MISSISSIPPI LEGISLATURE
2009 Regular Session
To: Insurance
By: Senator(s) Hopson
AN ACT ENTITLED THE "MISSISSIPPI HEALTH INSURANCE EXCHANGE ACT OF 2009"; TO PROVIDE DEFINITIONS; TO ESTABLISH THE MISSISSIPPI HEALTH INSURANCE EXCHANGE AS AN INSTRUMENTALITY OF THE STATE OF MISSISSIPPI; TO PROVIDE FOR THE APPOINTMENT OF A BOARD OF DIRECTORS OF THE EXCHANGE AND EMPOWER THE BOARD TO APPOINT AN EXECUTIVE DIRECTOR AND ORGANIZE FOR BUSINESS; TO PRESCRIBE THE POWERS AND RESPONSIBILITIES OF THE EXCHANGE; TO PROVIDE FOR ENROLLMENT AND COVERAGE ELECTION UNDER THE PROGRAM; TO PROVIDE REQUIREMENTS FOR PARTICIPATION OF PLANS IN THE EXCHANGE; TO PRESCRIBE UNDERWRITING RULES FOR THE EXCHANGE; TO PROVIDE FOR CONTINUATION OF COVERAGE; TO PROVIDE FOR DISPUTE RESOLUTION; TO PROVIDE FOR PARTICIPATING EMPLOYER PLANS; TO PROVIDE FOR THE PAYMENT OF COMMISSIONS TO INSURANCE PRODUCERS; TO BRING FORWARD SECTIONS 83-61-1 THROUGH 83-61-19, MISSISSIPPI CODE OF 1972, KNOWN AS THE "VOLUNTARY BASIC HEALTH INSURANCE COVERAGE LAW", FOR PURPOSE OF AMENDMENT; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Short title. This act shall be known and may be cited as the "Mississippi Health Insurance Exchange Act of 2009."
SECTION 2. Definitions. For the purposes of this act, the following terms have the meanings indicated:
(a) "Applicant" means an individual seeking to participate in the Mississippi Health Insurance Exchange.
(b) "Carrier" means any person or organization subject to the authority of the commissioner that provides one or more health benefit plans or insurance in Mississippi, and includes an insurer, a hospital and medical services corporation, a fraternal benefit society, a health maintenance organization, or a multiple employer welfare arrangement.
(c) "COBRA" means the Consolidated Omnibus Budget Reconciliation Act of 1985, approved April 7, 1986 (100 Stat. 231; 29 USC, Section 1161 et seq.).
(d) "Commissioner" means the Insurance Commissioner of the State of Mississippi.
(e) "Creditable coverage" means continual coverage of the applicant under any of the following health plans, with no lapse in coverage of more than sixty-three (63) days immediately prior to the date of application:
(i) A group health plan;
(ii) Health insurance coverage;
(iii) Part A or Part B of Title XVIII of the Social Security Act, approved July 30, 1965 (79 Stat. 291; 42 USC, Section 1395c et seq. or 1395j et seq., respectively);
(iv) Title XIX of the Social Security Act, approved July 30, 1965 (79 Stat. 343; 42 USC, Section 1396 et seq.), other than coverage consisting solely of benefits under Section 1928;
(v) Chapter 55 of title 10, United States Code (10 USC, Section 1071 et seq.);
(vi) A medical care program of the Indian Health Service or of a tribal organization;
(vii) A state health benefits risk pool;
(viii) A health plan offered under Chapter 89 of Title 5, United States Code (5 USC, Section 8901 et seq.);
(ix) A public health plan (as defined in federal or state regulations);
(x) A health benefit plan under Section 5(e) of the Peace Corps Act (22 USC, Section 2504(e)); or
(xi) Any other qualifying coverage required by HIPAA, as it may be amended, or regulations under that act.
Creditable coverage does not
include coverage consisting solely of coverage of excepted benefits.
(f) "Dependent" means:
(i) The spouse of the principal insured, or;
(ii) An individual who is related to the principal insured by birth, marriage, or adoption; and
(iii) Who also meets the definition of a dependent as set forth in the United States Internal Revenue Code, (26 USC, Section 152).
(g) "Eligible individual" means an individual who is eligible to participate in the Mississippi Health Insurance Exchange by reason of meeting one or more of the following qualifications:
(i) The individual is a Mississippi resident, meaning that the individual, is and continues to be, legally domiciled and physically residing on a permanent and full-time basis in a place of permanent habitation in Mississippi that remains the person's principal residence and from which the person is absent only for temporary or transitory purpose.
(ii) The individual is a self-employed resident of Mississippi, meaning that the individual, is and continues to be, legally domiciled and physically residing on a permanent and full-time basis in a place of permanent habitation in Mississippi that remains the individual's principal residence and from which the individual is absent only for temporary or transitory purpose; and that at least fifty percent (50%) of the individual's annual gross income is attributable to self-employment and is reported as such on the individual's most recent federal income tax return.
(iii) The individual, whether a resident or not, is enrolled in, or eligible to enroll in, a participating employer plan.
