Summary: H.R.3626 — 102nd Congress (1991-1992)All Information (Except Text)

There is one summary for H.R.3626. Bill summaries are authored by CRS.

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Introduced in House (10/24/1991)

Health Insurance Reform and Cost Control Act of 1991 - Title I: Increase in Deduction for Health Insurance For Self-Employed Individuals - Amends the Internal Revenue Code to extend the current 25 percent tax deduction for health insurance costs of self-employed individuals through 1992, and to increase the deduction to 50 percent in 1993, 75 percent in 1994, and 100 percent in 1995 and thereafter.

Title II: Improvements In Health Insurance For Small Employers - Subtitle A: Standards And Requirements of Small Employer Health Insurance Reform - Amends the Social Security Act to add a new title XXI (Health Insurance Standards) under part A (Small Employer Health Insurance Standards) of which the Secretary of Health and Human Services (HHS) is required to develop specific standards to implement the requirements outlined in the three successive paragraphs below and in part B (Prohibition of Discrimination Based on Health Status for Certain Services) of such new title as added below which health insurance plans provided by entities employing from two to 50 employees (small employer plans) must be certified as meeting in order to be issued.

Requires each insurer to register with the Secretary and any applicable regulatory authority for each State in which it issues or offers a small employer plan. Specifies that no issuer may exclude from coverage any eligible employee or such employee's spouse or any dependent child to whom coverage is made available by a small employer. Requires, with respect to small employer plans, that insurers offering such plans guarantee that: (1) the same plans are available throughout the insurer's service area on a continuous, year-round basis; and (2) such plans are renewable, with specified exceptions. Requires a notice prior to expiration of the terms for renewal of the plan. Provides that except with respect to rates and administrative changes, such terms (including benefits) shall be the same as the terms of issuance. Requires that the period of renewal of each small employer plan be for a period of not less than 12 months. Details requirements with respect to the treatment of health maintenance organizations. Provides that an insurer may not offer to, or issue with respect to, a small employer a small employer plan with a term of less than 12 months.

Provides that the premium index rate for any block of business of an insurer may not exceed the index rate for any other block of business by more than 20 percent, with specified exceptions. Requires small employer plan premiums within a block of business to be community-rated for a given geographical area, with limited adjustments for age and sex permitted under specified guidelines. Specifies that, in defining communities for rating purposes, no insurer may use a geographic area that is smaller than a metropolitan statistical area. Requires small employer plans to permit enrollment of (and compute premiums separately for) individuals based on specified beneficiary classes. Places restrictions on transfers of small employers among blocks of business. Requires that any variation in annual small employer plan premium increases be limited to five percent. Requires full disclosure of rating practices and other premium rate information when a small employer plan is offered to the employer. Requires annual actuarial certification of an insurer's compliance with the premium rate requirements of this paragraph for filing with the Secretary and any applicable regulatory authority.

Requires small employer plans offered to contain a benefit package similar to the benefit package under Medicare (title XVIII of the Social Security Act), plus unlimited inpatient hospital services for children and specified pregnancy-related services, as well as the new preventive benefits added to the Medicare program by title V of this Act. Sets a single annual deductible of $250 per individual and $500 per family, indexed to annual increases in the contribution and benefit base. Makes deductibles inapplicable for preventive services provided consistent with any applicable periodicity schedules. Makes co-payments inapplicable for: (1) preventive services provided consistent with any applicable periodicity schedules; and (2) inpatient hospital services furnished to children. Sets an overall annual limit on deductibles and co-payments of $2,500 per individual and $3,000 per family, indexed in the manner described above. Preempts State mandates prohibiting the offering of the benefit package required to be contained in small employer plans.

Directs the Secretary to provide for the establishment of a toll-free telephone information and complaint system which provides for: (1) a system for the receipt and disposition of consumer complaints or inquiries regarding compliance of small employer plans with the requirements outlined above; and (2) information to small employers about insurers in the local area that offer those plans that meet such requirements.

Subtitle B: Tax Penalty on Noncomplying Insurers - Amends the Internal Revenue Code to impose an excise tax on: (1) insurers which issue small employer plans that do not comply with the requirements outlined above; and (2) small employers who self-insure for employee health benefits. Sets the amount of such excise tax for: (1) insurers at 25 percent of the gross premiums received from small employers in a year; and (2) small employers at 25 percent of the expenditures made for employee health benefits in a year.

Subtitle C: Studies and Reports - Directs the Comptroller General of the United States to study and report to the Congress on the impact of the rating requirements for small employer plans outlined above on the availability and price of insurance offered to small employers along with recommendations for adjusting such requirements to eliminate variation in premiums associated with demographic factors.

Title III: Improvements In Portability Of Private Health Insurance - Amends new title XXI (Health Insurance Standards) of the Social Security Act to add a part B (Prohibition of Discrimination Based on Health Status for Certain Services) under which all employer health plans (including self-insured plans) are barred from denying, limiting, or conditioning the coverage under (or benefits of) the plan with respect to standard health services based on the health status, claims experience, receipt of health care, medical history, or lack of evidence of insurability, of an individual. Provides that group health plan exclusions for pre-existing conditions shall be limited to six months, except with respect to newborns. Reduces such six-month period by up to three months of a period of continuous coverage of an individual for services with respect to a pre-existing condition.

Amends the Internal Revenue Code to impose the same excise tax as imposed above on insurers who violate a requirement of part A (Small Employer Health Insurance Standards) on insurers who violate a requirement of part B (Prohibition of Discrimination Based on Health Status for Certain Services).

Title IV: Health Care Cost Containment - Establishes in HHS the National Health Care Cost Containment Commission to: (1) review and make recommendations to the Secretary on the optional payments required below; and (2) report annually to the President and the Congress on increases in health care costs. Authorizes appropriations.

Directs the Secretary to establish maximum payment rates based upon existing Medicare payment methodologies, including the extra billing limits for physician services, that purchasers may elect to pay for health care services. Requires service providers to accept the rates as payment in full, subject to civil monetary penalty.

Directs the Secretary to develop uniform claims forms for use by beneficiaries and providers and uniform reporting standards to be employed by providers.

Title V: Medicare Prevention Benefits - Amends the Medicare program to add annual screenings for colon cancer for individuals over age 50 and for breast cancer for women over age 64, vaccinations for influenza and tetanus-diphtheria, and well-child care services as program benefits.

Directs the Secretary to establish and provide for ongoing demonstration projects providing for the coverage of other specified preventive services under Medicare to determine whether to include the coverage of such services for all individuals enrolled under Mediare part B (Supplementary Medical Insurance). Requires reports to specified congressional committees describing the findings made under such demonstration projects and the Secretary's plans for future such demonstration projects. Authorizes appropriations.

Requires an Office of Technology Assessment study to develop a process for the regular review of Medicare coverage of preventive services. Requires a report to the Congress on such study.