S*541 Session 110 (1993-1994)
S*0541(Rat #0368, Act #0339) General Bill, By Saleeby, Courtney, Land,
McConnell, Rankin and M.T. Rose
Similar(H 3708)
A Bill to enact the "Small Employer Health Insurance Availability Act",
including amending Sections 38-71-920, Code of Laws of South Carolina, 1976,
relating to definitions for small group health insurance purposes, so as to
make changes to certain definitions, add the definitions of "late enrollee"
and "actuarial base rate", and delete certain definitions; 38-71-960, relating
to small group health insurance and required disclosure in solicitation and
sales materials, so as to delete certain language and provide that each small
employer insurer shall make reasonable disclosure in solicitation and sales
materials provided to small employers of the extent to which premium rates for
a specific small employer are established or adjusted due to case
characteristics, family composition, and class of business; 38-71-730, as
amended, relating to requirements for group accident, group health, and group
accident and health insurance policies, so as to delete certain language and
provisions and provide, among other things, that a common group of small
employers may be formed solely for the purpose of obtaining insurance;
38-70-10, relating to definitions for the provisions of law on utilization
reviews and private review agents in connection with the allocation of health
care resources and services for a patient or group of patients, so as to
delete certain language and provisions from the definition of "private review
agent"; 38-70-15, relating to the applicability of Chapter 70 of Title 38
(Utilization Reviews and Private Review Agents), so as to provide that the
Chapter applies to insurance companies, administrators of insurance benefit
plans, and health maintenance organizations licensed and regulated by the
Department of Insurance, and provide that such insurance companies,
administrators, and health maintenance organizations are exempt from certain
provisions of law; and 38-71-940, relating to small group health insurance and
premium rates, rating factors, and the prohibition on the involuntary business
class transfer, so as to delete certain provisions and provide, among other
things, that the small employer insurer shall determine the actuarial base
rate for each health insurance plan it offers to small employers in the State;
to create a committee on health reform, appointed by the Governor, to issue a
report to the Governor on certain matters; and to provide for the severability
of the provisions of this Act.-amended title
03/11/93 Senate Introduced, read first time, placed on calendar
without reference SJ-10
03/16/93 Senate Amended SJ-18
03/16/93 Senate Read second time SJ-19
03/16/93 Senate Ordered to third reading with notice of
amendments SJ-19
03/25/93 Senate Read third time and sent to House SJ-12
03/30/93 House Introduced and read first time HJ-9
03/30/93 House Referred to Committee on Labor, Commerce and
Industry HJ-10
02/24/94 House Committee report: Favorable with amendment Labor,
Commerce and Industry HJ-373
03/29/94 House Debate adjourned until Wednesday, March 30, 1994 HJ-20
03/30/94 House Amended HJ-59
03/30/94 House Read second time HJ-81
03/30/94 House Unanimous consent for third reading on next
legislative day HJ-81
03/31/94 House Read third time and returned to Senate with
amendments HJ-4
03/31/94 Senate Concurred in House amendment and enrolled SJ-10
04/14/94 Ratified R 368
04/19/94 Signed By Governor
04/19/94 Effective date 07/01/95
04/19/94 See act for exception to or explanation of
effective date
05/10/94 Copies available
(A339, R368, S541)
AN ACT TO ENACT THE "SMALL EMPLOYER HEALTH
INSURANCE AVAILABILITY ACT", INCLUDING AMENDING
SECTIONS 38-71-920, CODE OF LAWS OF SOUTH CAROLINA, 1976,
RELATING TO DEFINITIONS FOR SMALL GROUP HEALTH
INSURANCE PURPOSES, SO AS TO MAKE CHANGES TO CERTAIN
DEFINITIONS, ADD THE DEFINITIONS OF "LATE
ENROLLEE" AND "ACTUARIAL BASE RATE", AND
DELETE CERTAIN DEFINITIONS; 38-71-960, RELATING TO SMALL
GROUP HEALTH INSURANCE AND REQUIRED DISCLOSURE IN
SOLICITATION AND SALES MATERIALS, SO AS TO DELETE
CERTAIN LANGUAGE AND PROVIDE THAT EACH SMALL
EMPLOYER INSURER SHALL MAKE REASONABLE DISCLOSURE
IN SOLICITATION AND SALES MATERIALS PROVIDED TO SMALL
EMPLOYERS OF THE EXTENT TO WHICH PREMIUM RATES FOR
A SPECIFIC SMALL EMPLOYER ARE ESTABLISHED OR
ADJUSTED DUE TO CASE CHARACTERISTICS, FAMILY
COMPOSITION, AND CLASS OF BUSINESS; 38-71-730, AS
AMENDED, RELATING TO REQUIREMENTS FOR GROUP
ACCIDENT, GROUP HEALTH, AND GROUP ACCIDENT AND
HEALTH INSURANCE POLICIES, SO AS TO DELETE CERTAIN
LANGUAGE AND PROVISIONS AND PROVIDE, AMONG OTHER
THINGS, THAT A COMMON GROUP OF SMALL EMPLOYERS MAY
BE FORMED SOLELY FOR THE PURPOSE OF OBTAINING
INSURANCE; 38-70-10, RELATING TO DEFINITIONS FOR THE
PROVISIONS OF LAW ON UTILIZATION REVIEWS AND PRIVATE
REVIEW AGENTS IN CONNECTION WITH THE ALLOCATION OF
HEALTH CARE RESOURCES AND SERVICES FOR A PATIENT OR
GROUP OF PATIENTS, SO AS TO DELETE CERTAIN LANGUAGE
AND PROVISIONS FROM THE DEFINITION OF "PRIVATE
REVIEW AGENT"; 38-70-15, RELATING TO THE
APPLICABILITY OF CHAPTER 70 OF TITLE 38 (UTILIZATION
REVIEWS AND PRIVATE REVIEW AGENTS), SO AS TO PROVIDE
THAT THE CHAPTER APPLIES TO INSURANCE COMPANIES,
ADMINISTRATORS OF INSURANCE BENEFIT PLANS, AND
HEALTH MAINTENANCE ORGANIZATIONS LICENSED AND
REGULATED BY THE DEPARTMENT OF INSURANCE, AND
PROVIDE THAT SUCH INSURANCE COMPANIES,
ADMINISTRATORS, AND HEALTH MAINTENANCE
ORGANIZATIONS ARE EXEMPT FROM CERTAIN PROVISIONS OF
LAW; AND 38-71-940, RELATING TO SMALL GROUP HEALTH
INSURANCE AND PREMIUM RATES, RATING FACTORS, AND THE
PROHIBITION AGAINST INVOLUNTARY BUSINESS CLASS
TRANSFER, SO AS TO DELETE CERTAIN PROVISIONS AND
PROVIDE, AMONG OTHER THINGS, THAT THE SMALL
EMPLOYER INSURER SHALL DETERMINE THE ACTUARIAL BASE
RATE FOR EACH HEALTH INSURANCE PLAN IT OFFERS TO
SMALL EMPLOYERS IN THE STATE; TO CREATE A COMMITTEE
ON HEALTH REFORM, APPOINTED BY THE GOVERNOR, TO
ISSUE A REPORT TO THE GOVERNOR ON CERTAIN MATTERS;
AND TO PROVIDE FOR THE SEVERABILITY OF THE PROVISIONS
OF THIS ACT.
