Vote to pass a bill that amends the regulations affecting insurers, HMOs and nonprofit mutual disability insurers.
Authorizes a nonprofit mutual disability insurer to merge with a nonprofit health care corporation, which will continue as a nonprofit entity and continue providing coverage to individuals and groups regardless of health status through January 1, 2014 (Secs. 5801, 5805 & 5826).
Requires a nonprofit mutual disability insurer that has merged with a nonprofit health care corporation to continue offering health care benefits to Medicare enrollees at the same rates until July 31, 2016 (Sec. 5805).
Prohibits an insurer from denying or conditioning the issuance or pricing of an insurance policy on the basis of health status, claims experience, receipt of health care, or medical condition, effective January 1, 2014 (Sec. 3472).
Requires an insurer, health maintenance organization (HMO), or nonprofit to charge a premium rate based solely on whether the policy covers an individual or family, the ratings area, age and tobacco usage, effective January 1, 2014 (Sec. 3474).
Prohibits an insurer or HMO from discontinuing a hospital, medical or surgical plan unless the insurer or HMO does the following (Sec. 2213):
Provides notice to the commissioner and each covered individual at least 90 days prior to discontinuation;
Offers the covered individual the option to purchase any other plan currently offered by that insurer without limiting coverage due to pre-existing conditions or establishing a waiting period; and
Discontinues coverage uniformly without regard to any health status factor.
Prohibits an insurer or HMO from using a “most favored nation clause” in any provider contract beginning January 1, 2014 (Sec. 3405).
Defines “most favored nation clause” as a provision which prohibits a health care provider from contracting with another entity to provide care at a lower rate than the payment specified in the contract (Sec. 3405).