SB 235

Abstract

Health insurance; association health plans. Provides that for policies of group accident and sickness insurance issued to an association, members of such an association may include (i) a self-employed individual and (ii) an employer member with at least one employee that is domiciled in the Commonwealth. The bill provides that for such policies issued to an association that covers at least 51 members and employees of employer members of such association on the first day of the plan year the policies shall be considered a large group market plan and are required to meet various provisions in the bill. The bill provides that to determine the size of an association all of the members and employees of employer members are aggregated and treated as employed by a single employer.The bill requires an insurer issuing a policy to an association to (a) treat all of the members and employees of employer members who are enrolled in coverage under the policy as a single risk pool; (b) set premiums based on the collective group experience of the members and employees of employer members who are enrolled in coverage under the policy; (c) vary premiums by age, except that the rate shall not vary by more than five to one for adults; (d) not vary premiums based on gender; and (e) not establish discriminatory rules based on the health status of an employer member, an individual employee of an employer member, or a self-employed individual for eligibility or contribution.The bill requires the Commissioner of Insurance to initiate proceedings to apply to the U.S. Secretary of Health and Human Services for a state innovation waiver under the federal Patient Protection and Affordable Care Act, P.L. 111-148, to implement the provisions of the bill and within 180 days of a certain judicial order to submit the waiver request to implement the provisions of the bill regarding association health plans. This bill is identical to HB 795.

Health insurance; association health plans. Provides that for policies of group accident and sickness insurance issued to an association, members of such an association may include (i) a self-employed individual and (ii) an employer member (a) with at least one employee that is domiciled in the Commonwealth or (b) that has a principal place of business that does not exceed the boundaries of a metropolitan area that is at least partially in the Commonwealth. The bill provides that for such policies issued to an association that covers at least 51 members and employees of employer members of such association on the first day of the plan year the policies shall be considered a large group market plan and are required to meet various provisions in the bill. The bill provides that to determine the size of an association all of the members and employees of employer members are aggregated and treated as employed by a single employer.The bill requires an insurer issuing a policy to an association to (1) treat all of the members and employees of employer members who are enrolled in coverage under the policy as a single risk pool; (2) set premiums based on the collective group experience of the members and employees of employer members who are enrolled in coverage under the policy; (3) vary premiums by age, except that the rate shall not vary by more than 5 to 1 for adults; (4) not vary premiums based on gender; (5) not establish discriminatory rules based on the health status of an employer member, an individual employee of an employer member, or a self-employed individual for eligibility or contribution.The bill requires the Commissioner of Insurance to, within 90 days of the enactment of the bill, apply to the U.S. Secretary of Health and Human Services for a state innovation waiver under the federal Patient Protection and Affordable Care Act, P.L. 111-148, to implement the provisions of the bill. The provisions of the bill regarding association health plans will become effective 30 days following the date the Commissioner of Insurance notifies the Governor and the Chairs of the House and Senate Committees on Commerce and Labor of federal approval of such waiver.

Health insurance; association health plans. Providesthat for policies of group accident and sickness insurance issued to anassociation, members of such an association may include (i) a self-employedindividual and (ii) an employer member (a) with at least one employee that isdomiciled in the Commonwealth or (b) that has a principal place of businessthat does not exceed the boundaries of a metropolitan area that is at leastpartially in the Commonwealth. The bill provides that for such policies issuedto an association that covers at least 51 members and employees of employermembers of such association on the first day of the plan year the policiesshall be considered a large group market plan and are required to meet variousprovisions in the bill. The bill provides that to determine the size of anassociation all of the members and employees of employer members are aggregatedand treated as employed by a single employer.The bill requires an insurer issuing a policy to an associationto (1) treat all of the members and employees of employer members who areenrolled in coverage under the policy as a single risk pool; (2) set premiumsbased on the collective group experience of the members and employees ofemployer members who are enrolled in coverage under the policy; (3) varypremiums by age, except that the rate shall not vary by more than 5 to 1 foradults; (4) not vary premiums based on gender; (5) not establish discriminatoryrules based on the health status of an employer member, an individual employeeof an employer member, or a self-employed individual for eligibility orcontribution.The bill requires the Commissioner of Insurance to, within 90days of the enactment of the bill, apply to the U.S. Secretary of Health andHuman Services for a state innovation waiver under the federal PatientProtection and Affordable Care Act, P.L. 111-148, to implement the provisionsof the bill. The provisions of the bill regarding association health plans willbecome effective 30 days following the date the Commissioner of Insurancenotifies the Governor and the Chairs of the House and Senate Committees onCommerce and Labor of federal approval of such waiver.