Bill
Number: S.B. 1397
Rios
Floor Amendment
Reference
to: printed bill
Amendment
drafted by: Sean Laux
FLOOR
AMENDMENT EXPLANATION
Extends the requirement for health care insurers to provide
coverage for preexisting conditions to group and small employer health plans.
Prohibits a health care insurer from excluding essential
benefits from such coverage.
Prohibits a health care insurer from imposing an annual or
lifetime dollar limit on any essential benefit.
Requires a health care insurer to provide coverage to an
insured’s child until age 26.
Requires a health care insurer to allow an individual who
turns 26 and was previously covered under a family health benefits plan to
enroll in another health benefits plan without having to wait for an open
enrollment period.
Defines “essential benefits” as:
a)
ambulatory
services.
b)
emergency
services.
c)
hospitalization
provided in an inpatient care setting.
d)
pregnancy,
maternity and newborn care services.
e)
mental
health and substance use disorder services, including behavioral health
treatment services.
f)
prescription
drug benefits.
g)
rehabilitative
and habilitative services and devices that assist an individual with an injury,
disability or chronic condition to gain or recover mental or physical skills.
h)
laboratory
services.
i)
preventive,
wellness and chronic disease management services.
j)
pediatric
services, including pediatric oral and vision care services.
Page 1, line
7, after "INDIVIDUAL" insert ", GROUP OR SMALL
EMPLOYER"
Line 9,
after "ELIGIBLE" insert "EMPLOYER OR"
Between
lines 14 and 15, insert:
"3. CHARGE AN ADDITIONAL PREMIUM FOR A PREEXISTING
CONDITION.
4.
EXCLUDE ESSENTIAL BENEFITS FROM SUCH COVERAGE.
5.
IMPOSE AN ANNUAL OR LIFETIME DOLLAR LIMIT ON ANY ESSENTIAL BENEFIT.
6. DECLINE
TO CONTINUE TO COVER AN INSURED'S CHILD WHO IS COVERED UNDER THE HEALTH
BENEFITS PLAN UNTIL THE CHILD REACHES TWENTY‑SIX YEARS OF AGE EVEN IF THE
CHILD IS ANY OF THE FOLLOWING:
(a) MARRIED.
(b) NOT LIVING WITH THE CHILD'S PARENTS.
(c) ATTENDING
SCHOOL.
(d) NOT
FINANCIALLY DEPENDENT ON THE CHILD'S PARENTS.
(e) ELIGIBLE
TO ENROLL IN THE HEALTH BENEFITS PLAN PROVIDED BY THE CHILD'S EMPLOYER.
7. REQUIRE
AN ELIGIBLE INDIVIDUAL WHO REACHES TWENTY‑SIX YEARS OF AGE AND WHO WAS
PREVIOUSLY COVERED UNDER A FAMILY HEALTH BENEFITS PLAN TO WAIT TO ENROLL IN
ANOTHER HEALTH BENEFITS PLAN FOR AN OPEN ENROLLMENT PERIOD IF THE INDIVIDUAL
QUALIFIES FOR THE PLAN."
Line 15, after
"B." insert "EXCEPT AS PROVIDED IN SUBSECTION A
OF THIS SECTION, "; strike "INDIVIDUAL"
Line
20, strike "INDIVIDUAL"
Between
lines 25 and 26, insert:
"1. "ESSENTIAL BENEFIT" MEANS ANY OF THE
FOLLOWING:
(a) AMBULATORY
SERVICES.
(b) EMERGENCY
SERVICES.
(c) HOSPITALIZATION
PROVIDED IN AN INPATIENT CARE SETTING.
(d) PREGNANCY,
MATERNITY AND NEWBORN CARE SERVICES.
(e) MENTAL
HEALTH AND SUBSTANCE USE DISORDER SERVICES, INCLUDING BEHAVIORAL HEALTH
TREATMENT SERVICES.
(f) PRESCRIPTION
DRUG BENEFITS.
(g) REHABILITATIVE
AND HABILITATIVE SERVICES AND DEVICES THAT ASSIST AN INDIVIDUAL WITH AN INJURY,
DISABILITY OR CHRONIC CONDITION TO GAIN OR RECOVER MENTAL OR PHYSICAL SKILLS.
(h) LABORATORY
SERVICES.
(i) PREVENTIVE,
WELLNESS AND CHRONIC DISEASE MANAGEMENT SERVICES.
(j) PEDIATRIC
SERVICES, INCLUDING PEDIATRIC ORAL AND VISION CARE SERVICES."
Renumber to
conform
Page
1, line 36, strike "INDIVIDUAL"
Amend title to conform