00RS HB201


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HB 201 (BR 995) - R. Crimm, S. Baugh, J. Gooch

     AN ACT relating to health insurance.
     Amend KRS 304.17A-005 to change the definitions of "guaranteed acceptance program," high-cost condition," and "individual market;" amend KRS 304.17A-095 to delete participation of Attorney General in review of health insurance rate filings; provide that rate filings are deemed approved if they contain a guaranteed loss ratio; define "loss ratio" as claims incurred, plus local and state premium taxes, plus preferred provider organization expenses, plus guaranteed acceptance plan assessments, divided by premiums received; establish loss ratio tables; require premium refunds to bring the actual aggregate loss ratio up to the guaranteed minimum loss ratio; amend KRS 304.17A-0952 to increase from 35% to 40% the variation from index rate for individual policies; increase adjustment for health conditions from 10% to 15%; amend KRS 304.17A-210 to require issuance of plans on a guaranteed-issue basis by each guaranteed acceptance program participating insurer rather than each insurer in the individual market; delete cap on individuals with high-cost conditions for new insurers; delete enrollment limits; amend KRS 304.17A-230 to define preexisting condition for individual policies; delete provision that prohibits imposition of preexisting condition exclusions on any eligible individual; amend KRS 304.17A-250 to delete provision that requires an insurer to issue coverage if the insurer fails to issue a premium rate quote within 30 days of receiving application; require insurer to send denial letter within 20 days after completion of underwriting rather than within 20 days after the request for coverage; amend 304.17A-280 to provide that when commissioner adds to high-cost conditions it does not have to be based on diagnosis and severity; amend KRS 304.17A-410 to provide that market share does not include guaranteed acceptance plan premiums; amend KRS 304.17A-420 to delete requirement that each insurer with 25% or more market share must participate in the guaranteed acceptance plan; amend KRS 304.17A-430 to eliminate the alternative underwriting mechanism; delete provisions pertaining to policies covering persons with high-cost conditions where claims paid for any 3 consecutive years are less than the premiums paid; amend KRS 304.17A-470 to eliminate a provision on reimbursement for program plan losses attributable to plans issued to persons without a high-cost condition; amend KRS 304.17A-510, 304.17A-525, and 304.17A-550 to restrict provisions to insurers that offer managed care plans; amend KRS 304.17A-535 to restrict the drug utilization review program requirements to managed care plans that utilize a drug formulary.


     HCS - Retain the original provisions except delete Sections 1, 4, 7, 8, 9, 10, and 11; delete provisions on reasonableness and adequacy of rates; require the minimum loss ratio to contain a statement certifying that all rates, fees, dues, and other charges are not excessive, inadequate, or unfairly discriminatory; allow premium refunds of less than ten dollars to be aggregated and paid to the insurance regulatory trust fund and used for health care coverage for high cost individuals in the individual market; provide that when determining the loss ratio the insurer shall also use the preferred provider organization expenses, case management and utilization expenses, and reinsurance premiums less reinsurance recoveries; restore provision that requires an insurer to issue coverage to a person if the insurer failed to provide a premium quote within 30 days of receiving a completed application.

     (Prefiled by the sponsor(s))

     Jan 4-introduced in House; to Banking and Insurance (H)
     Feb 16-posted in committee
     Mar 9-reported favorably, 1st reading, to Calendar with Committee Substitute
     Mar 10-2nd reading, to Rules
     Mar 16-recommitted to Appropriations and Revenue (H)

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