Summary:
The goal of this bill is to create an opt-out of Atlascare for the Southern Region, to pass certain regulations to prevent unfair health insurance practices. It also imposes certain rules for reducing the costs of providing health insurance and reduces regulations on health insurance which drive up costs.
Section 1 Creates the Office of Insurance Commissioner with the powers included at the end of this summary.
Section 2 - 5 is my plan to comply with the requirements for a Regional opt-out under Atlascare. These sections authorize a special class of private insurers to become Insurers of Last Resort, or ILRs. ILRs would be allowed to negotiate Most Favored Nation Contracts, or MFNs, with non-profit healthcare providers. MFNs are contracts between parties where one party (Hospitals) agree to only negotiate contracts with other suppliers (insurers) at the same or higher price of the MFN rates in exchange for volume (lots of sick customers).
Non-ILR private insurers would not be permitted to negotiate MFNs of their own, which basically amounts to ILRs setting the minimum price paid to compensate providers. In exchange, ILRs would be required to cover the Atlascare care minimum essential coverage and also certain transgender treatments and surgeries. ILRs would also be required to cover any customer regardless of individual rating.
Section 6 allows any private insurer to sell policies in any State in the Southern Region.
Section 7 prohibits an individual health insurance mandate
Section 8 prohibits any private insurer from rationing healthcare services
Section 9 lists individual factors insurers are allowed to use in their actuarial models when determining how much to charge each customer to make their pools work, and also allows the Insurance Commissioner to block unfair factors.
Section 10 requires private insurers to file their maximum pricing agreements with healthcare providers for a public database.
Section 11 caps annual premium hikes over 20% and requires necessity to increase annual premiums over 12%.
Section 12 prohibits any private insurer from dropping customers just for using the insurance or getting sick.
Section 13 lowers the lazy child rule from 26 to 22.
Section 14 requires the phasing out of certain types of wasteful pricing contracts between insurers and healthcare providers.
Section 15 allows private insurers to pay a bonus to healthcare providers who have high success rates and follow best management practices.
Section 16 prohibits non-ILR insurers from offering insurance plans which do not have co-pays, unless a $300 deductible has first been met.
Section 17 prohibits price gouging customers who need emergency treatment and get sent to healthcare providers not in their insurance network.
Section 18 prohibits private insurers from imposing lifetime dollar caps on healthcare services.
Section 19 specifically allows certain types of supplemental health insurance plans.
Section 20 prohibits doctors and certain healthcare workers under contract from engaging in certain unfair labor practices.
Section 21 empowers the Insurance Commissioner to audit all private insurance investments and also creates an FDIC/PBGC type entity to insure the insurance pool.
Section 22 prohibits the paying of commissions to people who negotiate health insurance contracts
Section 23 requires private insurers to give 1 year notice before they discontinue service in a specific area
Section 24 empowers the Insurance Commissioner to impose price caps on certain services ancillary to providing healthcare services.
Section 25 places the start date in a little over a year.
Duties of the Regional Insurance Commissioner
- Approve Insurer-of-Last-Resort Applications
- Approve Rate increases > 12%
- Approve non-listed risk factors
- Set rates for listed ancillary healthcare services
- Enforce unfair trade practices
- Ban on non-ILR MFN Provisions
- Ban on non-ILR first-dollar coverage
- Ban on Insurer rationing
- Ban on Insurer unfair client dropping
- Ban on broker commissions
- Audits
- Insurance Company investment portfolios
- Fee-for-Service billing codes
- Compile and Report Databases
- Publish Insurer Max Prices
- Publish Provider Max and Min Prices*
- Publish Market Exit notice
*Assumes More Doctors and Hospitals Act passes
