coverage under IC 27-8-5.6.
(2) Breast cancer screening related coverage under
IC 27-13-7-15.3.
(3) Morbid obesity related coverage under IC 27-13-7-14.5.
(4) Pervasive developmental disorder related coverage under
IC 27-13-7-14.7.
(5) Diabetes related coverage under IC 27-8-14.5.
(6) Prostate cancer testing related coverage under
IC 27-13-7-16.
(7) Colorectal cancer testing related coverage under
IC 27-13-7-17.
(8) Off label drug treatment coverage under IC 27-8-20.
(9) Minimum maternity related benefits under IC 27-8-24.
(10) Inherited metabolic disease related coverage under
IC 27-13-7-18.
(11) Mastectomy related coverage under IC 27-13-7-14.
(12) Mental illness related coverage under IC 27-13-7-14.8.
(13) Dental anesthesia related coverage under IC 27-13-7-15.
(14) Adopted child coverage under IC 27-8-5-21.
SOURCE: IC 27-13-1-27.8; (06)IN1041.1.3. -->
SECTION 3. IC 27-13-1-27.8 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2006]: Sec. 27.8. "Prospective purchaser"
means an:
(1) individual who requests coverage under an individual
contract; or
(2) employer that:
(A) employs not more than fifty (50) employees, a majority
of whom were not offered coverage for health care services
by:
(i) the employer; or
(ii) a parent, a subsidiary, or an affiliate of the employer;
during the preceding calendar year; and
(B) requests coverage for the employer's employees under
a group contract.
SOURCE: IC 27-13-7.5; (06)IN1041.1.4. -->
SECTION 4. IC 27-13-7.5 IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2006]:
Chapter 7.5. Health Benefit Mandate Option
Sec. 1. Notwithstanding any other law, a health maintenance
organization may offer to a prospective purchaser an individual
contract or a group contract without complying with all health
benefit mandates if:
(1) when the offer is made, the health maintenance
organization provides a list of the health benefit mandates
with which the offer does not comply; and
(2) the contract offered includes the following:
(A) Newborn coverage that is substantially similar to the
coverage required under IC 27-8-5.6.
(B) Diabetes related coverage required under IC 27-8-14.5.
(C) If the prospective purchaser is described in
IC 27-13-1-27.8(2):
(i) breast cancer screening related coverage required
under IC 27-13-7-15.3;
(ii) prostate cancer testing related coverage required
under IC 27-13-7-16; and
(iii) colorectal cancer testing related coverage required
under IC 27-13-7-17.
(D) Adopted child coverage required under IC 27-8-5-21.
(E) Minimum maternity related benefits of examination
and testing of the newborn child required under
IC 27-8-24-4(a)(2) and IC 27-8-24-4(a)(3).
Sec. 2. A health maintenance organization that offers to a
prospective purchaser an individual contract or a group contract
described in section 1 of this chapter shall also offer to the
prospective purchaser an individual contract or a group contract
in compliance with all health benefit mandates.
Sec. 3. A health maintenance organization that enters into or
delivers an individual contract or a group contract described in
section 1 of this chapter shall provide to an enrollee a written
disclosure that:
(1) acknowledges that the individual contract or group
contract is not entered into in compliance with all health
benefit mandates; and
(2) lists in summary form the health benefits:
(A) to which a health benefit mandate applies; and
(B) for which coverage is provided in the individual
contract or group contract.
SOURCE: ; (06)IN1041.1.5. -->
SECTION 5. [EFFECTIVE JULY 1, 2006]
(a) As used in this
SECTION, "department" refers to the department of insurance
created by IC 27-1-1-1.
(b) An insurer that issues or delivers a policy of accident and
sickness insurance described in IC 27-8-13.5-5, as added by this
act, and a health maintenance organization that enters into or
delivers a contract described in IC 27-13-7.5-1, as added by this
act, shall report the following information to the department not
later than November 15, 2007:
(1) The number of policies described in this subsection that
are issued or delivered by the insurer and the number of
individuals covered under each policy.
(2) The number of contracts described in this subsection that
are entered into or delivered by the health maintenance
organization and the number of individuals covered under
each contract.
(3) The premium charged for each policy or contract
described in this subsection.
(4) The difference between:
(A) the premium charged for each policy or contract
described in this subsection; and
(B) the premium that would be charged for any other
policy or contract offered by the insurer or health
maintenance organization to a prospective purchaser that
purchased a policy or contract described in this subsection.
(c) Not later than December 1, 2007, the department shall
compile the information reported to the department under
subsection (b) and report the information to the legislative council
in an electronic format under IC 5-14-6. The department:
(1) shall include in the report information concerning the
number of uninsured individuals in Indiana; and
(2) may include any other information in the report that the
department determines is relevant.
(d) This SECTION expires December 31, 2007.