Mediplan Health Care Act of 1991

Summary

Mediplan Health Care Act of 1991 - Title I: Health Care Eligibility and Benefits - Adds a new title XXI to the Social Security Act entitled "Mediplan Health Benefits." Makes all U.S. residents eligible for Mediplan benefits. Requires the development of a Mediplan enrollment mechanism that includes automatic enrollment at birth and the issuance of Mediplan cards for identification and claims processing purposes. Provides the same benefits under the Mediplan program as are provided under title XVIII (Medicare) of the Social Security Act to individuals who are entitled to benefits under part A (Hospital Insurance) and enrolled under part B (Supplementary Medical Insurance) of the Medicare program. Imposes a $500 annual deductible on Mediplan beneficiaries, but limits an individual's annual out-of-pocket costs for deductibles, coinsurance, and copayments to $2,500. Provides additional Mediplan coverage to children under age 23, pregnant women, and low-income individuals. Imposes no coinsurance, deductible, or copayment for benefits provided to such children, to individuals whose income is below the Federal poverty level, or for pregnancy-related services provided to pregnant women. Charges individuals whose income is above the Federal poverty level but does not exceed twice that level with a proportion of cost-sharing amounts equal to the extent to which their income spans such limits. Provides children with preventive health care services, and children and individuals whose income is below the Federal poverty level with outpatient prescription drugs and biologicals, eyeglasses and hearing aids and examinations therefor, and inpatient hospital services without durational limitations. Includes postnatal family planning services among covered pregnancy-related services. Requires that payments under the Mediplan program be made only on an assignment-related basis. Requires payments for obstetrical services to be made on the basis of a global fee for the group of obstetrical services typical during the course of pregnancy, with slightly greater payments for prenatal care services begun in a women's first trimester of pregnancy and for non-caesarean deliveries. Requires the Secretary of Health and Human Services to establish a prospective payment methodology for outpatient prescription drugs and biologicals. Establishes the Mediplan Trust Fund which shall consist of revenues raised by this Act's financing mechanisms and amounts States save under their Medicaid (title XIX of the Social Security Act) programs due to the Mediplan program. Requires the modification of Medicaid and other Federal health programs to avoid their duplication of Mediplan coverage. Applies various administrative provisions of the Medicare program to the Mediplan program. Requires group health plans which provide their current beneficiaries with benefits which are in addition to Mediplan benefits to continue to provide such benefits to such individuals, though they needn't provide such additional benefits to individuals who are not entitled to them before this Act's enactment. Title II: Financing Provisions - Amends the Internal Revenue Code to impose an additional income tax on individuals, a tax on every taxpayer other than an individual, and a tax on the wages paid by employers to finance Mediplan health care premiums.

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2 official files

• Introduced in House (text)

  Introduced in House · EN

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• Introduced in House

  summary · EN · 24 January 1991

  Open at official source

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