2024 -- S 2382 SUBSTITUTE A | |
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LC004906/SUB A | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2024 | |
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A N A C T | |
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES -- | |
LIFETIME LIMITS | |
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Introduced By: Senators Miller, Sosnowski, Felag, Gallo, McKenney, Euer, Pearson, | |
Date Introduced: February 12, 2024 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Section 27-18-73 of the General Laws in Chapter 27-18 entitled "Accident |
2 | and Sickness Insurance Policies" is hereby amended to read as follows: |
3 | 27-18-73. Prohibition on annual and lifetime limits. |
4 | (a) Annual limits. |
5 | (1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health |
6 | insurance carrier and a health benefit plan subject to the jurisdiction of the commissioner under this |
7 | chapter may establish an annual limit on the dollar amount of benefits that are essential health |
8 | benefits provided the restricted annual limit is not less than the following: |
9 | (A)(i) For a plan or policy year beginning after September 22, 2011, but before September |
10 | 23, 2012 — one million two hundred fifty thousand dollars ($1,250,000); and |
11 | (B)(ii) For a plan or policy year beginning after September 22, 2012, but before January 1, |
12 | 2014 — two million dollars ($2,000,000). |
13 | (2) For plan or policy years beginning on or after January 1, 2014, a health insurance carrier |
14 | and a health benefit plan shall not establish any annual limit on the dollar amount of essential health |
15 | benefits for any individual, except: |
16 | (A)(i) A health flexible spending arrangement, as defined in Section 106(c)(2)(i) of the |
17 | Federal Internal Revenue Code, a medical savings account, as defined in section 220 of the federal |
18 | Internal Revenue Code, and a health savings account, as defined in Section 223 of the federal |
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1 | Internal Revenue Code are not subject to the requirements of subdivisions (1) and (2) of this |
2 | subsection. |
3 | (B)(ii) The provisions of this subsection shall not prevent a health insurance carrier and a |
4 | health benefit plan from placing annual dollar limits for any individual on specific covered benefits |
5 | that are not essential health benefits to the extent that such limits are otherwise permitted under |
6 | applicable federal law or the laws and regulations of this state. |
7 | (3) In determining whether an individual has received benefits that meet or exceed the |
8 | allowable limits, as provided in subdivision (1) of this subsection, a health insurance carrier and a |
9 | health benefit plan shall take into account only essential health benefits. |
10 | (b) Lifetime limits. |
11 | (1) A health insurance carrier and health benefit plan offering group or individual health |
12 | insurance coverage shall not establish a lifetime limit on the dollar value of essential health benefits |
13 | for any individual. |
14 | (2) Notwithstanding subdivision (1) above, a health insurance carrier and health benefit |
15 | plan is not prohibited from placing lifetime dollar limits for any individual on specific covered |
16 | benefits that are not essential health benefits, in accordance with federal laws and regulations. |
17 | (c)(1) The provisions of this section relating to lifetime limits apply to any health insurance |
18 | carrier providing coverage under an individual or group health plan, including grandfathered health |
19 | plans. |
20 | (2) The provisions of this section relating to annual limits apply to any health insurance |
21 | carrier providing coverage under a group health plan, including grandfathered health plans, but the |
22 | prohibition and limits on annual limits do not apply to grandfathered health plans providing |
23 | individual health insurance coverage. |
24 | (d) This section shall not apply to a plan or to policy years prior to January 1, 2014 for |
25 | which the Secretary of the U.S. Department of Health and Human Services issued a waiver pursuant |
26 | to 45 C.F.R. § 147.126(d)(3). This section also shall not apply to insurance coverage providing |
27 | benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long |
28 | term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) |
29 | sickness or bodily injury or death by accident or both; and (9) other limited benefit policies. |
30 | (e) If the commissioner of the office of the health insurance commissioner determines that |
31 | the corresponding provision of the federal Patient Protection and Affordable Care Act has been |
32 | declared invalid by a final judgment of the federal judicial branch or has been repealed by an act |
33 | of Congress, on the date of the commissioner’s determination this section shall have its |
34 | effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this |
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1 | section. Nothing in this subsection shall be construed to limit the authority of the Commissioner to |
2 | regulate health insurance under existing state law. |
3 | SECTION 2. Section 27-19-63 of the General Laws in Chapter 27-19 entitled "Nonprofit |
4 | Hospital Service Corporations" is hereby amended to read as follows: |