Be it enacted by the General Assembly of the State of South Carolina:
Name of act
SECTION 1. This act shall be known and may be cited as the
"Small Employer Health Insurance Availability Act".
Purpose and intent
SECTION 2. The purpose and intent of this act is to promote the
availability of health insurance coverage to small employers, excluding
individual health insurance plans, regardless of their health status or claims
experience, to provide for development of "basic" and
"standard" health insurance plans to be offered to all small
employers, to provide for establishment of a reinsurance program, and to
improve the overall fairness and efficiency of the small group health
insurance market.
Definitions
SECTION 3. As used in this act:
(A) "Basic health insurance plan" means a lower cost health
insurance plan developed pursuant to Section 12.
(B) "Board" means the board of directors of the program
established pursuant to Section 11.
(C) "Commissioner" means the Chief Insurance
Commissioner of this State.
(D) "Committee" means the advisory committee to the
commissioner referred to in Section 12.
(E) "Dependent" means a spouse, an unmarried child under
the age of nineteen years, an unmarried child who is a full-time student
between the ages of nineteen and twenty-two and who is financially
dependent upon the parent, and an unmarried child of any age who is
medically certified as disabled and dependent upon the parent.
(F) "Eligible employee" means an employee as defined in
Section 38-71-710(1) of the 1976 Code who works on a full-time basis and
has a normal work week of thirty or more hours.
(G) "Health insurance plan" means any hospital or medical
policy or certificate, major medical expense insurance, or health
maintenance organization subscriber contract. It includes the entire
contract between the insurer and the insured, including the policy, riders,
endorsements, and the application, if attached. Health insurance plan does
not include accident-only, blanket accident and sickness, specified disease,
credit, dental, vision, Medicare supplement, long-term care, or disability
income insurance, coverage issued as a supplement to liability or other
insurance, coverage designed solely to provide payments on a per diem,
fixed indemnity, or nonexpense incurred basis, coverage for Medicare or
Medicaid services pursuant to a contract with state or federal government,
workers' compensation or similar insurance, or automobile medical
payment insurance.
(H) "Insurer" means any entity that provides health
insurance in this State. For the purposes of this act, insurer includes an
insurance company, a health maintenance organization, and any other entity
providing a plan of health insurance or health benefits subject to state
insurance regulation, including multiple employer self-insured health plans
licensed pursuant to Section 38-41-10, et seq.
(I) "Late enrollee" means an eligible employee or
dependent who requests enrollment in a health insurance plan of a small
employer following the initial enrollment period during which the
individual is entitled to enroll under the terms of the health insurance plan,
provided that the initial enrollment period is a period of at least thirty days.
However, an eligible employee or dependent shall not be considered a late
enrollee if the individual:
(1) meets each of the following:
(a) was covered under qualifying previous coverage at the time of
the initial enrollment;
(b) lost coverage under qualifying previous coverage as a result of
termination of employment or eligibility, the involuntary termination of the
qualifying previous coverage, death of a spouse, or divorce; and
(c) requests enrollment within thirty days after termination of the
qualifying previous coverage; or
(2) is employed by an employer which offers multiple health
insurance plans and elects a different plan during an open enrollment
period; or
(3) a court has ordered that coverage be provided for a spouse or
minor or dependent child under a covered employee's health insurance plan
and request for enrollment is made within thirty days after issuance of the
court order.
(J) "Plan of operation" means the plan of operation of the
program established pursuant to Section 11.
(K) "Program" means the South Carolina Small Employer
Insurer Reinsurance Program created by Section 11.
(L) "Qualifying previous coverage" means benefits or
coverage provided under:
(1) Medicare or Medicaid;
(2) an employer-based health insurance or health benefit arrangement
that provides benefits similar to or exceeding benefits provided under the
basic health insurance plan; or
(3) an individual health insurance policy, including coverage issued
by a health maintenance organization, that provides benefits similar to or
exceeding the benefits provided under the basic health insurance plan,
provided that such policy has been in effect for at least one year.
(M) "Reinsuring insurer" means a small employer insurer
participating in the reinsurance program pursuant to Section 11.
(N) "Risk-assuming insurer" means a small employer
insurer whose application is approved by the commissioner pursuant to
Section 9.
(O) "Small employer" means any person, firm, corporation,
partnership, or association that is actively engaged in business that, on at
least fifty percent of its working days during the preceding calendar year,
employed no more than fifty eligible employees. In determining the
number of eligible employees, companies that are affiliated companies, or
that are eligible to file a combined tax return for purposes of state taxation,
shall be considered one employer.
(P) "Small employer insurer" means an insurer that offers
health insurance plans covering eligible employees of one or more small
employers in this State.
(Q) "Standard health insurance plan" means a health
insurance plan developed pursuant to Section 12.
Applicability of act
SECTION 4. (A) Except as provided in subsection (B), the provisions of
this act apply to any health insurance plan which provides group coverage
to groups of two to fifty.
(B) The provisions of this act do not apply to individual health
insurance policies which are subject to policy form and premium rate
approval as may be provided in Title 38 of the 1976 Code.
Premium rates
SECTION 5. Premium rates for health insurance plans subject to this act
are governed by the rating restrictions contained in Section 38-71-910, et
seq. of the 1976 Code, as amended by this act.
Premium rates for health insurance plans shall comply with the
requirements of this section notwithstanding any reinsurance premiums or
assessments paid or payable by small employer insurers pursuant to Section
11.
Market at least two plans, etc.
SECTION 6. (A) (1) Every small employer insurer shall, as a condition
of transacting business in this State with small employers, fairly market to
small employers at least two health insurance plans. One health insurance
plan offered by each small employer insurer must be a basic health
insurance plan and one plan must be a standard health insurance plan.
