National Voluntary Health Insurance Act of 1985

Summary

National Voluntary Health Insurance Act of 1985 - Creates a National Voluntary Health Insurance Agency to operate a National Voluntary Health Insurance Plan with funds supplied by voluntary subscriptions and matching Treasury funds. States that the Agency shall issue no rules or regulations, but shall be governed solely by this Act and its amendments. Authorizes appropriations for the first calendar year after this Act becomes effective. Eliminates hospital and medical service insurance benefits or payments provided by other Government agencies, including Medicare, Medicaid, and the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). Extends coverage to: (1) medical services, wherever furnished, including psychiatric medicine, surgery, obstetrics, radiological and electrical procedures, pathology tests, transfusions, medication and immunization, injections and anesthesia, and osteopathic services; (2) reconstructive oral surgery; (3) podiatric surgery; (4) laboratory services; and (5) inpatient or outpatient hospital service, supplies, medication, transfusions, and food provided by approved hospitals, including general or special hospitals, outpatient clinics, emergency wards, convalescent hospitals, nursing homes, and acute alcohol or drug toxification treatment centers. Excludes from coverage: (1) cosmetic surgery not approved under this Act; (2) certain services which are not medically necessary; (3) services for the benefit of a second party other than the enrollee; (4) certain employer responsibilities, such as a workmen's compensation insurer; (5) services which are already covered by another plan; (6) unapproved hospital or laboratory services; and (7) certain other medical advice and services. Sets the amount of premium payments at $40 per month for each adult and one-half of such amount for each child. Entitles subscribers with a total annual family income of less than $12,000 to have their premiums calculated at two and one-half percent of such income for each adult and one-half of such amount for each child. Provides for the payment of premiums by employers and for the reinstatement of coverage on account of unpaid premiums. Directs the Agency to establish a trust fund for the deposit of all premiums and at least an equal amount of money appropriated from the Treasury. Directs Congress to deposit in such fund the amount of $5,000,000,000 by the effective date of the Plan. Stipulates that the total amount of general funds appropriated to the fund shall not exceed the total amount of subscribers' premiums after the Plan's fifth year of operation. Reserves 35 percent of the total amount of subscribers' premiums for the payment of medical and laboratory service benefits, 62 percent of such premiums for hospital service benefits, and three percent for administrative costs. Sets forth reimbursement provisions. Allows participating providers to require an enrollee to pay a reasonable charge in addition to the Plan fee. Provides for the participation in the Plan by laboratories and hospitals. Directs the Agency to: (1) set a fee for every professionally recognized diagnostic and therapeutic medical service; and (2) provide each approved hospital with a schedule or per diem rate and charges that it will pay. Requires such hospital charges to be based on each hospital's certified annual financial and operating cost statement. Specifies certain additional requirements with respect to hospital charges. Sets forth requirements with respect to the auditing, payment, and assessment of claims and the utilization of Plan benefits. Authorizes the Agency to temporarily or permanently exclude any enrollee or provider for false payment or service claims. Requires the Congress, at the time this Act becomes operational, to amend the rates of Social Security taxes relative to the reduction in Social Security health insurance expenditures effected by this Act. Requires the arbitration of Plan malpractice claims. Provides that the resources of the Agency and Plan shall not be used in any way directly to regulate the quality or availability of, or to establish or operate, medical and hospital services. Details the estimated cost of the Plan for FY 1984.

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1 official file

• Introduced in House

  summary · EN · 6 February 1985

  Open at official source

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