This bill makes amendments to current law regarding individual health insurance coverage. It guarantees that all health insurance carriers offering coverage in the individual market must provide coverage to any eligible applicant in the state and cannot decline coverage or impose preexisting condition exclusions. The bill also allows carriers to offer plans with reduced cost sharing for qualifying eligible applicants based on available federal funds or state funds. The bill includes several amendments to current law regarding health insurance coverage in the individual market. It allows for the establishment of a high risk pool program, contingent upon approval by the general assembly. The program must be designed in accordance with the State High Risk Pool Funding Extension Act of 2006. The bill also allows health insurance carriers to limit enrollment in network plans to individuals who live, reside, or work within the service areas for the plan. Carriers may deny coverage to individuals if they can demonstrate that they do not have the capacity to deliver services adequately to additional enrollees. Additionally, the bill requires carriers to allow eligible applicants to enroll in coverage during open enrollment periods, special enrollment periods, and any other enrollment periods established by federal or state law. The bill also addresses the renewal and discontinuation of health insurance coverage in the individual market. It requires carriers to renew or continue coverage at the option of the individual, with certain exceptions such as non-payment of premiums or fraud. It establishes requirements for carriers that decide to discontinue offering a particular type of coverage or all coverage in the individual market. The bill also prohibits preexisting condition exclusions in health insurance policies, subscriber contracts, or health plans offered in the state. The director has the power to enforce the provisions of the bill and may promulgate rules and regulations to effectuate its purposes. This bill makes amendments to current law regarding health insurance coverage. It removes the definition of "preexisting condition exclusion" and specifies that the section does not apply to certain types of insurance coverage. The bill also adds a new section that defines "essential health benefits" and "preventive services" and requires health insurance policies to provide coverage for these categories. It also grants the office of the health insurance commissioner the authority to issue guidance on what services qualify as preventive services.

Statutes affected:
5426  SUB A: 27-50-11
5426: 27-50-11, 27-18-73, 27-19-63, 27-20-59, 27-41-76