Analysis
TOPIC: Nonprofit Health Care Corporation Reform Act
Sponsor: Senator Schwarz
SENATE COMMITTEE: Health Policy and Senior Citizens
PROBLEM/BACKGROUND: The current Nonprofit Health Care Corporation Reform Act states that for an individual covered under a nongroup certificate, a health care corporation may exclude or limit coverage for a condition only if the exclusion or limitation relates to a condition for which medical advice, diagnosis, care, or treatment was recommended or received within six months before enrollment and the exclusion or limitation does not extend for more than six months after the effective date of the certificate.
DESCRIPTION OF BILL: SB 640 introduces a new clause to the current Nonprofit Health Care Corporation Reform Act that calls for a few additional conditions to the existing bill regarding nongroup health care certificates. The bill proposes that, in spite of the current provisions regarding nongroup certificates, a health care corporation shall not issue a certificate to a person eligible for nongroup coverage that excludes or limits coverage for a pre-existing condition or provides a waiting period if all of the following apply:
the person's most recent health coverage prior to applying for coverage with the health care corporation was under a group health plan,
the person was continuously covered prior to the application for coverage with the health care corporation under one or more health plans for an aggregate of at least 18 months with no break in coverage that exceeded 62 days,
the person is no longer eligible for group coverage, and
the person did not lose eligibility for coverage for failure to pay any required contribution or for an act to defraud the health care corporation.
"Group coverage" as introduced in this bill means a group of two or more subscribers.
Analyst: N. Pasteur
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