Daily bulletin [2007 : February 20, v.2007 : no.16]

Daily Bulletin ACTIONS BY THE NORTH CAROLINA GENERAL ASSEMBLY Institute of Government — School of Government The University of North Carolina at Chapel Hill Legislative Reporting Service, Box 7294 State Legislative Building, Raleigh, NC 27601 Phone 919.733.2484 - Fax 919.715.3464 - www.dbulletin.org House Legislative Day 1 6 Vol. 2007, No. 1 6 Senate Legislative Day 1 6 Tuesday, February 20, 2007 SUMMARIES OF BILLS FILED HOUSE BILLS H 265. ESTABLISH HIGH-RISK POOL Filed 2/19/07. TO ESTABLISH THE NORTH CAROLINA HEALTH INSURANCE RISK POOL. Enacts new Part 7 of Article 50 of GS Chapter 58, establishing the NC Health Insurance Risk Pool, subject to oversight of the Board of Directors of the Pool (Board), to consist of the Commissioner of Insurance (Commissioner) and eleven members appointed as specified in the act. Operation of the Pool. The Board must submit a Plan of Operation within 180 days after the appointment of the Board. Specifies the content of the Plan of Operation for the Pool and generally authorizes the Pool to perform all functions necessary to establish and administer the Pool. Requires that the Plan be approved in writing by the Commissioner. Requires that the Board operate the Pool so that the cost of providing the benefit plans during any calendar year is not anticipated to exceed the Pool’s total income. Also authorizes the Board to impose an enrollment cap or suspend enrollment if estimated costs are anticipated to exceed income. Requires the Executive Director to submit an annual report to the Speaker, the President Pro Tern., the Commissioner, the Joint Legislative Health Care Oversight Committee, and the Committee on Employee Hospital and Medical Benefits regarding earned premiums, plan enrollment, administrative expenses, and losses. Provides for indemnification in performance of duties for the Pool, Executive Director, and the Director’s representatives, as well as the Board and the Commissioner and their representatives. Directs the Board to use a competitive bidding process, applying criteria set forth in the act and otherwise established by the Board, to select one or more insurers or a third-party administrator to administer the Pool. Pool Rates. Requires the Pool to determine the standard risk rate by considering premium risk rates charged by other insurers offering health insurance coverage to individuals and using reasonable actuarial techniques. Requires that Pool rates be 175% of rates established as applicable for individual standard rates, to be adjusted annually, and that rates and rate schedules be approved by the Commissioner before the Pool may use them. Requires that the Pool provide individuals enrolled in the Pool with at least 45 days’ notice of any change to the Pool premium rates or rate schedules. Authorizes the Pool to impose premium surcharges for covered indivi duals who are smokers. Limits provider reimbursement rates under Pool coverage to rates allowed for providers under the Medicare Program for services covered by Medicare and directs the Board to establish reimbursement rates for sen/ices for which Medicare has not established an allowed rate. Eligibility for Pool coverage. Provides that individuals who are NC residents are eligible for Pool coverage if evidence is provided of any of the following: (1) a notice of rejection from an insurer to provide substantially similar health insurance because of the individual’s health, (2) an offer to issue insurance only with conditional riders, (3) a refusal to issue insurance except at a rate exceeding the Pool rate, (4) the individual’s diagnosis of one of the medical or health conditions listed by the Board, (5) qualification as a federally defined eligible individual, (6) the individual’s legal domicile in NC and eligibility for health insurance costs under the Trade Adjustment Assistance Reform Act of 2002, or (7) the individual has current individual health insurance coverage at a rate higher than the Pool rate. Further states that individuals are ineligible for Pool coverage if: (1) they have, © 2007 Institute of Government — School of Government The University of North Carolina at Chapel Hill This work is copyrighted and subject to "fair use" as permitted by federal copyright law. No portion of this publication maybe reproduced or transmitted in any form or by any means without the express written permission of the publisher. Distribution by third parties is prohibited. Prohibited distribution includes, but is not limited to, posting, e-mailing, faxing, archiving in a public database, installing on intranets or servers, and redistributing via a computer network or in printed form. Unauthorized use or reproduction may result in legal action against the unauthorized user.