(2) Coverage under the basic or standard health insurance plan must
be offered to all eligible employees of a small employer and their
dependents. A small employer insurer may not offer coverage only to
certain individuals in a small employer group, or to only part of the group,
except as provided in Section 7B.
(3) Except with respect to applicable preexisting condition limitation
periods or late enrollees as provided in Section 7B, a small employer
insurer shall not modify a health insurance plan with respect to a small
employer or any eligible employee or dependent through rider,
endorsements, or otherwise, to restrict or exclude coverage or benefits for
specific diseases, medical conditions or services otherwise covered under
the plan.
(4) (a) A small employer insurer shall issue a basic health insurance
plan or a standard health insurance plan to any eligible small employer that
applies for either such plan and agrees to make the required premium
payments and to satisfy the other reasonable provisions of the health
insurance plan not inconsistent with this act.
(b) In the case of a small employer insurer that establishes more than
one class of business pursuant to Section 38-71-920(11) of the 1976 Code
of Laws, the small employer insurer shall maintain and issue to eligible
small employers at least one basic health insurance plan and at least one
standard health insurance plan in each class of business so established. A
small employer insurer may apply reasonable criteria in determining
whether to accept a small employer into a class of business, provided
that:
(i) The criteria are not intended to discourage or prevent acceptance
of small employers applying for a basic or standard health insurance
plan;
(ii) The criteria are not related to the health status or claim
experience of the small employer;
(iii) The criteria are applied consistently to all small employers
applying for coverage in the class of business; and
(iv) The small employer insurer provides for the acceptance of all
eligible small employers into one or more classes of business.
The requirement to offer at least two health insurance plans to small
employers shall not apply to a class of business into which the small
employer insurer is no longer enrolling new small businesses.
(5) The provisions of this subsection (A) of this section shall be
effective one hundred eighty days after the commissioner's approval of the
basic health insurance plan and the standard health insurance plan
developed pursuant to Section 12; provided, that if the Small Employer
Insurer Reinsurance Program created pursuant to Section 11 is not yet
operative on that date, the provisions of this paragraph shall be effective on
the date that the program begins operation.
(B) (1) After the commissioner's approval of the basic health insurance
plan and the standard health insurance plan developed pursuant to
Section 12, a small employer insurer shall file with the commissioner, in
the form and manner prescribed by the commissioner, the basic and
standard health insurance plans to be used by the insurer. The insurer shall
certify to the commissioner that the plans as filed are in substantial
compliance with the provisions as approved by the commissioner. Upon
the commissioner's receipt of the certification, the insurer may use the
certified plans unless their use is disapproved by the commissioner.
(2) The commissioner may, at any time, after providing notice and an
opportunity for hearing, disapprove the continued use by a small employer
insurer of a basic or standard health insurance plan on the grounds that the
plan does not meet the requirements of this act.
(C) (1) A health maintenance organization shall not be required to offer
coverage or accept applications pursuant to subsection (A) in the case of
the following:
(a) to a small employer, where the small employer is not physically
located in the health maintenance organization's established geographic
service area;
(b) to an employee, when the employee does not work or reside
within the health maintenance organization's established geographic service
area; or
(c) within an area where the health maintenance organization
reasonably anticipates, and demonstrates to the satisfaction of the
commissioner, that it will not have the capacity within its established
geographic service area to deliver service adequately to the members of
such groups because of its obligations to existing group policyholders and
enrollees.
(2) A health maintenance organization that cannot offer coverage
pursuant to paragraph (1)(c) may not offer coverage in the applicable area
to new cases of employer groups with more than fifty eligible employees or
to any small employer groups until the later of one hundred eighty days
following each such refusal or the date on which the health maintenance
organization notifies the commissioner that it has regained capacity to
deliver services to small employer groups.
(D) A small employer insurer may not be required to provide coverage
to small employers pursuant to subsection (A) for any period of time for
which the commissioner determines that requiring the acceptance of small
employers in accordance with the provisions of subsection (A) would place
the small employer insurer in a financially impaired condition.
Applicability of certain Code sections
SECTION 7. (A) Except to the extent inconsistent with specific
provisions of this act, all provisions of Article 5 of Chapter 71 of Title 38
of the 1976 Code of Laws are applicable to the basic and standard health
insurance plans required to be offered by small employer insurers.
(B) Late enrollees may be excluded from coverage for the greater of
eighteen months or an eighteen-month preexisting condition exclusion;
provided that if both a period of exclusion from coverage and a preexisting
condition exclusion are applicable to a late enrollee, the combined period
shall not exceed eighteen months.
Notification of intent; etc.
SECTION 8. (A) (1) Within sixty days after the plan of operation is
approved by the commissioner under Section 11, each small employer
insurer shall notify the commissioner of the insurer's intention to operate as
a risk-assuming insurer or a reinsuring insurer. A small employer insurer
seeking to operate as a risk-assuming insurer shall make an application
pursuant to Section 9.
(2) The decision shall be binding for a five-year period except that the
initial decision shall be binding for two years. The commissioner may
permit an insurer to modify its decision at any time for good cause
shown.
(3) The commissioner shall establish an application process for small
employer insurers seeking to change their status under this subsection. In
the case of a small employer insurer that has been acquired by another such
insurer, the commissioner may waive or modify the time periods
established in paragraph (2).
(B) A reinsuring insurer that applies and is approved to operate as a
risk-assuming insurer shall not be permitted to continue to reinsure any
health insurance plan with the program. Such an insurer shall pay a
prorated assessment based upon business issued as a reinsuring insurer for
any portion of the year that the business was reinsured.
Election to become risk-assuming insurer; etc.
SECTION 9. (A) Any small employer insurer may elect to become a
risk-assuming insurer upon application to and approval by the
commissioner. A small employer insurer shall not be approved as a
risk-assuming insurer if the commissioner finds that the insurer is not
capable of assuming that status pursuant to the criteria set forth in
subsection (B) of this section. The insurer shall provide public notice of its
application to become a risk-assuming insurer. A small employer insurer's
application to be a risk-assuming insurer shall be approved unless
disapproved by the commissioner within sixty days after the insurer's
application. A small employer insurer that has had its application to be a
risk-assuming insurer disapproved may request and shall be granted a
public hearing within sixty days after the disapproval.
(B) In determining whether or not to approve an application by a small
employer insurer to become a risk-assuming insurer, the commissioner
shall consider the insurer's financial condition and the financial condition
of its parent or guaranteeing corporation, if any; its history of assuming and
managing risk; its ability to assume and manage the risk of enrolling small
employers without the protection of the reinsurance provided in Section 11;
and its commitment to fairly market to all small employers.
