Bill Summary – FastDemocracy

0392.01000
     Sixty-eighth
     Legislative Assembly                     HOUSE BILL NO. 1413
     of North Dakota
     Introduced by
       Representatives Karls, Kiefert, Rohr, Satrom, Steiner
       Senator Dever
  A BILL for an Act to create and enact a new section to chapter 26.1-36 of the North Dakota
  Century Code, relating to out-of-pocket expenses for health care services; and to amend and
  reenact section 26.1-36.6-03 of the North Dakota Century Code, relating to self-insurance
  health care plans.
  BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
      SECTION 1. A new section to chapter 26.1-36 of the North Dakota Century Code is created
  and enacted as follows:
      Out-of-pocket expenses - Health care services.
      1.   As used in this section:
          a.     "Cost sharing" means any coinsurance, copayment, or deductible under a policy.
          b.     "Enrollee" means an individual entitled to health care services under a policy.
          c.     "Health care services" means items or services furnished to an enrollee for the
                 purpose of preventing, alleviating, curing, or healing human illness, injury, or
                 physical disability.
          d.     "Policy" means an accident and health insurance policy, contract, or evidence of
                 coverage on a group, individual, blanket, franchise, or association basis.
     2.   To the extent permitted by federal law and regulation, an insurer may not deliver,
          issue, execute, or renew a policy that provides health care services coverage unless
          that policy provides when calculating an enrollee's overall contribution to any
          out-of-pocket maximum or any cost-sharing requirement under the policy, the
          calculation must include any amount paid by the enrollee or paid on behalf of the
          enrollee by another person.
     SECTION 2. AMENDMENT. Section 26.1-36.6-03 of the North Dakota Century Code is
 amended and reenacted as follows:
                                                Page No. 1                         23.0392.01000
     Sixty-eighth
     Legislative Assembly
     26.1-36.6-03. Self-insurance health plans - Requirements.
      1.   The following policy provisions apply to a self-insurance health plan or to the
           administrative services only or third-party administrator, and are subject to the
           jurisdiction of the commissioner: sections 26.1-36-03, 26.1-36-03.1, 26.1-36-05,
           26.1-36-10, 26.1-36-12, 26.1-36-12.4, 26.1-36-12.6, 26.1-36-13, 26.1-36-14,
           26.1-36-17, 26.1-36-18, 26.1-36-19, 26.1-36-23, 26.1-36-29, 26.1-36-37.1, 26.1-36-38,
           26.1-36-39, 26.1-36-41, 26.1-36-44, and 26.1-36-46.
      2.   The following health benefit provisions applicable to a group accident and health
           insurance policy under chapter 26.1-36 apply to a self-insurance health plan and are
          subject to the jurisdiction of the commissioner: sections 26.1-36-06, 26.1-36-06.1,
          26.1-36-07, 26.1-36-08, 26.1-36-08.1, 26.1-36-09, 26.1-36-09.1, 26.1-36-09.2,
          26.1-36-09.3, 26.1-36-09.5, 26.1-36-09.6, 26.1-36-09.7, 26.1-36-09.8, 26.1-36-09.9,
          26.1-36-09.10, 26.1-36-09.11, 26.1-36-09.12, 26.1-36-09.13, 26.1-36-09.14,
          26.1-36-09.15, 26.1-36-11, 26.1-36-12.2, 26.1-36-20, 26.1-36-21, 26.1-36-22,
          26.1-36-23.1, and 26.1-36-43. Section 1 of this Act applies to a self-insurance health
          plan and is subject to the jurisdiction of the commissioner.
                                              Page No. 2                         23.0392.01000
Statutes affected: 
INTRODUCED: 26.1-36.6-03