MISSISSIPPI LEGISLATURE

1998 Regular Session

To: Insurance

By: Representative Holden

AN ACT TO PROVIDE THAT A PERSON OR ENTITY ENGAGED IN THE BUSINESS OF INSURANCE OR AS A HEALTH CARRIER IN THIS STATE SHALL NOT KNOWINGLY DENY, CANCEL OR FAIL TO RENEW COVERAGE, OR ADD A PREMIUM DIFFERENTIAL TO ANY INSURANCE POLICY OR HEALTH BENEFIT PLAN, ON THE BASIS OF THE APPLICANT'S STATUS AS A SUBJECT OF ABUSE; TO PROVIDE DEFINITIONS; TO REQUIRE HEALTH CARRIERS AND INSURERS TO DEVELOP AND FOLLOW GUIDELINES DESIGNED TO ENCOURAGE APPROPRIATE BEHAVIOR WHEN CONDUCTING BUSINESS IN CASES INVOLVING ABUSE; AND FOR RELATED PURPOSES. 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. (1) For purposes of this section, the following definitions apply:

(a) "Abuse" means the occurrence of one or more of the following acts:

(i) Attempting to cause or intentionally, knowingly or recklessly causing another person, including a minor child, bodily injury, physical harm, severe emotional distress, psychological trauma, rape, sexual assault or involuntary sexual intercourse;

(ii) Subjecting another person, including a minor child, to false imprisonment; or

(iii) Attempting to cause or intentionally, knowingly or recklessly causing damage to property so as to intimidate or attempt to control the behavior of another person, including a minor child.

(b) "Abuse-related claims" means claims for damages incurred by a subject of abuse under property and casualty policies that are caused by acts of abuse.

(c) "Abuse-related medical condition" means a medical condition sustained by a subject of abuse that arises in whole or in part out of an act or pattern of abuse.

(d) "Abuse status" means the fact or perception that a person is, has been or may be a subject of abuse, regardless of whether the person has sustained abuse-related medical conditions or has incurred abuse-related claims.

(e) "Health carrier" means a disability insurer, a health care service contractor or a health maintenance organization.

(f) "Health benefit plan" means any policy, contract or agreement offered by a health carrier to provide, arrange, reimburse or pay for health care service.

(g) "Subject of abuse" means a person to whom a family member or a current or former household member or a current or former intimate partner or a current or former caretaker or a perpetrator of sexual assault or a sex offender has directed an act defined in paragraph (a) of this subsection; who has had prior injuries, illnesses or disorders that resulted from abuse; or who seeks, may have sought or should have sought medical or psychological treatment for abuse, protection, court-ordered protection or shelter from abuse.

(2) A person or entity engaged in the business of insurance or as a health carrier in this state shall not engage in any of the following acts or practices against a subject of abuse:

(a) Knowingly denying, refusing to issue, renew or reissue, canceling or otherwise terminating an insurance policy or health benefit plan; restricting or excluding insurance or a health benefit plan coverage; or adding a premium differential to any insurance policy or health benefit plan on the basis of the applicant's, insured's or enrolled participant's abuse status;

(b) Excluding or limiting coverage for losses or denying a claim incurred by an insured as a result of abuse on the basis of the insured's abuse status, except as otherwise permitted or required by the laws of this state relating to acts of abuse committed by an insurance beneficiary;

(c) Asking an insured or applicant for an insurance policy or health benefit plan about their abuse status; or

(d) Disclosing or transferring any information by any person relating to an applicant or insured who is the subject of abuse or who has an abuse-related medical condition or abuse-related claim; or the applicant's or insured's status as a family member, employer or associate or a person in a relationship with a subject of abuse for any purpose unrelated to the direct provision of or payment for specific health care or social services, except where required by the Commissioner of Insurance, a court of competent jurisdiction, abuse reporting laws or as otherwise required by state law.

(3) Nothing in this section prohibits a life insurer from declining to issue a life insurance policy if the applicant or prospective owner of the policy is or would be designated as a beneficiary of the policy, and if:

(a) The applicant or prospective owner of the policy lacks an insurable interest in the insured; or

(b) The applicant or prospective owner of the policy is known, on the basis of police or court records, to have committed an act of abuse against a prospective insured; or

(c) The insured or prospective insured is a subject of abuse and that person, or a person who has assumed the care of that person if a minor or incapacitated, has objected to the issuance of the policy in good faith and with probable cause on the ground that the policy would be issued to or for the direct or indirect benefit of the abuser.

(4) An insurer shall not be held civilly or criminally liable for any cause of action that may be brought because of compliance with this section.

(5) Any insurer or health carrier that takes an action that adversely affects a subject of abuse on the basis of an abuse-related medical condition or an abuse-related claim shall, upon written request, directly notify in writing the applicant, insured or enrolled participant of the reason for the action and must be able to demonstrate that the action and any applicable policy provision:

(a) Does not have the purpose or effect of treating abuse status as a medical condition or underwriting criterion;

(b) Is not based upon any actual or perceived correlation between a medical condition or a type of property and casualty claim and abuse;

(c) Is otherwise permissible by law and applies in the same manner and to the same extent to all applicants and insureds with a similar medical condition or property and casualty claim without regard to whether the condition or claim is abuse-related; and

(d) Is based on a determination made in conformance with sound actuarial principles and supported by reasonable statistical evidence that there is a correlation between the medical condition or the type of property and casualty claim and a material increase in insurance risk.

(6) Health carriers and insurers shall develop guidelines, file the guidelines with the Commissioner of Insurance and require employees specifically involved with abuse cases to follow such guidelines that shall be designed to encourage greater sensitivity and appropriate behavior when conducting any business in cases involving abuse. Such guidelines shall specify allowable exceptions to the carrier's or insurer's standard operating procedures if the carrier or insurer determines that such exceptions may provide additional confidentiality or other changes that could increase the safety of the victim of abuse.

SECTION 2. This act shall take effect and be in force from and after July 1, 1998.