Private Insurers

Sets out provisions to determine an acute hospital's annual assessment to cover a portion of estimated expenses of the Division of Health Care Finance and Policy and the Health Safety Net office.

Requires family policies to extend coverage to children up to 26 years of age or for 2 years after "loss of dependent status," whichever occurs first.

Requires commercial insurers to provide written statements verifying that a health plan provides creditable coverage to both the insured and the Commissioner of Revenue.

Provides that Blue Cross plans may only offer policies to employers if the insurance is offered to all full-time employees. The employer must offer to cover the same premium contribution percentage for each employee but may allow greater contribution percentages to lower paid employees and separate percentages for employees with collective bargaining agreements.

Requires family policies to extend coverage to children up to 26 years of age or for 2 years after "loss of dependent status," whichever occurs first.

Requires commercial insurers to provide written statements verifying that a health plan provides creditable coverage to both the insured and the Commissioner of Revenue.

Blue Cross Blue Shield may only offer coverage to employers if the insurance is offered to all full-time employees. The employer must offer to cover the same premium contribution percentage for each employee but may allow greater contribution percentages to lower paid employees and separate percentages for employees with collective bargaining agreements.

Requires family policies to extend coverage to children up to 26 years of age or for 2 years after "loss of dependent status," whichever occurs first.

Requires insurers to provide written statements verifying that a health plan provides creditable coverage to both the insured and to the commissioner of revenue.

Requires HMO family policies to extend coverage to children up to 26 years of age or for 2 years after "loss of dependent status," whichever occurs first.

Provides that an HMO may only sell a group health plan to employers if the insurance is offered to all full-time employees. The employer must offer to cover the same premium contribution percentage for each employee but may allow greater contribution percentages to lower paid employees and separate percentages for employees with collective bargaining agreements.

Allows individuals to purchase coverage through the small group insurance market, and provides that the small group insurance law provisions apply to all small business and individual plans issued by an insurance carrier, by the Connector, or through an intermediary.

Sets the factors used to set premiums for the merged individual and small group market. This section establishes a maximum rate band range from .66 to 1.32 for the following factors: age, industry rate, participation-rate rate, wellness program rate, and tobacco use rate. Additionally, carriers can apply only the following factors outside the rating band in establishing premiums: benefit level, geographic region, adjustment factor for an eligible individual and a small group, and group size. Additionally, requirements are laid out for which carriers with 5,000 or more members will be required to file a plan annually with the Connector to be considered for the "Connector Seal of Approval."

Requires insurance carriers to make available to individuals and small groups information for all plans and prices of plans offered to any other individuals and small groups. • Modifies the current requirement of carriers to make health benefit plans available in the following ways: Requires carriers to offer coverage effective within 30 days after application to any eligible individuals if they request coverage within 63 days of any prior creditable coverage. If the 63 day period has lapsed, carriers must offer coverage effective on the first day of the month following enrollment to eligible individuals who apply during the mandatory biannual open enrollment periods. • For a Trade Act/Health Coverage Tax Credit Eligible Individual, carriers may impose a 6 month exclusion of coverage for pre-existing conditions if the individual had less than 3 months of continuous coverage before becoming eligible for the tax credit or had a break in coverage for more than 62 days before applying for the plan. However, plans offered to individuals without creditable coverage for 18 months prior to application may not be subjected to a waiting period. • A carrier can deny enrollment in any plan if the carrier files with the Commissioner proof of intent to stop selling that plan. • Carriers can require individuals or groups of 1-5 to enroll in plans via the Connector or an intermediary.

Provides that the Commissioner of the Division of Insurance may approve, according to established criteria, health insurance policies for individuals or small businesses that cover more restricted networks that differ from the overall carrier's network. The Commissioner may also disapprove any proposed rate changes if the Commissioner disapproves proposed rate increases to a small group plan, an insurance carrier must notify all members of the plan that the proposed increase has been disapproved and is subject to a public hearing. The carrier may not implement the proposed rates until the Commissioner has approved the rates.

Requires insurance carriers to disclose to prospective small business customers the surcharge that may be applied to the group’s premium and the participation requirements or participation rate adjustments for each health plan. • Requires insurance carriers to file electronically with the Division of Insurance rates and notification of actuarial methodology and any relevant changes prior to filing.

Requires the governing committee of the carrier-funded small-group reinsurance plan implemented in 1992 to establish a plan to phase out the program by June 2007.

Provides definitions for sections 96, 97, 98, 99, 100 of Chapter 58 of the Acts of 2006.

Provides definitions pertaining to merger of individual and small group health insurance markets.