Health Insurance Market Reform Act of 1992

Summary

Health Insurance Market Reform Act of 1992 - Amends the Social Security Act (SSA) to add a new title XXI, Requirements Concerning Health Insurance. States under part A of new SSA title XXI that the purposes of such title are to increase the availability, portability, and affordability of health insurance, particularly to small employers and their employees and dependents, by seeking to ensure, among other things, that: (1) affordable health insurance is available to individuals and groups, and premiums do not vary substantially, regardless of health status or claims experience; (2) States regulating health insurance do not place an undue burden on small employers; and (3) insurers, providers, purchasers, and consumers are encouraged to contain costs of health care and health insurance. Applies the provisions of new SSA title XXI to health insurance plans offered in any State and to insurers offering such plans. Provides for the establishment of Federal and State regulatory programs implementing the requirements of parts B and C of new SSA title XXI. Requires the Secretary of Health and Human Services to: (1) request the National Association of Insurance Commissioners (NAIC) to recommend model standards for compliance with such requirements; and (2) using such model standards, with revisions as necessary, publish implementing regulations. Requires the Secretary to determine whether each State has established a regulatory program adequate to ensure compliance with such requirements. Allows State programs to establish standards more stringent than those required under new title XXI, if the Secretary finds them consistent with its purposes. Provides that an approved State program shall take effect, in lieu of the above mentioned implementing regulations, as of a specified date: (1) with respect to all insurers and health insurance plans subject to part B of new SSA title XXI; and (2) with respect to all insurers and health insurance plans subject to part C, except for employee welfare benefit plans which are not multiple employer welfare arrangements (MEWAs). Requires the Secretary to implement a program: (1) under part C in all States with respect to those insurers and health insurance plans not subject to State regulation; and (2) under both parts B and C with respect to all insurers and health insurance plans in each State without an approved program. Authorizes the Secretary to waive, with respect to one or all States, any provision of new SSA title XXI, or of Medicare or Medicaid (SSA titles XVIII and XIX, respectively), to the extent and for the period he or she finds likely to promote the purposes of facilitate the administration of new title XXI. Provides for Federal oversight over State programs. Makes the requirements of parts A, B, and C of new SSA title XXI generally effective with respect to health insurance plans offered, issued, or renewed in a State on or after January 1, 1994 (or certain later dates necessary to allow for enactment of State legislation). Provides that certain provisions concerning variations in premiums among and within blocks of business, and the rate of premium increases shall not apply, until two years after the general effective date, to a renewal of a health insurance plan that was in effect before the effective date. Provides that under part B of new SSA title XXI each insurer must register with the Secretary and the appropriate official for each State in which it issues or offers any health insurance plan to a small employer. Requires, subject to specified exceptions, any insurer offering a health insurance plan to any small employer in a State (or to any small employer in a local service area within the State, in the case of an insurer offering health insurance only within such an area) to: (1) make such plan available to every small employer in the State or local service area; (2) make available to every small employer any basic insurance plan a State may require; and (3) not cancel or refuse to renew any small employer health insurance plan. Requires an insurer providing small employer health insurance to notify the employer, at least 60 days before expiration, of the terms for renewal, and the extent to which any premium increase is based on actual or expected claims experience of covered individuals. Requires, subject to specified exceptions, that each health insurance plan offered to a small employer accept for enrollment, on the same terms as any other enrollee, every eligible employee and (in the case of a family plan) the employee's spouse and any dependent child under age 19 or, if older, under age 25 and a full-time student. Prohibits a small employer that made health insurance available to employees from using criteria related to health status or claims experience to determine eligibility for, benefits under, or terms of such health insurance for individual employees. Permits a State to define a basic benefit plan and to require that it be offered to small employers in the State by insurers (other than health insurance networks (HINs) or MEWAs) offering heatlh insurance plans to small employers in the State. Subjects the plan to review and approval by the Secretary to ensure that it is affordable by small employers. Requires that the regulatory program established with respect to a State require all insurers offering health insurance plans to small employers, during a specified period, to: (1) participate in an interim risk pooling mechanism; and (2) comply with requirements designed to limit variations among and increases in premium rates for such health insurance plans. Permits the interim risk pooling mechanism to be either a reinsurance program or an assigned risk program. Provides for funding such a mechanism. States that no Federal entity shall be at risk, as a guarantor of the solvency of a reinsurance fund or otherwise, for all or any part of the cost of health insurance plans subject to interim risk pooling. Provides that, for any rating period, no base premium rate for any small employer block of business may exceed the equivalent base premium rate for any other block of the insurer by more than 20 percent. Provides that the highest premium rate for a specific health insurance plan that an insurer can charge any small employer in a block of business for a rating period shall not exceed the corresponding base premium rate by more than: (1) 50 percent for a period ending before January 1, 1997; and (2) 35 percent for a period thereafter. Limits annual percentage increases in the premium rate charged to a small employer. Sets forth requirements concerning rate-setting methodology, including requirements for full disclosure of rating practices and actuarial certification. Establishes requirements for the permanent health risk pool system in a State. Provides continued health insurance coverage for certain college students. Provides under part C of new SSA title XXI that, except to the extent permitted under an assigned risk program, an insurer may not refuse to offer, refuse to renew, cancel, or condition the coverage under any employment-based health insurance plan on the basis of the health status, claims experience, receipt of health care, medical history, or lack of evidence of insurability, of one or more individuals. Sets limits on exclusions under employment-based health insurance plans for pre-existing conditions. Preempts certain State laws relating to health insurance. Sets forth requirements an entity must meet in order to be entitled to certification as a health insurance network (HIN). Permits the Secretary to fund health risk pooling demonstrations in as many as four States. Authorizes the Secretary to develop model health risk pooling systems. Requires the Secretary to develop methods for measuring the health risk differential of individuals. Authorizes appropriations. Amends the Internal Revenue Code to impose an excise tax of $1000 per covered employee on insurers for noncompliance with the requirements of part B or C of SSA new title XXI.

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2 official files

• Introduced in Senate (text)

  Introduced in Senate · EN

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• Introduced in Senate

  summary · EN · 14 May 1992

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