Signed by Governor Bill Richardson

Vote Smart's Synopsis:

Vote to pass a bill that provides minimum reimbursement levels for direct health insurer services.

Highlights:

-Requires a health insurer, health maintenance organization, and health care plan to make reimbursement for direct services at a level not less than 85 percent of premiums across all health product lines, except individually underwritten health insurance policies, contracts or plans (Sec. 1, 3, & 4). -Specifies that for individually underwritten health care policies, plans or contracts, the superintendent will establish the level of reimbursement for direct services, as determined by the reports filed with the insurance division, as a percent of premiums (Sec. 1, 3, & 4). -Requires a health maintenance organization and health plan that fails to comply with the reimbursement requirements to issue a dividend or credit against future premiums to all policy or contract holders in an amount sufficient to assure that the benefits paid in the previous three calendar years plus the amount for the dividends or credits are equal to the required direct services reimbursement level (Sec. 1, 3, & 4). -Requires health insurers to make reimbursement for direct services at a level not less than 85% of premiums on all health product lines for the preceding three calendar years, but not earlier than calendar year 2010, as determined by reports filed with the insurance division of the commission (Sec. 2). -Requires an insurer that fails to comply with the reimbursement requirement to issue a dividend or credit against future premiums to all policyholders in an amount sufficient to assure that benefits paid in the previous three calendar years plus the amount of the dividends or credits equal 85 percent of the premiums collected in the preceding three calendar years (Sec. 2). -Defines "direct services" as services rendered to an individual by a health insurer or a health care practitioner, facility or other provider, including case management, disease management, health education and promotion, preventive services, quality incentive payments to providers and any portion of an assessment that covers services rather than administration and for which an insurer does not receive a tax credit (Sec. 1-4). -Defines "health maintenance organization" as any person who undertakes to provide or arrange for the delivery of basic heath care services to enrollees on a prepaid basis but does not include a person that only issues a limited-benefit policy or contract intended to supplement major medical coverage, or that only issues policies for long-term care or disability income (Sec. 3). -Defines "health care plan" as a nonprofit corporation authorized by the superintendent to enter into contracts with subscribers and to make health care expense payments but does not include a person that only issues a limited-benefit policy intended to supplement major medical coverage, including Medicare supplement, vision, dental disease-specific, accident-only or hospital indemnity-only insurance policies, or that only issues policies for long-term care or disability income (Sec. 4).

Full Bill Text

Vote Smart's Synopsis:

Vote to pass a bill that provides minimum reimbursement levels for direct health insurer services.

Highlights:

-Requires a health insurer, health maintenance organization, and health care plan to make reimbursement for direct services at a level not less than 85 percent of premiums across all health product lines, except individually underwritten health insurance policies, contracts or plans (Sec. 1, 3, & 4). -Specifies that for individually underwritten health care policies, plans or contracts, the superintendent will establish the level of reimbursement for direct services, as determined by the reports filed with the insurance division, as a percent of premiums (Sec. 1, 3, & 4). -Requires a health maintenance organization and health plan that fails to comply with the reimbursement requirements to issue a dividend or credit against future premiums to all policy or contract holders in an amount sufficient to assure that the benefits paid in the previous three calendar years plus the amount for the dividends or credits are equal to the required direct services reimbursement level (Sec. 1, 3, & 4). -Requires health insurers to make reimbursement for direct services at a level not less than 85% of premiums on all health product lines for the preceding three calendar years, but not earlier than calendar year 2010, as determined by reports filed with the insurance division of the commission (Sec. 2). -Requires an insurer that fails to comply with the reimbursement requirement to issue a dividend or credit against future premiums to all policyholders in an amount sufficient to assure that benefits paid in the previous three calendar years plus the amount of the dividends or credits equal 85 percent of the premiums collected in the preceding three calendar years (Sec. 2). -Defines "direct services" as services rendered to an individual by a health insurer or a health care practitioner, facility or other provider, including case management, disease management, health education and promotion, preventive services, quality incentive payments to providers and any portion of an assessment that covers services rather than administration and for which an insurer does not receive a tax credit (Sec. 1-4). -Defines "health maintenance organization" as any person who undertakes to provide or arrange for the delivery of basic heath care services to enrollees on a prepaid basis but does not include a person that only issues a limited-benefit policy or contract intended to supplement major medical coverage, or that only issues policies for long-term care or disability income (Sec. 3). -Defines "health care plan" as a nonprofit corporation authorized by the superintendent to enter into contracts with subscribers and to make health care expense payments but does not include a person that only issues a limited-benefit policy intended to supplement major medical coverage, including Medicare supplement, vision, dental disease-specific, accident-only or hospital indemnity-only insurance policies, or that only issues policies for long-term care or disability income (Sec. 4).

Full Bill Text