5 | 27-19-63. Prohibition on annual and lifetime limits. |
6 | (a) Annual limits. |
7 | (1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health |
8 | insurance carrier and health benefit plan subject to the jurisdiction of the commissioner under this |
9 | chapter may establish an annual limit on the dollar amount of benefits that are essential health |
10 | benefits provided the restricted annual limit is not less than the following: |
11 | (i) For a plan or policy year beginning after September 22, 2011, but before September 23, |
12 | 2012 — one million two hundred fifty thousand dollars ($1,250,000); and |
13 | (ii) For a plan or policy year beginning after September 22, 2012, but before January 1, |
14 | 2014 — two million dollars ($2,000,000). |
15 | (2) For plan or policy years beginning on or after January 1, 2014, a health insurance carrier |
16 | and health benefit plan shall not establish any annual limit on the dollar amount of essential health |
17 | benefits for any individual, except: |
18 | (i) A health flexible spending arrangement, as defined in section 106(c)(2) of the Internal |
19 | Revenue Code, a medical savings account, as defined in section 220 of the Internal Revenue Code, |
20 | and a health savings account, as defined in section 223 of the Internal Revenue Code, are not subject |
21 | to the requirements of subsections (a)(1) and (a)(2) of this section. |
22 | (ii) The provisions of this subsection (a) shall not prevent a health insurance carrier and |
23 | health benefit plan from placing annual dollar limits for any individual on specific covered benefits |
24 | that are not essential health benefits to the extent that such limits are otherwise permitted under |
25 | applicable federal law or the laws and regulations of this state. |
26 | (3) In determining whether an individual has received benefits that meet or exceed the |
27 | allowable limits, as provided in subsection (a)(1) of this section, a health insurance carrier and |
28 | health benefit plan shall take into account only essential health benefits. |
29 | (b) Lifetime limits. |
30 | (1) A health insurance carrier and health benefit plan offering group or individual health |
31 | insurance coverage shall not establish a lifetime limit on the dollar value of essential health benefits |
32 | for any individual. |
33 | (2) Notwithstanding subsection (b)(1), a health insurance carrier and health benefit plan is |
34 | not prohibited from placing lifetime dollar limits for any individual on specific covered benefits |
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1 | that are not essential health benefits in accordance with federal laws and regulations. |
2 | (c)(1) The provisions of this section relating to lifetime limits apply to any health insurance |
3 | carrier providing coverage under an individual or group health plan, including grandfathered health |
4 | plans. |
5 | (2) The provisions of this section relating to annual limits apply to any health insurance |
6 | carrier providing coverage under a group health plan, including grandfathered health plans, but the |
7 | prohibition and limits on annual limits do not apply to grandfathered health plans providing |
8 | individual health insurance coverage. |
9 | (d) This section shall not apply to a plan or to policy years prior to January 1, 2014, for |
10 | which the Secretary of the U.S. Department of Health and Human Services issued a waiver pursuant |
11 | to 45 C.F.R. § 147.126(d)(3). This section also shall not apply to insurance coverage providing |
12 | benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) |
13 | Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease |
14 | indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit |
15 | policies. |
16 | (e) If the commissioner of the office of the health insurance commissioner determines that |
17 | the corresponding provision of the federal Patient Protection and Affordable Care Act has been |
18 | declared invalid by a final judgment of the federal judicial branch or has been repealed by an act |
19 | of Congress, on the date of the commissioner’s determination this section shall have its |
20 | effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this |
21 | section. Nothing in this subsection shall be construed to limit the authority of the commissioner to |
22 | regulate health insurance under existing state law. |
23 | SECTION 3. Section 27-20-59 of the General Laws in Chapter 27-20 entitled "Nonprofit |
24 | Medical Service Corporations" is hereby amended to read as follows: |
25 | 27-20-59. Annual and lifetime limits. |
26 | (a) Annual limits. |
27 | (1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health |
28 | insurance carrier and health benefit plan subject to the jurisdiction of the commissioner under this |
29 | chapter may establish an annual limit on the dollar amount of benefits that are essential health |
30 | benefits provided the restricted annual limit is not less than the following: |
31 | (i) For a plan or policy year beginning after September 22, 2011, but before September 23, |
32 | 2012 — one million two hundred fifty thousand dollars ($1,250,000); and |
33 | (ii) For a plan or policy year beginning after September 22, 2012, but before January 1, |
34 | 2014 — two million dollars ($2,000,000). |
