SB 37

This bill requires certain health plans to guarantee access to coverage;

prohibits plans from imposing preexisting condition exclusions; prohibits plans from

setting premiums or cost-sharing amounts based on a health status-related factors;

prohibits plans from setting lifetime or annual limits on benefits; requires plans to

cover certain essential health benefits; and requires coverage of certain preventive

services by plans without a cost-sharing contribution by an enrollee.

Coverage of individuals with preexisting conditions; rating; benefit limits.

This bill requires every individual health insurance policy, known in the bill as

a health benefit plan, to accept every individual who, and every group health

insurance policy to accept every employer that, applies for coverage, regardless of

sexual orientation, gender identity, or whether an employee or individual has a

preexisting condition. The bill allows health benefit plans to restrict enrollment in

coverage to open or special enrollment periods and requires the commissioner of the

Office of the Commissioner of Insurance to establish a statewide open enrollment

period of no shorter than 30 days for every individual health benefit plan. The bill

prohibits a group health insurance policy, including a self-insured governmental

health plan, from imposing a preexisting condition exclusion. The bill also prohibits

an individual health insurance policy from reducing or denying a claim or loss

incurred or disability commencing under the policy on the ground that a disease or

physical condition existed prior to the effective date of coverage.

A health benefit plan offered on the individual or small employer market or a

self-insured governmental health plan may not vary premium rates for a specific

plan except on the basis of whether the plan covers an individual or family, area in

the state, age, and tobacco use as specified in the bill. An individual health benefit

plan or self-insured health plan is prohibited under the bill from establishing rules

for the eligibility of any individual to enroll based on health-status related factors,

which are specified in the bill. A self-insured health plan or an insurer offering an

individual health benefit plan is also prohibited from requiring an enrollee to pay a

greater premium, contribution, deductible, copayment, or coinsurance amount than

is required of a similarly situated enrollee based on a health-status related factor.

Current state law prohibits group health benefit plans from establishing rules of

eligibility or requiring greater premium or contribution amounts based on a

health-status related factor. The bill adds to these current law requirements for

group health benefit plans that the plan may not require a greater deductible,

copayment, or coinsurance amount based on a health-status related factor.

Under the bill, an individual or group health benefit plan or a self-insured

governmental health plan may not establish lifetime or annual limits on the dollar

value of benefits for an enrollee or a dependent of an enrollee under the plan.

The requirements and prohibitions in this bill related to coverage of individuals

with preexisting conditions and prohibition of lifetime and annual benefit limits also