Current Status Introducing Body:
SenateBill Number: 500Primary Sponsor: LandCommittee Number: 02Type of Legislation: GBSubject: Bare Bones health insuranceResiding Body: SenateCurrent Committee: Banking and InsuranceComputer Document Number: BBM/10303JM.93Introduced Date: 19930304Last History Body: SenateLast History Date: 19930304Last History Type: Introduced, read first time, referred to CommitteeScope of Legislation: StatewideAll Sponsors: Land Elliott Martin Matthews Courtney PassailaigueType of Legislation: General Bill
Bill Body Date Action Description CMN Leg Involved ____ ______ ____________ ______________________________ ___ ____________ 500 Senate 19930304 Introduced, read first time, 02 referred to CommitteeView additional legislative information at the LPITS web site.
TO AUTHORIZE THE ISSUANCE OF LIMITED BENEFIT HEALTH INSURANCE POLICIES, OR THE DEVELOPMENT AND MARKETING OF "BARE BONES" HEALTH INSURANCE PLANS, IN AN EFFORT TO MAKE SUCH COVERAGE MORE AFFORDABLE FOR THE RESIDENTS OF THE STATE, AND TO PROVIDE FOR RELATED AND INCIDENTAL MATTERS.
Whereas, the General Assembly recognizes that the availability of an insurance policy with limited benefits and modest premiums will reduce the number of uninsured persons in this State, will reduce the risk of financial disaster for the citizens of this State, will reduce the burden upon health care providers of furnishing health care without payment therefor, and will reduce the shifting of such cost for uncompensated care to other insurers; and
Whereas, the General Assembly further recognizes that there is need for such a limited benefit policy on the part of individuals who are not employed, whether such individuals are not in the job market or because such individuals are between jobs, and on the part of employers who desire to and are willing to provide a measure of insurance protection to their employees; and
Whereas, the General Assembly further recognizes that the continuation of insurance after termination of employment will reduce the periods of time when individuals will be uninsured and that the naming of an employee as the insured will enhance the furtherance of that objective. The General Assembly further finds that it is not desirable to make the benefits of this policy or any of its incidents depend upon whether the employee or the employer pays or appears to pay any part of the premiums; and
Whereas, the General Assembly believes that the insurers in this State, working with the South Carolina Department of Insurance, should develop and market "bare bones" health insurance plans in an effort to make coverage more affordable for the residents of the State as previously stated. Now, therefore,
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. (A) Any insurer authorized to transact business in this State may issue a policy containing in suitable type as approved by the Chief Insurance Commissioner words that the policy is issued pursuant to this act. The words must contain a statement that the benefits in the policy are limited and that the limitations are authorized pursuant to this act.
(B) A policy may not state that it is a limited benefit policy issued pursuant to this act unless the actuarial value of the benefits provided in the policy is not greater than sixty percent of the actuarial value of the benefits provided in the standard risk policy as defined in Section 6 of Act 127 of 1989, relating to the South Carolina Health Insurance Pool.
(C) The policy form for such limited benefits policy shall not be approved unless the application for approval is accompanied by a certification from a qualified actuary acceptable to the commissioner that the policy conforms to the requirements of subsection (B).
SECTION 2. Except as otherwise stated in this act, such limited benefit policies shall conform to the requirements of Articles 1, 3, and 5 of Chapter 71 of Title 38 of the 1976 Code of Laws, which provisions of law relate to accident and health insurance, individual accident and health policies, and group accident and health insurance.