Election to become reinsuring insurer; etc.
SECTION 10. (A) A small employer insurer may elect to become a
reinsuring insurer and operate under the provisions of this section and
Section 11.
(B) Each reinsuring insurer shall conduct business with its members and
subscribers, and administer claims for coverage reinsured by the program,
in the same manner as it would administer health claims that it writes
without reinsurance.
Small Employer Insurer Reinsurance Program established
SECTION 11. (A) There is hereby created a nonprofit entity to be known
as the South Carolina Small Employer Insurer Reinsurance Program, which
shall become operational on July 1, 1995.
(B) (1) The program shall operate subject to the supervision and
control of the board. Subject to the provisions of paragraph (2), the board
shall consist of eight members appointed by the commissioner plus the
commissioner or his designated representative, who shall serve as an ex
officio member of the board.
(2) In selecting the members of the board, the commissioner shall
include representatives of small employers and small employer insurers and
such other individuals determined to be qualified by the commissioner. At
least five members of the board shall be representatives of insurers, one of
whom shall be a licensed independent insurance agent who represents
multiple health and accident insurance carriers, and shall be selected from
individuals nominated in this State pursuant to procedures and guidelines
developed by the commissioner.
(3) The initial board members shall be appointed as follows: two of
the members to serve a term of two years; three of the members to serve a
term of four years; and three of the members to serve a term of six years.
Subsequent board members shall serve for a term of three years. A board
member's term shall continue until his successor is appointed.
(4) A vacancy in the board shall be filled by the commissioner. A
board member may be removed by the commissioner for cause.
(C) Not later than September 1, 1994, each small employer insurer shall
make a filing with the commissioner containing the insurer's net health
insurance premium derived from health insurance plans delivered or issued
for delivery to small employers in this State in the previous calendar
year.
(D) Within one hundred eighty days after the appointment of the initial
board, the board shall submit to the commissioner a plan of operation and
thereafter any amendments thereto necessary or suitable to assure the fair,
reasonable, and equitable administration of the program. The
commissioner may, after notice and hearing, approve the plan of operation
if the commissioner determines it to be suitable to assure the fair,
reasonable, and equitable administration of the program, and to provide for
the sharing of program gains or losses on an equitable and proportionate
basis in accordance with the provisions of this section. The plan of
operation shall become effective upon written approval by the
commissioner.
(E) If the board fails to submit a suitable plan of operation within one
hundred eighty days after its appointment, the commissioner shall, after
notice and hearing, adopt and promulgate a temporary plan of operation.
The commissioner shall amend or rescind any plan adopted under this
subsection at the time a plan of operation is submitted by the board and
approved by the commissioner.
(F) The plan of operation shall:
(1) establish procedures for handling and accounting of program
assets and monies and for an annual fiscal reporting to the
commissioner;
(2) establish procedures for selecting an administering insurer and
setting forth the powers and duties of the administering insurer;
(3) establish procedures for reinsuring risks in accordance with the
provisions of this section;
(4) establish procedures for collecting assessments from reinsuring
insurers to fund claims and administrative expenses incurred or estimated to
be incurred by the program;
(5) establish a methodology for applying the dollar thresholds
contained in this section in the case of insurers that pay or reimburse health
care providers though capitation or salary; and
(6) provide for any additional matters necessary for the
implementation and administration of the program.
(G) The program shall have the general powers and authority granted
under the laws of this State to insurance companies and health maintenance
organizations licensed to transact business, except the power to issue health
insurance plans directly to either groups or individuals. In addition, the
program shall have the specific authority to:
(1) enter into contracts as are necessary or proper to carry out the
provisions and purposes of this act, including the authority, with the
approval of the commissioner, to enter into contracts with similar programs
of other states for the joint performance of common functions or with
persons or other organizations for the performance of administrative
functions;
(2) sue or be sued, including taking any legal actions necessary or
proper to recover any assessments and penalties for, on behalf of, or against
the program or any reinsuring insurers;
(3) take any legal action necessary to avoid the payment of improper
claims against the program;
(4) define the health insurance plans for which reinsurance will be
provided, and to issue reinsurance policies, in accordance with the
requirements of this act;
(5) establish rules, conditions, and procedures for reinsuring risks
under the program;
(6) establish actuarial functions as appropriate for the operation of the
program;
(7) assess reinsuring insurers in accordance with the provisions of
subsection (K), and make advance interim assessments as may be
reasonable and necessary for organizational and interim operating
expenses. Any interim assessments shall be credited as offsets against any
regular assessments due following the close of the fiscal year;
(8) appoint appropriate legal, actuarial, and other committees as
necessary to provide technical assistance in the operation of the program,
policy and other contract design, and any other function within the
authority of the program;
(9) borrow money to effect the purposes of the program. Any notes or
other evidence of indebtedness of the program not in default shall be legal
investments for insurers and may be carried as admitted assets;
(H) A reinsuring insurer may reinsure with the program as provided for
in this subsection:
(1) With respect to a basic health insurance plan or a standard health
insurance plan, the program shall reinsure the level of coverage
provided.
(2) A small employer insurer may reinsure an entire employer group
within sixty days of the commencement of the group's coverage under a
health insurance plan.
(3) A reinsuring insurer may reinsure an eligible employee or
dependent within a period of sixty days following the commencement of
the coverage with the small employer. A newly-eligible employee or
dependent of the reinsured small employer may be reinsured within sixty
days of the commencement of his coverage.
(4) (a) The program shall not reimburse a reinsuring insurer with
respect to the claims of a reinsured employee or dependent until the insurer
has incurred an initial level of claims for such employee or dependent of
five thousand dollars in a calendar year for benefits covered by the
program. In addition, the reinsuring insurer shall be responsible for ten
percent of the next fifty thousand dollars of benefit payments during a
calendar year and the program shall reinsure the remainder. A reinsuring
insurers' liability under this subparagraph shall not exceed a maximum limit
of ten thousand dollars in any one calendar year with respect to any
reinsured individual.
(b) The board annually shall adjust the initial level of claims and the
maximum limit to be retained by the insurer to reflect increases in costs and
utilization within the standard market for health insurance plans within the
State. The adjustment shall not be less than the annual change in the
medical component of the "Consumer Price Index for All Urban
Consumers" of the Department of Labor, Bureau of Labor Statistics,
unless the board proposes and the commissioner approves a lower
adjustment factor.
(5) A small employer insurer may terminate reinsurance with the
program for one or more of the reinsured employees or dependents of a
small employer on any anniversary of the health insurance plan.