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1 | (2) For plan or policy years beginning on or after January 1, 2014, a health insurance carrier |
2 | and health benefit plan shall not establish any annual limit on the dollar amount of essential health |
3 | benefits for any individual, except: |
4 | (i) A health flexible spending arrangement, as defined in section 106(c)(2) of the federal |
5 | Internal Revenue Code, a medical savings account, as defined in section 220 of the federal Internal |
6 | Revenue Code, and a health savings account, as defined in section 223 of the federal Internal |
7 | Revenue Code are not subject to the requirements of subsections (a)(1) and (a)(2) of this section; |
8 | and |
9 | (ii) The provisions of this subsection (a) shall not prevent a health insurance carrier from |
10 | placing annual dollar limits for any individual on specific covered benefits that are not essential |
11 | health benefits to the extent that such limits are otherwise permitted under applicable federal law |
12 | or the laws and regulations of this state. |
13 | (3) In determining whether an individual has received benefits that meet or exceed the |
14 | allowable limits, as provided in subsection (a)(1) of this section, a health insurance carrier shall |
15 | take into account only essential health benefits. |
16 | (b) Lifetime limits.(1) A health insurance carrier and health benefit plan offering group or |
17 | individual health insurance coverage shall not establish a lifetime limit on the dollar value of |
18 | essential health benefits for any individual. |
19 | (2) Notwithstanding subsection (b)(1) above, a health insurance carrier and health benefit |
20 | plan is not prohibited from placing lifetime dollar limits for any individual on specific covered |
21 | benefits that are not essential health benefits, as designated pursuant to a state determination and in |
22 | accordance with federal laws and regulations. |
23 | (c)(1) Except as provided in subsection (c)(2) of this section, this section applies to any |
24 | health insurance carrier providing coverage under an individual or group health plan. |
25 | (2)(i) The prohibition on lifetime limits applies to grandfathered health plans. |
26 | (ii) The prohibition and limits on annual limits apply to grandfathered health plans |
27 | providing group health insurance coverage, but the prohibition and limits on annual limits do not |
28 | apply to grandfathered health plans providing individual health insurance coverage. |
29 | (d) This section shall not apply to a plan or to policy years prior to January 1, 2014, for |
30 | which the Secretary of the U.S. Department of Health and Human Services issued a waiver pursuant |
31 | to 45 C.F.R. § 147.126(d)(3). This section also shall not apply to insurance coverage providing |
32 | benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) |
33 | Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease |
34 | indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit |
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1 | policies. |
2 | (e) If the commissioner of the office of the health insurance commissioner determines that |
3 | the corresponding provision of the federal Patient Protection and Affordable Care Act has been |
4 | declared invalid by a final judgment of the federal judicial branch or has been repealed by an act |
5 | of Congress, on the date of the commissioner’s determination this section shall have its |
6 | effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this |
7 | section. Nothing in this subsection shall be construed to limit the authority of the commissioner to |
8 | regulate health insurance under existing state law. |
9 | SECTION 4. Section 27-41-76 of the General Laws in Chapter 27-41 entitled "Health |
10 | Maintenance Organizations" is hereby amended to read as follows: |
11 | 27-41-76. Prohibition on annual and lifetime limits. |
12 | (a) Annual limits. |
13 | (1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health |
14 | maintenance organization subject to the jurisdiction of the commissioner under this chapter may |
15 | establish an annual limit on the dollar amount of benefits that are essential health benefits provided |
16 | the restricted annual limit is not less than the following: |
17 | (i) For a plan or policy year beginning after September 22, 2011, but before September 23, |
18 | 2012 — one million two hundred fifty thousand dollars ($1,250,000); and |
19 | (ii) For a plan or policy year beginning after September 22, 2012, but before January 1, |
20 | 2014 — two million dollars ($2,000,000). |
21 | (2) For plan or policy years beginning on or after January 1, 2014, a health maintenance |
22 | organization shall not establish any annual limit on the dollar amount of essential health benefits |
23 | for any individual, except: |
24 | (i) A health flexible spending arrangement, as defined in 26 U.S.C. § 106(c)(2), a medical |
25 | savings account, as defined in 26 U.S.C. § 220, and a health savings account, as defined in 26 |
26 | U.S.C. § 223, are not subject to the requirements of subsections (a)(1) and (a)(2) of this section. |
27 | (ii) The provisions of this subsection (a) shall not prevent a health maintenance |
28 | organization from placing annual dollar limits for any individual on specific covered benefits that |
29 | are not essential health benefits to the extent that such limits are otherwise permitted under |
