House Bill 1627

AN ACT TO CREATE NEW SECTION 83-1-111, MISSISSIPPI CODE OF 1972, TO EXEMPT NONPROFIT AGRICULTURAL MEMBERSHIP ORGANIZATIONS FROM INSURANCE REGULATION; TO PROVIDE THAT A NONPROFIT AGRICULTURAL MEMBERSHIP ORGANIZATION MAY PROVIDE COVERAGE FOR HEALTHCARE BENEFITS OR SERVICES FOR ITS MEMBERS AND THEIR FAMILIES PURSUANT TO CONTRACTS BETWEEN MEMBERS AND THE ORGANIZATION OR ITS AFFILIATES; TO PROVIDE THAT A NONPROFIT AGRICULTURAL MEMBERSHIP ORGANIZATION OR ITS AFFILIATE SHALL HAVE A DESIGNATED INDIVIDUAL WHO, IN CONSULTATION WITH THE STATE INSURANCE DEPARTMENT, OPERATES AS AN OMBUDSMAN TO ADDRESS CONCERNS FROM INSURED MEMBERS REGARDING THE NAMO PLAN; TO PROVIDE THAT THE STATE INSURANCE DEPARTMENT SHALL HAVE THE AUTHORITY TO REVIEW AND COMMENT ON THE COMPLAINT, PROVIDED THAT ALL COMPLAINTS SHALL BE INVESTIGATED AND RESOLVED SOLELY BY THE OMBUDSMAN AND NAMO OR ITS DESIGNEE; TO PROVIDE CERTAIN REQUIREMENTS FOR NAMO PLANS; TO PROVIDE THAT HEALTHCARE BENEFITS OR SERVICES MAY BE SOLD OR SOLICITED ONLY BY AN INSURANCE PRODUCER WHO IS BOTH APPOINTED BY AN ORGANIZATION MEETING THE REQUIREMENTS OF THIS ACT AND LICENSED AS AN INSURANCE PRODUCER TO SELL OR SOLICIT ACCIDENT AND HEALTH INSURANCE IN THIS STATE; TO AMEND SECTION 83-1-101, MISSISSIPPI CODE OF 1972, TO CONFORM TO THE PROVISIONS OF THE ACT; TO BRING FORWARD SECTIONS 83-5-1 AND 83-5-3, MISSISSIPPI CODE OF 1972, FOR THE PURPOSE OF POSSIBLE AMENDMENT; AND FOR RELATED PURPOSES.

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

SECTION 1. The following shall be codified as Section 83-1-111, Mississippi Code of 1972:

83-1-111. (1) For purposes of this act, a "nonprofit agricultural membership organization" (NAMO) shall mean an organization that:

(a) Is incorporated under the laws of this state;

(b) Has representation in every county of this state;

(c) Has a purpose of promoting the interests of farmers, growers, ranchers, rural citizens, association members or their affiliates in this state; and

(d) Provides coverage for healthcare benefits or services for its members and their families pursuant to contracts between members and the organization or its affiliates.

(2) Healthcare benefits or services covered by a nonprofit agricultural membership organization must be provided, under a self-funded arrangement, hereinafter referred to as a "NAMO Plan," and administered by an entity that holds a certificate of authority as a third-party administrator in this state.

(3) A nonprofit agricultural membership organization providing coverage for healthcare benefits or services under a NAMO Plan shall have a designated individual who, in consultation with the State Insurance Department, operates as an ombudsman to address concerns from NAMO Plan members pursuant to a complaint policy and procedure to be created by the nonprofit agricultural membership organization that is materially similar to the policy and procedure used by the State Insurance Department. The State Insurance Department shall have the authority to review and comment on the complaint, provided that all complaints shall be investigated and resolved solely by the ombudsman and nonprofit agricultural membership organization or its designee.

(4) If a complaint is received by the State Insurance Department from members enrolled in a NAMO Plan, then the department shall forward the complaint to the designated individual operating as the applicable nonprofit agricultural membership organization's ombudsman.