(6) A reinsuring insurer shall apply all managed care and claims
handling techniques, including utilization review, individual case
management, preferred provider provisions, and other managed care
provisions or methods of operation consistently with respect to reinsured
and nonreinsured business.
(I) (1) The board, as part of the plan of operation, shall establish a
methodology for determining premium rates to be charged by the program
for reinsuring small employers and individuals pursuant to this section.
The methodology must contain a provision surcharging the reinsurance
premium rate of a small employer insurer which does not employ effective
cost containment and managed care arrangements including, but not limited
to:
(a) preferred provider organizations;
(b) utilization review;
(c) case management;
(d) other.
The methodology shall include a system for classification of small
employers that reflects the types of case characteristics commonly used by
small employer insurers in the State. The methodology shall provide for
the development of base reinsurance premium rates which shall be
multiplied by the factors set forth in paragraph (2) to determine the
premium rates for the program. The base reinsurance premium rates shall
be established by the board, subject to the approval of the commissioner,
and shall be set at levels which reasonably approximate gross premiums
charged to small employers by small employer insurers for health insurance
plans with benefits similar to the standard health insurance plan.
(2) Premiums for the program shall be as follows:
(a) An entire small employer group may be reinsured for a rate that
is one and one-half times the base reinsurance premium rate for the group
established pursuant to this paragraph.
(b) An eligible employee or dependent may be reinsured for a rate
that is five times the base reinsurance premium rate for the individual
established pursuant to this paragraph.
(3) The board periodically shall review the methodology established
under paragraph (1), including the system of classification and any rating
factors, to assure that it reasonably reflects the claims experience of the
program. The board may propose changes to the methodology which shall
be subject to the approval of the commissioner.
(J) If a health insurance plan for a small employer is entirely or
partially reinsured with the program, the premium charged to the small
employer for any rating period for the coverage issued shall meet the
requirements relating to premium rates set forth in Section 38-71-910, et
seq. of the 1976 Code.
(K) (1) Before March first of each year, the board shall determine and
report to the commissioner the program net loss for the previous calendar
year, including administrative expenses and incurred losses for the year,
taking into account investment income and other appropriate gains and
losses.
(2) Any net loss for the year shall be recouped by assessments of
reinsuring insurers.
(a) The board shall establish, as part of the plan of operation, a
formula by which to make assessments against reinsuring insurers. The
assessment formula shall be based on:
(i) each reinsuring insurer's share of the total premiums earned in
the preceding calendar year from health insurance plans delivered or issued
for delivery to small employers in this State by reinsuring insurers; and
(ii) each reinsuring insurer's share of the premiums earned in the
preceding calendar year from newly-issued health insurance plans delivered
or issued for delivery during the calendar year to small employers in this
State by reinsuring insurers.
(b) The formula established pursuant to subparagraph (a) shall not
result in any reinsuring insurer having an assessment share that is less than
fifty percent nor more than one hundred fifty percent of an amount which is
based on the proportion of the reinsuring insurer's total premiums earned in
the preceding calendar year from health insurance plans delivered or issued
for delivery to small employers in this State by reinsuring insurers to the
total premiums earned in the preceding calendar year from health insurance
plans delivered or issued for delivery to small employers in this State by all
reinsuring insurers.
(c) The board may, with approval of the commissioner, change the
assessment formula established pursuant to subparagraph (a) from time to
time as appropriate. The board may provide for the shares of the
assessment base attributable to total premium and to the previous year's
premium to vary during a transition period.
(d) Subject to the approval of the commissioner, the board shall
make an adjustment to the assessment formula for reinsuring insurers that
are approved health maintenance organizations which are federally
qualified under 42U.S.C. Sec. 300, et seq., to the extent, if any, that
restrictions are placed on them that are not imposed on other small
employer insurers.
(3) (a) Before March first of each year, the board shall determine and
file with the commissioner an estimate of the assessments needed to fund
the losses incurred by the program in the previous calendar year.
(b) If the board determines that the assessments needed to fund the
losses incurred by the program in the previous calendar year will exceed
the amount specified in subparagraph (c), the board shall evaluate the
operation of the program and report its findings, including any
recommendations for changes to the plan of operation, to the commissioner
within ninety days following the end of the calendar year in which the
losses were incurred. The evaluation shall include an estimate of future
assessments and consideration of the administrative costs of the program,
the appropriateness of the premiums charged, the level of insurer retention
under the program, and the costs of coverage for small employers. If the
board fails to file a report with the commissioner within ninety days
following the end of the applicable calendar year, the commissioner may
evaluate the operations of the program and implement such amendments to
the plan of operation the commissioner considers necessary to reduce future
losses and assessments.
(c) For any calendar year, the amount specified in this subparagraph
is five percent of total premiums earned in the previous calendar year from
health insurance plans delivered or issued for delivery to small employers
in this State by reinsuring insurers.
(4) If assessments exceed net losses of the program, the excess shall
be held at interest and used by the board to offset future losses or to reduce
program premiums. As used in this paragraph, "future losses"
includes reserves for incurred but not reported claims.
(5) Each reinsuring insurer's proportion of the assessment shall be
determined annually by the board based on annual statements and other
reports considered necessary by the board and filed by the reinsuring
insurers with the board.
(6) The plan of operation shall provide for the imposition of an
interest penalty for late payment of assessments.
(7) A reinsuring insurer may seek from the commissioner a deferment
from all or part of an assessment imposed by the board. The commissioner
may defer all or part of the assessment of a reinsuring insurer if the
commissioner determines that the payment of the assessment would place
the reinsuring insurer in a financially impaired condition. If all or part of
an assessment against a reinsuring insurer is deferred, the amount deferred
shall be assessed against the other participating insurers in a manner
consistent with the basis for assessment set forth in this subsection. The
reinsuring insurer receiving the deferment shall remain liable to the
program for the amount deferred and shall be prohibited from reinsuring
any individuals or groups with the program until such time as it pays the
assessments.
(L) Neither the participation in the program as reinsuring insurers, the
establishment of rates, forms, or procedures, nor any other joint or
collective action required by this act shall be the basis of any legal action,
criminal or civil liability, or penalty against the program or any of its
reinsuring insurers either jointly or separately.
(M) The board, as part of the plan of operation, shall develop standards
setting forth the manner and levels of compensation, if any, to be paid to
agents for the sale of basic and standard health insurance plans. In
establishing such standards, the board shall take into consideration the need
to assure the broad availability of coverages, the objectives of the program,
the time and effort expended in placing the coverage, the need to provide
on-going service to the small employer, the levels of compensation
currently used in the industry, and the overall costs of coverage to small
employers selecting these plans.