30 | applicable federal law or the laws and regulations of this state. |
31 | (3) In determining whether an individual has received benefits that meet or exceed the |
32 | allowable limits, as provided in subsection (a)(1) of this section, a health maintenance organization |
33 | shall take into account only essential health benefits. |
34 | (b) Lifetime limits. |
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1 | (1) A health insurance carrier and health benefit plan offering group or individual health |
2 | insurance coverage shall not establish a lifetime limit on the dollar value of essential health benefits |
3 | for any individual. |
4 | (2) Notwithstanding subsection (b)(1), a health insurance carrier and health benefit plan is |
5 | not prohibited from placing lifetime dollar limits for any individual on specific covered benefits |
6 | that are not essential health benefits in accordance with federal laws and regulations. |
7 | (c)(1) The provisions of this section relating to lifetime limits apply to any health |
8 | maintenance organization or health insurance carrier providing coverage under an individual or |
9 | group health plan, including grandfathered health plans. |
10 | (2) The provisions of this section relating to annual limits apply to any health maintenance |
11 | organization or health insurance carrier providing coverage under a group health plan, including |
12 | grandfathered health plans, but the prohibition and limits on annual limits do not apply to |
13 | grandfathered health plans providing individual health insurance coverage. |
14 | (d) This section shall not apply to a plan or to policy years prior to January 1, 2014, for |
15 | which the Secretary of the U.S. Department of Health and Human Services issued a waiver pursuant |
16 | to 45 C.F.R. § 147.126(d)(3). This section also shall not apply to insurance coverage providing |
17 | benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) |
18 | Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease |
19 | indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit |
20 | policies. |
21 | (e) If the commissioner of the office of the health insurance commissioner determines that |
22 | the corresponding provision of the federal Patient Protection and Affordable Care Act has been |
23 | declared invalid by a final judgment of the federal judicial branch or has been repealed by an act |
24 | of Congress, on the date of the commissioner’s determination this section shall have its |
25 | effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this |
26 | section. Nothing in this subsection shall be construed to limit the authority of the commissioner to |
27 | regulate health insurance under existing state law. |
28 | SECTION 5. Section 42-14.5-3.1 of the General Laws in Chapter 42-14.5 entitled "The |
29 | Rhode Island Health Care Reform Act of 2004 — Health Insurance Oversight" is hereby amended |
30 | to read as follows: |
31 | 42-14.5-3.1. Reporting changes in federal law. |
32 | If any provision of the federal Patient Protection and Affordable Care Act and/or its |
33 | implementing regulations relating to coverage for essential health benefits or preventive services |
34 | are determined by the commissioner to have been repealed or to have been declared invalid or |
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1 | nullified by the final judgment of a federal court applicable to the state or by executive or |
2 | administrative action, which shall be deemed to include an action of the executive or judicial branch |
3 | that nullifies the effectiveness of the provision, such that the commissioner intends to take action |
4 | pursuant to the authority conferred on the commissioner pursuant to the authority granted by § 27- |
5 | 18.5-11, § 27-18.6-3.2, or § 27-50-18, or if any provision of the federal Patient Protection and |
6 | Affordable Care Act and/or its implementing regulations relating to annual and/or lifetime limits is |
7 | similarly determined by the commissioner to no longer be in effect, the commissioner shall report |
8 | to the general assembly as soon as possible to describe the impact of the change and to make |
9 | recommendations regarding consumer protections, consumer choices, and stabilization and |
10 | affordability of the Rhode Island insurance market. |
11 | SECTION 6. This act shall take effect upon passage. |
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LC004906/SUB A | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES -- | |
LIFETIME LIMITS | |
*** | |
1 | This act would repeal the authority of the health insurance commissioner to enforce any |
2 | act of the United States Congress or a federal court decision that invalidates or repeals the |
3 | prohibition of annual and lifetime limits on health insurance contained in the federal Patient |
4 | Protection and Affordable Care Act as it pertains to this state. This act also provides that if any |
5 | provision of the Federal Patient Protection and Affordable Care Act annual and/or lifetime limits |
6 | are determined to no longer be in effect then the commissioner shall report to the general assembly |
7 | as soon as possible the impact of the change. |
8 | This act would take effect upon passage. |
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LC004906/SUB A | |
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