(5) Any risk of loss arising out of a contract for coverage for healthcare benefits or services between a member of a nonprofit agricultural membership organization and a nonprofit agricultural membership organization, or its affiliate, may be reinsured by an insurer that is authorized to transact insurance in this state. A nonprofit agricultural membership organization, or its affiliate, shall annually file a signed, certified actuarial statement of plan reserves with the State Insurance Department demonstrating that such reserves are adequate and conform to appropriate actuarial standards of practice.

(6) Coverage for healthcare benefits or services as set forth in this section shall be subject to the following:

(a) The application for coverage of any healthcare benefits or services provided pursuant to this section must prominently state that the healthcare benefits or services plan providing such coverage is not insurance, is not provided by an insurance company, is not subject to the laws and rules governing insurance, and is not subject to the jurisdiction of the State Insurance Department or the Commissioner of Insurance. The application should provide the phone number for the plan's ombudsman. Any contract for coverage of any healthcare benefits or services provided pursuant to a NAMO Plan shall include the same information as required for the application in this paragraph.

(b) Coverage for healthcare benefits or services covered under a NAMO Plan must include a level of coverage for:

(i) Ambulatory patient services;

(ii) Hospitalization;

(iii) Emergency services; and

(iv) Laboratory services.

(c) The aggregate value of healthcare benefits or services covered under a NAMO Plan shall not be subject to an annual limit of less than Two Million Dollars ($2,000,000.00) per year per enrollee.

(d) Notwithstanding any other provision of this chapter, a nonprofit agricultural organization that offers healthcare benefits or services under a NAMO Plan shall not require a waiting period of more than six (6) months for treatment of a preexisting condition otherwise covered by the NAMO Plan.

(7) Healthcare benefits or services provided under this section may be sold or solicited only by an insurance producer who is both appointed by an organization meeting the requirements of this section and licensed as an insurance producer to sell or solicit accident and health insurance in this state.

(8) The provisions of Title 83, Mississippi Code of 1972, and any rules promulgated by the State Insurance Department shall not apply to a nonprofit agricultural membership organization operating in accordance with the provisions of this section.

SECTION 2. Section 83-1-101, Mississippi Code of 1972, is amended as follows:

83-1-101. Notwithstanding any other provision of law to the contrary, and except as provided herein, any person or other entity which provides coverage in this state for medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, or optometric expenses, whether such coverage is by direct payment, reimbursement, or otherwise, shall be presumed to be subject to the jurisdiction of the State Insurance Department, unless (a) the person or other entity shows that while providing such services it is subject to the jurisdiction of another agency of this state, any subdivisions thereof, or the federal government; * * *or (b) the person or other entity is providing coverage under the Direct Primary Care Act in Sections 83-81-1 through 83-81-11; or (c) the entity that is providing coverage is a nonprofit agricultural membership organization acting in accordance with Section 83-1-111.

SECTION 3. Section 83-5-1, Mississippi Code of 1972, is brought forward as follows:

83-5-1. All indemnity or guaranty companies, all companies, including those companies defined in Section 83-41-303(n), corporations, partnerships, associations, individuals and fraternal orders, whether domestic or foreign, transacting, or to be admitted to transact, the business of insurance in this state are insurance companies within the meaning of this chapter, and shall be subject to the inspection and supervision of the commissioner.

SECTION 4. Section 83-5-3, Mississippi Code of 1972, is brought forward as follows:

83-5-3. Every insurance company, foreign or domestic, that qualifies to do business in the State of Mississippi shall be required to execute an agreement to be bound by the statute laws of the State of Mississippi pertaining to the periods of limitation prescribed by the statute law of this state.

The insurance commissioner is hereby required, as a condition precedent to authorizing any insurance company to qualify and operate under the laws of this state or to do business in this state, to require said companies to execute an agreement binding said company to conform to and to be bound and regulated by the statute laws of this jurisdiction as defined in the first paragraph.

For purposes of the administration of this section, insurance companies shall consist of all types of insurance companies, both domestic and foreign, that operate in this jurisdiction, including stock companies, mutuals, and fraternal societies and organizations when such fraternal society or organization engages in the insuring of its members or other persons.

SECTION 5. This act shall take effect and be in force from and after July 1, 2024.