HB 768

Abstract

Health insurance; association health plan for real estate salespersons. Provides that a licensed insurer may issue a policy of group accident and sickness insurance to an association of real estate salespersons (association), which association shall be deemed the policyholder, and that such association health plan is not considered to be insurance and is not subject to the existing requirements for insurance if certain requirements are met. The bill requires that (i) all members of the association be eligible for coverage and membership, including employer members with at least one employee that is domiciled in the Commonwealth or self-employed individuals; (ii) membership in the association not be conditioned on any health status–related factor; (iii) the coverage offered through the association be available to all members regardless of any health status–related factor; (iv) the association not make health insurance coverage offered through the association available other than in connection with a member of the association; and (v) premiums for the policy be paid from funds contributed by the association or associations, or by employer members, or by both, or from funds contributed by the covered persons or from both the covered persons and the association, associations, or employer members. The bill also requires that the association (a) has at the outset a minimum of 25,000 members; (b) has been organized and maintained in good faith for purposes other than that of obtaining insurance; (c) has been in active existence for at least five years; and (d) has a constitution and bylaws that provide that the association hold regular meetings not less than annually to further purposes of the members, that the association collects dues or solicits contributions from members, and that the members have voting privileges and representation on the governing board and committees.The bill provides that any such policy shall (1) be considered a large group market plan subject to all coverage mandates applicable to a large group market plan, (2) be subject to the group health plan coverage requirements under the federal Patient Protection and Affordable Care Act, (3) be prohibited from denying coverage under the policy on the basis of a pre-existing condition, (4) be guaranteed issue and guaranteed renewable, (5) provide essential health benefits and cost-sharing requirements, and (6) 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.The bill requires an insurer issuing such 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 on the basis of the collective group experience of the members and employees of employer members who are enrolled in coverage under the policy; (C) not vary premiums by age, except that the rate shall not vary by more than four to one for adults; (D) not vary premiums on the basis of gender; (E) not vary premiums on the basis of the health status of an individual employee of an employer member or a self-employed individual member; and (F) 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.Finally, the bill provides that a policy that meets certain requirements of the bill is considered to be compliant with the large group market insurance regulations under the federal Public Health Service Act and, as such, the Commonwealth is considered to be substantially enforcing the federal Patient Protection and Affordable Care Act with regard to such policy. The bill requires the State Corporation Commission to regulate the policy in a manner that is consistent with such provisions. The bill provides that, in any case in which a federal agency renders a decision that is contrary to such provisions, notwithstanding any other provision of law, the Attorney General may resolve any difference between federal law and the laws of the Commonwealth. This bill is identical to SB 335.

Health insurance; association health plan for real estatesalespersons. Provides that a licensed insurer may issue a policy of groupaccident and sickness insurance to an association of real estate salespersons(association), which association shall be deemed the policyholder, and thatsuch association health plan is not considered to be insurance and is notsubject to the existing requirements for insurance if certain requirements are met.The bill requires that (i) all members of the association be eligible forcoverage and membership, including employer members with at least one employeethat is domiciled in the Commonwealth or self-employed individuals; (ii)membership in the association not be conditioned on any health status–relatedfactor; (iii) the coverage offered through the association be available to allmembers regardless of any health status–related factor; (iv) the associationnot make health insurance coverage offered through the association availableother than in connection with a member of the association; and (v) premiums forthe policy be paid from funds contributed by the association or associations,or by employer members, or by both, or from funds contributed by the coveredpersons or from both the covered persons and the association, associations, oremployer members. The bill also requires the association (a) has at the outseta minimum of 100 members; (b) has been organized and maintained in good faithfor purposes other than that of obtaining insurance; (c) has been in activeexistence for at least five years; and (d) has a constitution and bylaws thatprovide that the association hold regular meetings not less than annually tofurther purposes of the members, that the association collects dues or solicitscontributions from members, and that the members have voting privileges andrepresentation on the governing board and committees.The bill provides that any such policy shall (1) be considereda large group market plan subject to all coverage mandates applicable to alarge group market plan, (2) be subject to the group health plan coveragerequirements under the federal Patient Protection and Affordable Care Act, (3)be prohibited from denying coverage under the policy on the basis of apre-existing condition, (4) shall be guaranteed issue and guaranteed renewable,(5) provide essential health benefits and cost-sharing requirements, and (6)offer a minimum level of coverage designed to provide benefits that are actuariallyequivalent to 60 percent of the full actuarial value of the benefits providedunder the plan.The bill requires an insurer issuing such policy to anassociation to (A) treat all of the members and employees of employer memberswho are enrolled in coverage under the policy as a single risk pool; (B) setpremiums on the basis of the collective group experience of the members andemployees of employer members who are enrolled in coverage under the policy;(C) not vary premiums by age, except that the rate shall not vary by more thanfour to one for adults; (D) not vary premiums on the basis of gender; (E) notvary premiums on the basis of the health status of an individual employee of anemployer member or a self-employed individual member; and (F) not establishdiscriminatory rules based on the health status of an employer member, anindividual employee of an employer member, or a self-employed individual foreligibility or contribution.Finally, the bill provides that a policy that meets certainrequirements of the bill is considered to be compliant with the large groupmarket insurance regulations under the federal Public Health Service Act and,as such, the Commonwealth is considered to be substantially enforcing thefederal Patient Protection and Affordable Care Act with regard to such policy.The bill requires the State Corporation Commission to regulate the policy in amanner that is consistent with such provisions. The bill provides that, in anycase in which a federal agency renders a decision that is contrary to suchprovisions, notwithstanding any other provision of law, the Attorney Generalmay resolve any difference between federal law and the laws of theCommonwealth.