(N) The program shall be exempt from any and all taxes.
Advisory committee
SECTION 12. (A) The Governor shall appoint an advisory committee to
the commissioner which shall recommend the form and level of coverages
to be made available by small employer insurers pursuant to Section 6. At
least one member of the committee shall be a licensed independent
insurance agent who represents multiple health and accident insurance
carriers. In preparing its initial recommendations, the advisory committee
shall build on the work of the Governor's Committee on Basic Health
Services.
(B) The committee shall recommend benefit levels, cost-sharing levels,
exclusions and limitations for the basic health insurance plan and the
standard health insurance plan. The committee shall specifically
recommend which, if any, mandated coverages of health care services or
health care providers should be included in the basic and standard health
insurance plans and shall recommend as well whether the plans should be
exempt from any other statutory provisions otherwise applicable to group
health insurance policies. Section 38-71-200 is applicable to the basic and
standard health insurance plans and is not subject to exemption. The
committee also shall design a basic health insurance plan and a standard
health insurance plan which contain benefit and cost-sharing levels that are
consistent with the basic method of operation and the benefit plans of
health maintenance organizations, including any restrictions imposed by
federal law.
(1) The plans recommended by the committee may include cost
containment features such as:
(a) utilization review of health care services, including review of
medical necessity of hospital and physician services;
(b) case management;
(c) selective contracting with hospitals, physicians, and other health
care providers;
(d) reasonable benefit differentials applicable to providers that
participate or do not participate in arrangements using restricted network
provisions; and
(e) other managed care provisions.
(2) The committee shall submit the health insurance plans described in
paragraphs (A) and (B) to the commissioner for approval by January 1,
1995. If, for any reason, the committee does not provide the commissioner
with a recommendation as to the form and level of coverages to be made
available pursuant to this act, the board shall make such recommendation to
the commissioner. If, subsequent to the approval of the benefit levels of the
basic and standard health insurance plans, amendments to the plans become
necessary, the board shall make such recommendations to the
commissioner for his approval.
Annual public report
SECTION 13. The board, in consultation with members of the committee,
shall study and make a public report each year to the commissioner on the
effectiveness of this act. The report shall analyze the effectiveness of the
act in promoting rate stability, product availability, and coverage
affordability. The report shall include the total number of basic and
standard policies sold in the State noting whether these insureds have ever
been denied coverage before the effective date of this act. The report shall
contain a detailed analysis of the financial condition of the reinsurance pool
including losses and assessments by year. The report may contain
recommendations for actions to improve the overall effectiveness,
efficiency, and fairness of the small group health insurance marketplace.
The report shall address whether insurers and agents are fairly marketing or
issuing health insurance plans to small employers in fulfillment of the
purposes of the act. The report may contain recommendations for market
conduct or other regulatory standards or action.
Requirements upon small employer insurers; etc.
SECTION 14. (A) Each small employer insurer shall fairly market health
insurance plan coverage, including the basic and standard health insurance
plans, to eligible small employers in the State. If a small employer insurer
denies coverage to a small employer on the basis of the health status or
claims experience of the small employer or its employees or dependents,
the small employer insurer shall offer the small employer the opportunity to
purchase a basic health insurance plan and a standard health insurance plan.
A small employer insurer shall not deny coverage to a small employer
based solely on the employer's occupation.
(B) (1) Except as provided in paragraph (2), no small employer insurer
or its agent shall, directly or indirectly, engage in the following
activities:
(a) encouraging or directing small employers to refrain from filing
an application for coverage with the small employer insurer because of the
health status, claims experience, industry, occupation, or geographic
location of the small employer;
(b) encouraging or directing small employers to seek coverage from
another insurer because of the health status, claims experience, industry,
occupation, or geographic location of the small employer.
(2) The provisions of paragraph (1) shall not apply with respect to
information provided by a small employer insurer or agent to a small
employer regarding the established geographic service area or a restricted
network provision of a small employer insurer or health maintenance
organization.
(C) (1) Except as provided in paragraph (2), no small employer insurer
shall, directly or indirectly, enter into any contract, agreement, or
arrangement with an agent that provides for or results in the compensation
paid to an agent for the sale of a health insurance plan to be varied because
of the health status, claims experience, industry, occupation, or geographic
location of the small employer.
(2) Paragraph (1) shall not apply with respect to a compensation
arrangement that provides compensation to an agent on the basis of
percentage of premium, provided that the percentage shall not vary because
of the health status, claims experience, industry, occupation, or geographic
area of the small employer.
(D) A small employer insurer shall provide reasonable compensation, if
provided under the plan of operation of the program, to an agent, if any, for
the sale of a basic or standard health insurance plan.
(E) No small employer insurer may terminate, fail to renew, or limit its
contract or agreement of representation with an agent for any reason related
to the health status, claims experience, occupation, or geographic location
of the small employers placed by the agent with the small employer
insurer.
(F) No small employer insurer or agent may induce or otherwise
encourage a small employer to separate or otherwise exclude an employee
from health coverage or benefits provided in connection with the
employee's employment.
(G) Denial by a small employer insurer of an application for coverage
from a small employer shall be in writing and shall state the reason or
reasons for the denial.
(H) If a small employer insurer enters into a contract, agreement, or
other arrangement with a third-party administrator to provide
administrative, marketing, or other services related to the offering of health
insurance plans to small employers in this State, the third-party
administrator shall be subject to this act as if it were a small employer
insurer.
Definitions; changes, additions, deletions
SECTION 15. Section 38-71-920 of the 1976 Code, as added by Act 131
of 1991, is amended to read:
"(1) `Small employer' means any person, firm, corporation,
partnership, or association actively engaged in business who, on at least
fifty percent of its working days during the preceding year, employed no
more than fifty eligible employees. In determining the number of eligible
employees, companies which are affiliated companies or which are eligible
to file a combined tax return for purposes of state taxation must be
considered one employer.
(2) `Insurer' means any person who provides health insurance in this
State. For the purposes of this subarticle, insurer includes a licensed
insurance company, a health maintenance organization, a multiple
employer welfare arrangement, or any other person providing a plan of
health insurance subject to state insurance regulation.
