05RS HB511

HB511

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HB 511 (BR 1337) - M. Denham

     AN ACT relating to the Healthy Kentucky Program.
     Create new sections of Subtitle 17A of KRS Chapter 304 to create the Healthy Kentucky program to make standardized insurance contracts available to qualifying small employers and qualifying individuals, to encourage small employers to offer health insurance coverage to their employees, and to make coverage available to uninsured employees whose employers do not provide group health insurance; require health insurers who offer health benefit plans in the small group or individual market to participate in the program; specify covered services and deductibles and copayments; exempt the program insurance contracts from state mandated health benefits; require that applications be accepted at all times throughout the year; exempt the contracts from pre-existing condition limitations; require a qualifying small employer to pay at least 50% of the premium for employees covered under a qualifying group health insurance contract and offer coverage to all employees receiving annual wages of $30,000 or less, establish criteria for premium rate calculations; require a participating insurer to submit reports to the commissioner as reasonably required to evaluate the operations and results of the program; require the commissioner of insurance to establish two funds to reimburse participating insurers, known as the small employer stop-loss fund and the qualifying individual stop-loss fund; provide that participating insurers are eligible to be reimbursed for 50% of claims paid between $30,000 and $100,000 in a calendar year for any member; provide that once claims paid on behalf of a covered member reach or exceed $100,000 in a calendar year, no further claims shall be paid on behalf of such member; require reimbursement requests to be submitted no later than April 1 following the end of the calendar year for which the request is made; require the commissioner to provide for a pro rata distribution, if the total amount of reimbursement requests exceed available funds; require excess funds be carried forward; direct the commissioner to determine the total eligible enrollment under qualifying group health insurance contracts and qualifying individual health insurance contracts; authorize the commissioner to suspend enrollment; authorize the commissioner to obtain the services of an organization to administer the stop-loss funds; authorize the commissioner to purchase stop-loss insurance and reinsurance.

     Feb 14-introduced in House
     Feb 15-to Banking and Insurance (H)


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