comprehensive health
insurance; risk pool
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Committee on Financial Institutions and Insurance |
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Committee on Health |
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Committee on Appropriations |
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Caucus and COW |
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As Passed the House |
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HB 2589 establishes a health insurance plan within the Department of Insurance to guarantee access for individuals who cannot obtain health insurance in the private market and provide protection for those individuals with a catastrophic medical condition.
HB 2589 has
a proposed strike everything amendment
Provisions
Plan
The comprehensive health insurance plan (plan) operates under the control of the board. The board consists of 10 members who serve three-year terms and the Director of the Department of Insurance who shall preside as chairman.
· Board members are not eligible to receive compensation.
· The board shall submit an annual report to the Speaker of the House, President of the Senate and Governor.
Plan of Operation
· The board is required to submit a plan of operation.
· The bill specifies what procedures shall be included in the plan of operation.
Powers of the Plan
Under the powers and authority granted by the state, the plan can enter into contracts, sue or be sued, establish and modify actuarial functions appropriate to the plan operation, issue insurance policies, borrow money, employ individuals, provide for reinsurance of risks incurred by the plan and employ cost containment measures.
Eligibility
· Plan is limited to 2,000 participants.
· An individual who is an Arizona resident for six months would be eligible for the plan upon:
1) Rejection by two other plans to issue substantially similar insurance for health reasons;
2) Diagnosis of certain health conditions determined by the board.
· An individual is not eligible for coverage under the plan if:
1) The plan has paid out one million dollars in benefits on behalf of the individual;
2) The individual has or would be eligible to have coverage substantially similar to the plan policy;
3) The individual is an inmate or resident of a public institution;
4) The individual has previously terminated plan coverage unless 12 months has passed since the termination;
5) The individual is eligible for health care benefits under AHCCCS.
Plan Administrator
· The board is required to select a plan administrator.
· The plan administrator’s functions include:
1) payment of claims;
2) establishing billing procedures for collection of premiums;
3) determining the eligibility of persons
Funding of the Plan
· Requires the individual to pay between 100-200 per cent of the average price for an individual HIPAA portability product.
· Six million dollars is to be appropriated to operate and administer the plan from the state general fund in both fiscal year 2001-2002 and 2002-2003.
· Requires the board to hold any excess amount in an interest bearing account and use the excess to offset future losses in the event that the appropriation is more than the plan’s actual losses and administrative expenses.
Benefits
· Requires the board to base benefits on the typical individual product.
· The plan is not required to cover existing state mandates unless the legislature specifically makes the benefit applicable to the plan.
· Care provided out of state is limited to emergency treatment only.
· Contains a 24-month look back and six-month pre-existing condition exclusion once a person enters the plan.
Dates
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Effective date of
December 31, 2001.
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The Auditor General’s
office is required to audit the plan and recommend if theplan is to continue by
November 15, 2005.
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Plan terminates on
January 1, 2007.
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44th Legislature
Second Regular
Session 3 March
2, 2001
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