(3) `Health insurance plan' or `plan' means any hospital or medical
expense incurred policy or certificate, or health maintenance organization
subscriber contract. It includes the entire contract between the insurer and
the insured, including the policy, riders, endorsements, and the application,
if attached. Health insurance plan does not include accident-only, blanket
accident and sickness, specified disease, credit, dental, vision, Medicare
supplement, long-term care, or disability-income insurance; coverage
issued as a supplement to liability or other insurance; coverage designed
solely to provide payments on a per diem, fixed indemnity, or nonexpense
incurred basis, coverage for Medicare or Medicaid services pursuant to a
contract with state or federal government, workers' compensation or similar
insurance; or automobile medical payment insurance.
(4) `Small employer insurer' means an insurer which offers health
insurance plans covering the employees of a small employer.
(5) `Case characteristics' means the following characteristics of a small
employer, as determined by a small employer insurer, which are considered
by the insurer in the determination of premium rates for the small
employer: age, gender, geographic area, industry, and family composition.
Geographic areas smaller than a county may not be used without prior
approval of the commissioner. Claim experience, health status, and
duration of coverage since issue are not case characteristics for the
purposes of this subarticle.
(6) `Commissioner' means the Chief Insurance Commissioner.
(7) `Department' means the Department of Insurance.
(8) `Late enrollee' means an eligible employee or dependent who
requests enrollment in a health insurance plan of a small employer
following the initial enrollment period during which the individual is
entitled to enroll under the terms of the health insurance plan, provided that
the initial enrollment period is a period of at least thirty days. However, an
eligible employee or dependent shall not be considered a late enrollee
if:
(1) The individual meets each of the following:
(a) the individual was covered under qualifying previous coverage at
the time of the initial enrollment;
(b) the individual lost coverage under qualifying previous coverage
as a result of termination of employment or eligibility, the involuntary
termination of the qualifying previous coverage, death of a spouse, or
divorce; and
(c) the individual requests enrollment within thirty days after
termination of the qualifying previous coverage; or
(2) The individual is employed by an employer which offers multiple
health insurance plans and the individual elects a different plan during an
open enrollment period; or
(3) A court has ordered that coverage be provided for a spouse or
minor or dependent child under a covered employee's health insurance plan
and request for enrollment is made within thirty days after issuance of the
court order.
(9) `Actuarial base rate' means the current estimated premium rate for a
health insurance plan, based solely on the claim experience for all small
employers insured by the insurer, on plan design, and without regard to the
nature of the groups assumed to select particular health insurance plans.
The insurer must be able to demonstrate a reasonable actuarial relationship
between the estimated premium rate and the plan design.
(10) `Class of business' means all or a distinct grouping of small
employers as shown on the records of the small employer insurer.
(a) A distinct grouping may be established only by the small employer
insurer on the basis that the applicable health insurance plans:
(i) are marketed and sold through individuals and organizations
which are not participating in the marketing or sale of other distinct
groupings of small employers for such small employer;
(ii) have been acquired from another small employer insurer as a
distinct grouping of plans;
(iii) are provided through an association with membership of not less
than fifty small employers which have been formed for purposes other than
obtaining insurance; or
(iv) are provided through a common group formed solely for the
purpose of obtaining insurance as permitted by Section
38-71-730(1)(b).
(b) A small employer insurer may establish no more than two
additional groupings on the basis of criteria, such as group size, which are
expected to produce substantial variation in administrative and marketing
costs.
(c) The commissioner may approve the establishment of additional
distinct groupings upon application to the commissioner and a finding by
the commissioner that action would enhance the efficiency and fairness of
the small employer insurance marketplace.
(11) `Actuarial certification' means a written statement by a member of
the American Academy of Actuaries or other individual acceptable to the
commissioner that a small employer insurer is in compliance with the
provisions of Section 38-71-940, based upon the person's examination,
including a review of the appropriate records and of the actuarial
assumptions and methods utilized by the insurer in establishing premium
rates for applicable health insurance plans.
(12) `Rating period' means the calendar period for which premium rates
established by a small employer insurer are assumed to be in effect, as
determined by the small employer insurer."
Disclosure changes
SECTION 16. Section 38-71-960 of the 1976 Code, as added by Act 131
of 1991, is amended to read:
"Section 38-71-960. Each small employer insurer shall make
reasonable disclosure in solicitation and sales materials provided to small
employers of:
(1) the extent to which premium rates for a specific small employer are
established or adjusted due to case characteristics, family composition, and
class of business;
(2) the provisions concerning the insurer's right to change premium
rates and the factors, including case characteristics, which affect changes in
premium rates;
(3) a description of the class of business in which the small employer is
or will be included, including the applicable grouping of plans;
(4) the provisions relating to renewability of coverage."
Common group of small employers, obtaining insurance; etc.
SECTION 17. Section 38-71-730 of the 1976 Code, as last amended by
Acts 283 and 286 of 1992, is further amended to read:
"Section 38-71-730. No policy of group health, group accident,
or group accident and health insurance may be delivered or issued for
delivery in this State unless it conforms to the following description:
(1) Except as provided in this item, the policy is issued to a trust or to
insure two or more persons who are associated in a common group for
purposes other than the obtaining of insurance.
(a) Group policies of credit accident and health insurance may be
issued to persons other than those in a common group.
(b) A common group of small employers may be formed solely for the
purpose of obtaining insurance. Such a group must comply with the
following provisions:
(i) It contains at least one thousand eligible employees.
(ii) It establishes requirements for membership. However, the
common group cannot exclude any small employer, which otherwise meets
the requirements for membership, on the basis of claim experience or health
status.
(iii) It holds an open enrollment period at least once a year during
which new members can join the common group.
(iv) It allows eligible employees and their dependents, upon initial
enrollment and during subsequent open enrollment periods, to choose
among health insurance plans offered through the group. Persons covered
by a health insurance plan offered through the group which requires an
enrollment period in excess of one year are eligible to choose among
available plans upon the completion of the enrollment period.
(v) It offers coverage under all plans offered through the group to all
eligible employees of member small employers and their dependents.
Coverage may not be offered only to certain employees of member small
employers and their dependents except as provided in Section 7(B) of this
act.
(vi) It does not assume any risk or form self-insurance plans among
its members unless it complies with the provisions of Chapter 41 of this
title.
(vii) It has the option of using any type of rating arrangement with
the health insurance plans and, at its discretion, premiums may be paid to
the health insurance plans by the common group, by member small
employers, or by eligible employees and their dependents.
(A) Health insurance plans offered through the common group
which rate each member small employer separately are subject to the laws
governing small employer health insurance; and
(B) Health insurance plans offered through the common group
which rate the entire group as a whole must charge each insured person
based on a community rate within the common group, adjusted for case
characteristics as permitted by Section 38-71-940 and plan selection, and
are subject to the laws governing group accident and health insurance.