SECTION 3. The limited benefit policies authorized by this act are not subject to the requirements of the following sections of the 1976 Code of Laws, or portions thereof:
(1) Section 38-71-140, relating to the coverage of newborn children;
(2) Section 38-71-170, relating to conversion privileges for former spouses;
(3) the second sentence of Section 38-71-200, relating to benefits for the services of a licensed podiatrist, licensed oral surgeon, or licensed optometrist;
(4) Section 38-71-210, relating to the requirement that health insurance policies include chiropractic services;
(5) Section 38-71-350, relating to continuation of coverage for handicapped and dependent children of the policyholder;
(6) Section 38-71-360, relating to continuation of coverage for nonhandicapped dependent children;
(7) Section 38-71-325, relating to requirements for approval of new individual major medical expense coverage policies;
(8) Section 38-71-730, relating to requirements for group accident, group health, and group accident and health policies;
(9) Section 38-71-735, relating to required provisions for group accident, group health, and group accident and health policies;
(10) Section 38-71-760, relating to standards for group accident and health insurance coverage, discontinuance, and replacement;
(11) Section 38-71-770, relating to mandatory continuation and conversion privileges with respect to group accident and health insurance.
SECTION 4. (A) In order to promote transferability of any policy approved for issuance pursuant to this act and to make possible the purchase by employers of policies approved for issuance pursuant to this act, premiums for any limited benefit policy issued pursuant to this act may be paid from the funds of the employer, from the funds of the insured persons, or from the funds of both, whether or not the employer provides assistance in the administration of the policy for one or more of its employees or other persons.
(B) Any limited benefits policy issued pursuant to this act in connection with which the employer pays all or a part of the premiums and performs any acts relating to the required contacts between the insured and the insurer must be issued in the name of the insured person, and the insured person upon termination of employment may continue the coverage provided upon payment of the premiums therefor.
SECTION 5. Any limited benefit policy issued pursuant to this act may contain provisions as follows:
(1) that benefits for transplants of any organs, both donor and donee, are excluded;
(2) that benefits for newborn children whose birth weight is under two pounds are excluded;
(3) that benefits for accident or illness and complications thereof after sixty days from the date of the accident or the onset of illness or in excess of fifty thousand dollars for each accident and illness and complications thereof are excluded;
(4) that benefits for psychiatric care are limited to ten days inpatient expenses and twenty days outpatient expenses or doctors' offices visits per year.
(5) that lifetime benefits are limited to a maximum of one hundred thousand dollars.
SECTION 6. Limited benefit policies may contain a provision requiring a statement from each insured person as to whether the insured person is employed and, if employed, whether benefits claimed are covered by workers' compensation insurance.
SECTION 7. Limited benefit policies may contain exclusions as approved by the South Carolina Department of Insurance, including, but not limited to, exclusions for investigational and experimental expenses, cosmetic expenses, infertility expenses, and weight loss expenses.
SECTION 8. If coverage is provided for physical examinations, such coverage may be limited to one examination every twenty-four months after the policy has been in effect for twelve months, with a limit on the cost of each such examination in the amount of one hundred dollars. If coverage is provided for mammograms, such coverage may be limited to one mammogram every five years after fifty years of age with the maximum benefit for each such examination limited to fifty dollars. Coverage for pap smears, childhood immunizations, and other procedures designed to enhance the health and well-being of the insured persons may be included with such limitations as may be approved by the Chief Insurance Commissioner.
SECTION 9. Limited benefit policies may contain provisions for reasonable co-payments, reasonable deductibles, and reasonable out-of-pocket maximums as may be approved by the Chief Insurance Commissioner.
SECTION 10. Any limited benefit policy issued pursuant to this act, whether obtained by the individual insured or obtained with the assistance of an employer, must contain a provision for the coordination of benefits, mutatis mutandis, as set out in Regulation 69-43 of the South Carolina Department of Insurance, or as hereafter amended.
SECTION 11. In any action to recover benefits claimed to be due under a limited benefit policy, trial must be by the court without a jury and recover is limited to the benefits claimed, except that attorney's fees may be awarded pursuant to Section 38-59-40 of the 1976 Code of Laws.
SECTION 12. Nothing in this act may be construed so as to create any implication as to the meaning of, or interpretation to be placed upon, any other provision of law relating to any policy other than the limited benefit policy authorized herein.
SECTION 13. This act takes effect upon approval by the Governor.