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

____________

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES --

LIFETIME LIMITS

     

     Introduced By: Senators Miller, Sosnowski, Felag, Gallo, McKenney, Euer, Pearson,
LaMountain, Lauria, and Murray

     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

 

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

 

LC004906/SUB A - Page 2 of 8

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

 

LC004906/SUB A - Page 3 of 8

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).

 

LC004906/SUB A - Page 4 of 8

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

 

LC004906/SUB A - Page 5 of 8

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.

 

LC004906/SUB A - Page 6 of 8

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

 

LC004906/SUB A - Page 7 of 8

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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LC004906/SUB A - Page 8 of 8

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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LC004906/SUB A - Page 9 of 8