Mr. President:
The Business and Labor Committee reports a favorable recommendation on H.B. 342,
INSURANCE CODE AMENDMENTS, by Representative J. Dunnigan, with the following
amendments and recommends it be considered read for the second time and placed on the
Consent Calendar.
2741
that is in
Respectfully,
Kevin T. VanTassell
Voting: 3-0-4
1. Page
2, Lines 38 through 40
:
38
Insurance Act;
39
. addresses when individual carriers must accept individuals; and
}
40
. makes additional technical amendments.
2. Page
3, Line 70
:
70
31A-30-108, as last amended by Laws of Utah 2004, Chapters 2 and 329
}
3. Page
12, Lines 341 through 354
House Floor Amendments
2-12-2008
:
341
(50) (a) "Eligible employee" means:
342
(i) an employee who:
343
(A) works on a full-time basis; and
344
(B) has a normal work week of 30 or more hours;
[
}
or
{
]
}
345
[
}
(ii) a person described in Subsection (50) (b).
{
]
}
346
[
}
(b) "Eligible employee" includes, if the individual is included under a
health benefit
347
plan of a small employer:
]
}
348
[
}
(i)
{
]
}
{
(ii)
}
a sole proprietor;
349
[
}
(ii)
{
]
}
{
(iii)
}
a partner in a partnership; or
350
[
}
(iii)
{
]
}
{
(iv)
}
an independent contractor.
351
[
}
(c)
{
]
}
{
(b)
}
"Eligible employee" does not include H. [[] ,
unless eligible under Subsection
352
(50)(b): (i) []] .H an individual who works on a temporary or substitute basis for a
small
352a
employer H. [[] ; []] [.]
353
[[] (ii) an employer's spouse; or []]
354
[[] (iii) a dependent of an employer. []] .H
4. Page
64, Line 1980 through Page 65, Line 1983
:
1980
(4) The Basic Health Care Plan adopted by the commissioner under this section
shall
1981
provide for:
1982
(a) a lifetime maximum benefit per person not to exceed $1,000,000;
1983
(b) an annual maximum benefit per person not
to exceed $300,000
}
less
than $250,000
;
5. Page
103, Line 3166 through Page 106, Line 3269
:
3166
Section 26.
Section
31A-30-108
is amended to read:
3167
31A-30-108. Eligibility for small employer and individual market.
3168
(1) (a) Small employer carriers shall accept residents for small group coverage
as set
3169
forth in the Health Insurance Portability and Accountability Act, P.L. 104-191, 110
Stat. 1962,
3170
Sec. 2701(f) and 2711(a).
3171
(b) Individual carriers shall accept residents for individual coverage pursuant:
3172
(i) to P.L. 104-191, 110 Stat. 1979, Sec. 2741(a)-(b); and
3173
(ii) Subsection (3).
3174
(2) (a) Small employer carriers shall offer to accept all eligible employees and
their
3175
dependents at the same level of benefits under any health benefit plan provided to a
small
3176
employer.
3177
(b) Small employer carriers may:
3178
(i) request a small employer to submit a copy of the small employer's quarterly
income
3179
tax withholdings to determine whether the employees for whom coverage is
provided or
3180
requested are bona fide employees of the small employer; and
3181
(ii) deny or terminate coverage if the small employer refuses to provide
documentation
3182
requested under Subsection (2)(b)(i).
3183
(3) Except as provided in Subsections (5) and (6) and Section
31A-30-110
,
individual
3184
carriers shall accept for coverage individuals to whom all of the following conditions
apply:
3185
(a) the individual is not covered or eligible for coverage:
3186
(i) (A) as an employee of an employer;
3187
(B) as a member of an association; or
3188
(C) as a member of any other group; and
3189
(ii) under:
3190
(A) a health benefit plan; or
3191
(B) a self-insured arrangement that provides coverage similar to that provided
by a
3192
health benefit plan as defined in Section
31A-1-301
;
3193
(b) the individual is not covered and is not eligible for coverage under any
public
3194
health benefits arrangement including:
3195
(i) the Medicare program established under Title XVIII of the Social Security
Act;
3196
[(ii) the Medicaid program established under Title XIX of the Social Security
Act;]
3197
[(iii)] (ii) any act of Congress or law of this or any other state that provides
benefits
3198
comparable to the benefits provided under this chapter; or
3199
[(iv)] (iii) coverage under the Comprehensive Health Insurance Pool Act
created in
3200
Chapter 29, Comprehensive Health Insurance Pool Act;
3201
(c) unless the maximum benefit has been reached the individual is not covered
or
3202
eligible for coverage under any:
3203
(i) Medicare supplement policy;
3204
(ii) conversion option;
3205
(iii) continuation or extension under COBRA; or
3206
(iv) state extension;
3207
(d) the individual has not terminated or declined coverage described in
Subsection
3208
(3)(a), (b), or (c) within 93 days of application for coverage, unless the individual is
eligible for
3209
individual coverage under P.L. 104-191, 110 Stat. 1979, Sec. 2741(b), in which case,
the
3210
requirement of this Subsection (3)(d) does not apply; and
3211
(e) the individual is certified as ineligible for the Health Insurance Pool if:
3212
(i) the individual applies for coverage with the Comprehensive Health
Insurance Pool
3213
within 30 days after being rejected or refused coverage by the covered carrier and
reapplies for
3214
coverage with that covered carrier within 30 days after the date of issuance of a
certificate
3215
under Subsection
31A-29-111
(5)(c); or
3216
(ii) the individual applies for coverage with any individual carrier within 45
days after:
3217
(A) notice of cancellation of coverage under Subsection
31A-29-115
(1); or
3218
(B) the date of issuance of a certificate under Subsection
31A-29-111
(5)(c) if
the
3219
individual applied first for coverage with the Comprehensive Health Insurance Pool.
