SB 861

Abstract

Group health benefit plans; bona fide associations; benefits consortium. Provides that certain trusts constitute a benefits consortium and are authorized to sell health benefits plans to members of a sponsoring association that (i) has been formed and maintained in good faith for purposes other than obtaining or providing health benefits; (ii) does not condition membership in the sponsoring association on any factor relating to the health status of an individual, including an employee of a member of the sponsoring association or a dependent of such an employee; (iii) makes any health benefit plan available to all members regardless of any factor relating to the health status of such members or individuals eligible for coverage through a member; (iv) does not make any health benefit plan available to any person who is not a member of the association; (v) makes available health plans or health benefit plans that meet requirements provided for in the bill; (vi) operates as a nonprofit entity under § 501(c)(5) or 501(c)(6) of the Internal Revenue Code; and (vii) has been in active existence for at least five years. The bill replaces references to "bona fide association," as used in provisions applicable to health care plans in the small employer market, with the term "sponsoring association."The bill requires any health benefit plan issued by a self-funded multiple employer welfare arrangement (MEWA) that covers one or more employees of one or more small employers to (a) provide essential health benefits and cost-sharing requirements; (b) offer a minimum level of coverage designed to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided under the plan; (c) not limit or exclude coverage for an individual by imposing a preexisting condition exclusion on that individual; (d) be prohibited from establishing discriminatory rules based on health status related to eligibility or premium or contribution requirements as imposed on health carriers; (e) meet the renewability standards set forth for health insurance issuers; (f) establish base rates formed on an actuarially sound, modified community rating methodology that considers the pooling of all participant claims; and (g) utilize each employer member's specific risk profile to determine premiums by actuarially adjusting above or below established base rates, and utilize either pooling or reinsurance of individual large claimants to reduce the adverse impact on any specific employer member's premiums.The bill prohibits a self-funded MEWA from issuing health benefit plans in the Commonwealth until it has obtained a license pursuant to regulations promulgated by the Commission. The bill authorizes the Commission to adopt regulations applicable to self-funded MEWAs, including regulations addressing financial condition, solvency requirements, and the exclusion of self-funded MEWAs from the Virginia Life, Accident and Sickness Insurance Guaranty Association.

Group health benefit plans; bona fide associations; benefits consortium. Provides that certain trusts constitute a benefits consortium and are authorized to sell health benefits plans to members of a sponsoring association that (i) has been formed and maintained in good faith for purposes other than obtaining or providing health benefits; (ii) does not condition membership in the sponsoring association on any factor relating to the health status of an individual, including an employee of a member of the sponsoring association or a dependent of such an employee; (iii) makes any health benefit plan available to all members regardless of any factor relating to the health status of such members or individuals eligible for coverage through a member; (iv) does not make any health benefit plan available to any person who is not a member of the association; (v) makes available health plans or health benefit plans that meet requirements provided for in the bill; (vi) operates as a nonprofit entity under § 501(c)(5) or 501(c)(6) of the Internal Revenue Code; and (vii) has been in active existence for at least five years. The bill replaces references to "bona fide association," as used in provisions applicable to health care plans in the small employer market, with the term "sponsoring association."The bill requires any health benefit plan issued by a self-funded multiple employer welfare arrangement (MEWA) that covers one or more employees of one or more small employers to (a) provide essential health benefits and cost-sharing requirements; (b) offer a minimum level of coverage designed to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided under the plan; (c) not limit or exclude coverage for an individual by imposing a preexisting condition exclusion on that individual; (d) be prohibited from establishing discriminatory rules based on health status related to eligibility or premium or contribution requirements as imposed on health carriers; (e) meet the renewability standards set forth for health insurance issuers; (f) establish base rates formed on an actuarially sound, modified community rating methodology that considers the pooling of all participant claims; and (g) utilize each employer member's specific risk profile to determine premiums by actuarially adjusting above or below established base rates, and utilize either pooling or reinsurance of individual large claimants to reduce the adverse impact on any specific employer member's premiums.

Group health benefit plans; bona fide associations;benefits consortium. Provides that certain trusts constitute a benefitsconsortium and are authorized to sell health benefits plans to members of asponsoring association that (i) has been formed and maintained in good faithfor purposes other than obtaining or providing health benefits; (ii) does notcondition membership in the sponsoring association on any factor relating tothe health status of an individual, including an employee of a member of thesponsoring association or a dependent of such an employee; (iii) makes anyhealth benefit plan available to all members regardless of any factor relatingto the health status of such members or individuals eligible for coveragethrough a member; (iv) does not make any health benefit plan available to anyperson who is not a member of the association; (v) makes available health plansor health benefit plans that meet requirements provided for in the bill; (vi)operates as a nonprofit entity under § 501(c)(6) of the Internal Revenue Code;and (vii) has been in active existence for at least five years. The billreplaces references to "bona fide association," as used in provisionsapplicable to health care plans in the small employer market, with the term"sponsoring association."The bill requires any health benefit plan issued by aself-funded multiple employer welfare arrangement (MEWA) that covers one ormore employees of one or more small employers to (a) provide essential healthbenefits and cost-sharing requirements; (b) offer a minimum level of coveragedesigned to provide benefits that are actuarially equivalent to 60 percent ofthe full actuarial value of the benefits provided under the plan; (c) not limitor exclude coverage for an individual by imposing a preexisting conditionexclusion on that individual; (d) be prohibited from establishingdiscriminatory rules based on health status related to eligibility or premiumor contribution requirements as imposed on health carriers; (e) meet therenewability standards set forth for health insurance issuers; (f) establishbase rates formed on an actuarially sound, modified community ratingmethodology that considers the pooling of all participant claims; and (g) utilizeeach employer member's specific risk profile to determine premiums byactuarially adjusting above or below established base rates, and utilize eitherpooling or reinsurance of individual large claimants to reduce the adverseimpact on any specific employer member's premiums.