where y is the subsidy (measured in terms of full cost of public option coverage) and x is defined as household income (measured in terms of poverty line).
2. Funding for the subsidy shall be derived from the healthcare payroll tax set at 6.1% as amended by Residential Taxation Reform Act of 2014.
3. Limits and/or guidelines for premiums, co-pays, deductibles:
a. The total out of pocket payment for co-pays and deductibles for an individual and/or household for the whole year may not exceed beyond 5% of the total income of that individual and/or household.
b. This co-pay limit shall apply to all services mentioned in Part II, Section 2 of this Act.
Part II - Changes to ANHC
The New National Healtcare Act is to be amended and replaced with the following text:
Section 1: Eligibility and Benefits
1. All individuals residing in Atlasia are eligible to enroll in a plan offered by the Atlasian National Health Care Program (ANHC), which shall all entitle them to a high standard of care at a low cost.
2.The health care benefits offered by ANHC plans shall cover all medically necessary services, including at least the following:
1.Primary care and prevention.
2.Inpatient care.
3.Outpatient care.
4.Emergency care.
5.Prescription drugs.
6.Durable medical equipment.
7.Long-term care.
8.Palliative care.
9.Mental health services.
10.The full scope of dental services (other than cosmetic dentistry).
11.Substance abuse treatment services.
12.Chiropractic services.
13.Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
14.Hearing services, including coverage of hearing aids.
15.Podiatric care.
16.Contraceptive services
17.End of Life Care - Shall be limited in hospital settings up to the cost of such care when attained through a hospice setting.
3. Healthcare professionals shall be licensed according to the laws and policies of their respective regions. Only licensed professionals shall be allowed to offer such services and only such licensed professionals will be eligible for reimbursement from the ANHC program.
Section 2: Finances
1. The levels of reimbursement to licensed professionals and medical facilities shall be determined by the CHPs, considering the cost of providing such care and ensuring the integrity and preservation of the providers.
2. The CHPs hall determine the level of premiums, co-pays and deductibles in accordance with the levels of reimbursement as established in the previous section of this act and any other limits as proscribed by law.
3. Licensed health care clinicians who perform a covered service under the ANHC, to any patient enrolled therein, may not bill the patient for the portion of the bill covered by the ANHC.
Section 3. Administration
1. The ANHC program shall be administered by the Health Directorate, made up by a Chairman and the Executives of the regional CHP boards.
2. The provision of healthcare and the administration of budgets and services shall be the responsibility of independent Community Health Partnerships (CHPs) congruent to the existing Regions, these shall be established as public sector corporations. Each CHP shall be headed by a board consisting of one Executive and further non-executive members.
3. CHP members shall be selected by the Health Directorate and shall be a non-partisan gathering of experts in the medical, pharmaceutical, and health insurance and administration industries.
4. All boards shall be required to have an audit committee consisting only of non-executive members on which the chair may not sit. This committee shall be entrusted with the supervision of financial audit and of systems of corporate governance within the CHP.
5. All members, directors and associated bodies shall be accountable to the Health Directorate as outlined in this section.
Part III: Coverage for Special Populations
Section 1: Coverage for Military and Veterans.
1. All active duty military personell shall be eligible for full coverage under ANHC, fully paid for by the Atlasian Department of Defense with no premiums, co-pays or deductibles.
2. All Veterans shall be eligible for full coverage under the ANHC, with no co-pays or deductibles, with subsidies for premiums as described in Part 1, Section 3 of this Act. Cost normally associated with co-pays and deductibles shall be covered by the government through the Veterans Benefits Administration.
3. A “veteran” is defined for the purpose of this section as any person who served on active duty in the armed forces of Atlasia and received an honorable or general discharge.
Section 2: Pre-existing Conditions and High Risk Populations
1. A Comprehensive Insurance Equality Pool (CIEP) shall be established within the ANHC so that those with pre-existing conditions can receive affordable care without discrimination. Those with pre-existing conditions or other factors such as age or gender which may increase risk to health or risk of health related cost shall be covered under ANHC at the same cost to the consumer as those without these conditions.
2. The CIEP shall be subsidized out of funds derived from the healthcare payroll tax to the extent necessary to achieve cost parity to the consumer.
3. The CIEP shall have open enrollment periods determined by the ANHC Health Directorate. Those with changes in condition or subject to increased premium cost at their current insurance provider may enroll in the high risk pool program through special enrollment so long as they have maintained coverage through ANHC or another insurer prior to such change in condition.
4. A Risk Adjustment Program will be established to involve private providers with annual net income greater than $50 million. Plans with lower actuarial risk will make payments to plans with higher actuarial risk to adjust for variation in distribution of high risk patients. This program will be administered by the Health Resources & Services Administration.[/quote]