3220
(4) (a) If coverage is obtained under Subsection (3)(e)(i) and the required
premium is
3221
paid, the effective date of coverage shall be the first day of the month following the
individual's
3222
submission of a completed insurance application to that covered carrier.
3223
(b) If coverage is obtained under Subsection (3)(e)(ii) and the required
premium is
3224
paid, the effective date of coverage shall be the day following the:
3225
(i) cancellation of coverage under Subsection
31A-29-115
(1); or
3226
(ii) submission of a completed insurance application to the Comprehensive
Health
3227
Insurance Pool.
3228
(5) (a) An individual carrier is not required to accept individuals for coverage
under
3229
Subsection (3) if the carrier issues no new individual policies in the state after July 1,
1997.
3230
(b) A carrier described in Subsection (5)(a) may not issue new individual
policies in
3231
the state for five years from July 1, 1997.
3232
(c) Notwithstanding Subsection (5)(b), a carrier may request permission to
issue new
3233
policies after July 1, 1999, which may only be granted if:
3234
(i) the carrier accepts uninsurables as is required of a carrier entering the
market under
3235
Subsection
31A-30-110
; and
3236
(ii) the commissioner finds that the carrier's issuance of new individual
policies:
3237
(A) is in the best interests of the state; and
3238
(B) does not provide an unfair advantage to the carrier.
3239
(6) (a) If the Comprehensive Health Insurance Pool as set forth under Title
31A,
3240
Chapter 29, is dissolved or discontinued, or if enrollment is capped or suspended, an
individual
3241
carrier may decline to accept individuals applying for individual enrollment, other
than
3242
individuals applying for coverage as set forth in P.L. 104-191, 110 Stat. 1979, Sec.
3243
(a)-(b).
3244
(b) Within two calendar days of taking action under Subsection (6)(a), an
individual
3245
carrier will provide written notice to the Utah Insurance Department.
3246
(7) (a) If a small employer carrier offers health benefit plans to small
employers
3247
through a network plan, the small employer carrier may:
3248
(i) limit the employers that may apply for the coverage to those employers with
eligible
3249
employees who live, reside, or work in the service area for the network plan; and
3250
(ii) within the service area of the network plan, deny coverage to an employer if
the
3251
small employer carrier has demonstrated to the commissioner that the small
employer carrier:
3252
(A) will not have the capacity to deliver services adequately to enrollees of any
3253
additional groups because of the small employer carrier's obligations to existing
group contract
3254
holders and enrollees; and
3255
(B) applies this section uniformly to all employers without regard to:
3256
(I) the claims experience of an employer, an employer's employee, or a
dependent of an
3257
employee; or
3258
(II) any health status-related factor relating to an employee or dependent of an
3259
employee.
3260
(b) (i) A small employer carrier that denies a health benefit product to an
employer in
3261
any service area in accordance with this section may not offer coverage in the small
employer
3262
market within the service area to any employer for a period of 180 days after the
date the
3263
coverage is denied.
3264
(ii) This Subsection (7)(b) does not:
3265
(A) limit the small employer carrier's ability to renew coverage that is in force;
or
3266
(B) relieve the small employer carrier of the responsibility to renew coverage
3267
force.
3268
(c) Coverage offered within a service area after the 180-day period specified in
3269
Subsection (7)(b) is subject to the requirements of this section.
}
Renumber remaining sections accordingly
Committee Chair
4 HB0342.SC1.wpd anicholson/AMN PO/AMN 2/21/08 9:49 am