Portability under group health benefit plans and independent review of insurance policy rescissions and preexisting condition exclusion denials under group and individual health benefit plans

What it would have done

Summary by the Legislative Reference Bureau, the Legislature's nonpartisan drafting office. It's their wording, not ours.

Under current law, for purposes of determining how long a preexisting condition exclusion may be imposed under a group health benefit plan, if a person who enrolls in the group health benefit plan had other coverage before that enrollment, the person must be given credit for the time during which he or she was previously covered when determining how long a preexisting condition exclusion may be imposed under the new coverage. Previous coverage may not be counted for the credit, however, if the person did not have coverage for a period of 63 or more days before the person's new coverage commenced. This bill increases that amount of time, so that a person may get credit for previous coverage if it ended up to 90 days, rather than 63 days, before the person enrolled in the group health benefit plan.

Also under current law, every insurer that issues a group or individual health benefit plan must have an internal grievance procedure under which an insured may submit a written grievance and a grievance panel must investigate the grievance and, if appropriate, take corrective action. In addition, every insurer that issues a group or individual health benefit plan must have an independent review procedure for review, after the internal grievance procedure has been exhausted, of certain decisions that are adverse to an insured. The adverse decision must relate to the insurer's denial of treatment or payment for treatment that the insurer determined was experimental or to the insurer's denial, reduction, or termination of a health care service or payment for a health care service on the basis that the health care service did not meet the plan's requirements for medical necessity, appropriateness, health care setting, level of care, or effectiveness. An independent review may be conducted only by an independent review organization that has been certified by the Commissioner of Insurance (commissioner).

Who's behind it

10 senators are its authors⁠. All 10 are Democrats.

8 more lawmakers signed on in support⁠.

What it would cost

State agencies filed a cost estimate. Each opens as a PDF from the Legislature.

• Fiscal Estimate From OCI