This bill makes several amendments to current law regarding individual health insurance coverage. It guarantees that all health insurance carriers must provide coverage to any eligible applicant and prohibits carriers from declining coverage or imposing preexisting condition exclusions. The bill also allows carriers to offer plans with reduced cost sharing for qualifying applicants, based on available federal or state funds. It clarifies that carriers offering coverage only in connection with group health plans or through bona fide associations are not required to offer coverage in the individual market. The bill also allows the Office of the Health Insurance Commissioner to pursue federal funding for the development of a high risk pool.

In addition, the bill allows for the creation of a high risk pool program, contingent upon approval by the general assembly. It allows health insurance carriers to limit enrollment in coverage to individuals who live, reside, or work within the service areas for the network plan, but carriers must apply this limitation uniformly to individuals without regard to their health status. The bill also establishes rules for enrollment periods, continuation and renewal of coverage, and prohibits preexisting condition exclusions in health insurance policies. The director has the power to enforce the provisions of the bill and may promulgate rules and regulations to effectuate its purposes.

Statutes affected:
23  SUB B: 27-50-11
23  SUB A: 27-50-11
23: 27-50-11