Bill Text: IN HB1062 | 2011 | Regular Session | Introduced
Bill Title: Basic health insurance coverage.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2011-01-05 - First reading: referred to Committee on Insurance [HB1062 Detail]
Download: Indiana-2011-HB1062-Introduced.html
Citations Affected: IC 27-8; IC 27-13.
Synopsis: Basic health insurance coverage. 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.
Effective: July 1, 2011.
January 5, 2011, read first time and referred to Committee on Insurance.
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or
A BILL FOR AN ACT to amend the Indiana Code concerning
insurance.
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) Mastectomy related coverage under IC 27-8-5-26.
(2) Mental illness related coverage under IC 27-8-5-15.6.
(3) Dental anesthesia related coverage under IC 27-8-5-27.
(4) Adopted child coverage under IC 27-8-5-21.
(5) Newborn coverage under IC 27-8-5.6.
(6) Breast cancer screening related coverage under IC 27-8-14.
(7) Morbid obesity related coverage under IC 27-8-14.1.
(8) Pervasive developmental disorder related coverage under IC 27-8-14.2.
(9) Diabetes related coverage under IC 27-8-14.5.
(10) Prostate cancer testing related coverage under IC 27-8-14.7.
(11) Colorectal cancer testing related coverage under IC 27-8-14.8.
(12) Off label drug treatment coverage under IC 27-8-20.
(13) Minimum maternity related benefits under IC 27-8-24.
(14) Inherited metabolic disease related coverage under IC 27-8-24.1.
(15) Orthotic device and prosthetic device coverage under IC 27-8-24.2.
(16) Care related to clinical trials coverage under IC 27-8-25.
(17) Cancer chemotherapy related coverage under IC 27-8-32.
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 a 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 each 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.
(1) a small employer; or
(2) an eligible employee or dependent;
through riders, endorsements, or otherwise to restrict or exclude coverage or benefits for specific diseases, medical conditions, or services otherwise covered by the plan.
[EFFECTIVE JULY 1, 2011]: 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) Mastectomy related coverage under IC 27-13-7-14.
(2) Mental illness related coverage under IC 27-13-7-14.8.
(3) Dental anesthesia related coverage under IC 27-13-7-15.
(4) Adopted child coverage under IC 27-8-5-21.
(5) Newborn coverage under IC 27-8-5.6.
(6) Breast cancer screening related coverage under
IC 27-13-7-15.3.
(7) Morbid obesity related coverage under IC 27-13-7-14.5.
(8) Pervasive developmental disorder related coverage under
IC 27-13-7-14.7.
(9) Diabetes related coverage under IC 27-8-14.5.
(10) Prostate cancer testing related coverage under
IC 27-13-7-16.
(11) Colorectal cancer testing related coverage under
IC 27-13-7-17.
(12) Off label drug treatment coverage under IC 27-8-20.
(13) Minimum maternity related benefits under IC 27-8-24.
(14) Inherited metabolic disease related coverage under
IC 27-13-7-18.
(15) Orthotic device and prosthetic device coverage under
IC 27-13-7-19.
(16) Cancer chemotherapy related coverage under
IC 27-13-7-20.
(17) Care related to clinical trials coverage under
IC 27-13-7-20.2.
(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.
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 a 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 each 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.