(viii) It may not act as an agent or engage in any activities for which
an insurance agent's license is required.
(ix) Before offering any health insurance plans through the common
group, and annually thereafter, it registers with the commissioner and
demonstrates continued compliance with the subitems (b)(i) through
(viii).
(2) The benefits provided by the policy are based on some plan or plans
precluding individual selection, except that insurance supplemental to the
basic coverage may be available to persons insured under the policy.
(3) For all groups, no evidence of individual insurability may be
required at the time the person first becomes eligible for insurance or
within thirty-one days thereafter. Nothing in this section precludes the
obtaining of medical information with respect to the members of the group
for use in determining the insurability of the group, but the information
may not be used to exclude an individual from coverage.
(4) The policies may contain a provision limiting coverage for
preexisting conditions. The preexisting conditions must be covered no later
than twelve months without medical care, treatment, or supplies ending
after the effective date of the coverage or twelve months after the effective
date of the coverage, whichever occurs first. Preexisting conditions are
defined as `those conditions for which medical advice or treatment was
received or recommended no more than twelve months before the effective
date of a person's coverage'. However, whenever a covered person moves
from one insured group to another, the insurer of the group to which the
covered person moves shall give credit for the satisfaction of the
preexisting condition period or portion thereof already served under the
prior plan if the coverage is selected when the person first becomes eligible
and the coverage is continuous to a date not more than thirty days prior to
the effective date of the new coverage. Service under a probationary
waiting period required by the employer is not considered to interrupt
continuous service.
(5) Except as provided in item (1)(b)(vii) of this section, the premium
for the policy must be paid by the policyholder from the policyholder's
funds or from funds contributed by the insured persons, or from both.
(6) A group policy or subscriber contract of accident and health
insurance which is advertised, marketed, or designed primarily as a
supplement to reimbursements under Medicare for the hospital, medical, or
surgical expenses of persons eligible for Medicare must equal, and may
exceed, the minimum standards for Medicare supplement policies as
contained in regulations promulgated by the commissioner."
Definition changed
SECTION 18. Section 38-70-10(2) of the 1976 Code, as added by Act
311 of 1990, is amended to read:
"(2) `Private review agent' means a person performing utilization
reviews who is either under contract with or acting on behalf of, but not
employed by:
(a) a South Carolina business entity;
(b) the State of South Carolina; or
(c) a hospital."
Applicability of Chapter 70, Title 38; exemptions
SECTION 19. Section 38-70-15 of the 1976 Code, as added by Act 311 of
1990, is amended to read:
"Section 38-70-15. This chapter applies to insurance companies,
administrators of insurance benefit plans, and health maintenance
organizations licensed and regulated by the South Carolina Department of
Insurance. Insurance companies, administrators of insurance benefit plans,
and health maintenance organizations so regulated are exempt from the
provisions of Sections 38-70-20(A) and (B), 38-70-30, and
38-70-50."
Provisions deleted, added
SECTION 20. Section 38-71-940 of the 1976 Code, as added by Act 131
of 1991, is amended to read:
"Section 38-71-940. (A) Premium rates for health insurance
plans subject to this subarticle are subject to the following
requirements:
(1) The small employer insurer shall determine the actuarial base rate
for each health insurance plan it offers to small employers in the State. In
determining the premium rates to be charged to a small employer for a
health insurance plan, the actuarial base rate for the plan may be adjusted
only to reflect the case characteristics and family composition of the small
employer, and the class of business to which the small employer is
assigned. The adjustments to the base rate must be objective and meet
sound actuarial standards.
(a) Small employer insurers shall apply case characteristics
consistently with respect to all small employers within a class of
business.
(b) Adjustments due to family composition shall be applied
consistently with respect to all small employers across all classes of
business.
(c) The maximum adjustment to the actuarial base rate, plus or
minus, due to class of business is ten percent of the actuarial base rate.
(2) The percentage increase in the renewal premium rate charged to a
small employer for a new rating period may not exceed the sum of:
(a) the percentage change in the actuarial base rate measured from
the first day of the prior rating period to the first day of the new rating
period; and
(b) any adjustment due to change in coverage, family composition,
or change in the case characteristics of the small employer, subject to the
limitations imposed by item (1) of this section and as determined from the
insurer's rate manual for the class of business.
(3) In the case of health insurance plans issued before January 1,
1995, the percentage increase in the renewal premium rate for a new rating
period may also include an adjustment for claim experience, health status,
or duration of coverage, not to exceed:
(a) twenty percent of the actuarial base rate for plans renewed during
calendar year 1995; and
(b) ten percent of the actuarial base rate for plans renewed during
calendar year 1996.
Effective January 1, 1997, all renewal premium rates must comply with
the provisions of item (1) of this subsection.
(B) Unless the small employer no longer meets the criteria established
for its existing class of business:
(1) A small employer insurer may not transfer involuntarily a small
employer into or out of a class of business; and
(2) A small employer insurer may not offer to transfer a small
employer into or out of a class of business, unless the offer is made to
transfer all small employers in the class of business without regard to case
characteristics, claim experience, health status, or duration since issue.
(C) The commissioner may approve wellness incentives developed by
small employer insurers that allow premium reductions from the rating
limitations of this section. Wellness incentives to be considered may
include, but are not limited to, smoking status, participation in physical
fitness activities, and dietary habits."
Committee on health reform
SECTION 21. The General Assembly finds and declares that it is in the
public interest to study other specific health reform ideas. To that end,
there is hereby created a committee on health reform to be appointed by the
Governor, whose task will be to issue a report to the Governor on:
(1) the benefits and drawbacks to establish accountable health plans,
voluntary health insurance purchasing cooperatives, and rating
methodologies; and
(2) the benefits and drawbacks to passage of state-enabling legislation
for the establishment of small employer medical IRA's.
The appointees to this committee shall include, at minimum, two health
insurance carriers actively engaged in small group business in South
Carolina, and one independent health insurance agent.
The committee shall issue a report to the Governor and General
Assembly by January 1, 1995.
Severability
SECTION 22. If any provision of this act or the application thereof to any
person or circumstances is for any reason held to be invalid, the remainder
of the act and the application of its provisions to other persons or
circumstances shall not be affected thereby.
Time effective
SECTION 23. Except as may otherwise be provided in this act, this act
takes effect July 1, 1995. Sections 17 and 21 of this act take effect July 1,
1994. Sections 15 and 20 of this act take effect January 1, 1995.
Approved the 19th day of April, 1994. |