(iv) The individual, whether a resident or not, is a dependent of another individual who is an eligible individual.
(h) "Employer" means any person, firm, corporation, partnership or association actively engaged in business which, on at least fifty percent (50%) of its working days during the preceding year, employed no more than fifty (50) eligible employees.
(i) "Excepted benefits" means benefits under one or more (or any combination thereof) of the following:
(i) Benefits not subject to requirements:
1. Coverage only for accident, or disability income insurance, or any combination thereof;
2. Coverage issued as a supplement to liability insurance;
3. Liability insurance, including general liability insurance and automobile liability insurance;
4. Workers' compensation or similar insurance;
5. Medical expense and loss of income benefits;
6. Credit-only insurance;
7. Coverage for on-site medical clinics; or
8. Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits;
(ii) Benefits not subject to requirements if offered separately:
1. Limited scope dental or vision benefits;
2. Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; or
3. Such other similar, limited benefits as are specified in regulations;
(iii) Benefits not subject to requirements if offered as independent, noncoordinated benefits:
1. Coverage only for a specified disease or illness; and
2. Hospital indemnity or other fixed indemnity insurance; and
(iv) Benefits not subject to requirements if offered as a separate insurance policy:
1. Medicare supplemental health insurance (as defined under Section 1882(g)(1) of the Social Security Act, approved June 9, 1980 (72 Stat. 1445; 42 USC, Section 1395ss(g)(1));
2. Coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code (10 USC, Section 1071 et seq.); or
3. Similar supplemental coverage provided to coverage under a group plan.
(j) "Exchange" means Mississippi Health Insurance Exchange established by this act.
(k) "Federal health coverage tax credit eligible individual" means any individual who is eligible for benefits under Section 201 of the Trade Act of 2002, approved August 6, 2002 (116 Stat. 933; 26 USC, Section 35(c) (2003)), as amended.
(l) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996, approved August 21, 1996 (Public Law 104-191; 110 Stat. 1136).
(m) "Participating employer plan" means a group health plan, as defined in federal law (Section 706 of ERISA (29 USC, Section 1186)), that is sponsored by an employer and for which the plan sponsor has entered into an agreement with the Mississippi Health Insurance Exchange, in accordance with the provisions of Section 12 of this act, for the exchange to offer and administer health insurance benefits for enrollees in the plan.
(n) "Participating individual" means a person who has been determined by the exchange to be, and continues to remain, an eligible individual for purposes of obtaining coverage under participating insurance plans offered through the Mississippi Health Insurance Exchange.
(o) "Participating insurance plan" means a health benefit plan offered through the Mississippi Health Insurance Exchange.
(p) "Plan year" means the period of time during which the insured is covered under a health benefit plan, as stipulated in the contract governing the plan.
(q) "Preexisting conditions provision" means a condition that would have caused an ordinary prudent person to seek medical advice, diagnosis, care or treatment during the six (6) months immediately preceding the effective coverage date; a condition for which medical advice, diagnosis, care or treatment was recommended or received during the six (6) months immediately preceding the effective date of coverage; a pregnancy existing on the effective date of coverage.
(r) "Producer" means a person who is licensed to sell, solicit, or negotiate insurance pursuant to Section 83-17-75 or any other state laws regulating agents and agencies.
(s) "Rate" means the premiums or fees charged by a health benefit plan for coverage under the plan.
SECTION 3. Establishment, purpose and corporate form. (1) There is hereby chartered and established by the State of Mississippi the Mississippi Health Insurance Exchange as a body corporate and an independent instrumentality of the State of Mississippi, created to effectuate public purposes provided for in this act, but with a legal existence separate from that of the State of Mississippi.
(2) The Mississippi Health Insurance Exchange is hereby recognized as a not-for-profit corporation in accordance with the provisions of 79-11-101 et seq., Mississippi Code of 1972, and shall seek recognition of the same status by the United States Treasury in accordance with the provisions of the United States Internal Revenue Code (26 USC, Section 501(c)).
(3) The Mississippi Health Insurance Exchange is created for the limited purpose of providing the residents of Mississippi, and such other individuals as may, from time to time, also be eligible to participate, with greater access to, and choice and portability of, health insurance products.
(4) The Mississippi Health Insurance Exchange shall operate in accordance with all requirements and restrictions set forth in this act and all other applicable laws of Mississippi and of the United States.
(5) All eligible individuals have the option to obtain health insurance benefits through the exchange, subject to the provisions of this act.
(6) The Legislature may appropriate funds for the establishment and administration of the Mississippi Health Insurance Exchange.
SECTION 4. Governance. (1) The exchange shall be governed by a Board of Directors which shall consist of seven (7) members appointed by the Governor with the advice and consent of the Senate, as follows:
(a) Two (2) members who are representatives of the assessable insurer companies, one (1) of which shall be a health insurance company domiciled in the State of Mississippi;
(b) Two (2) members who are insurance agents, who are licensed in accordance with Section 83-17-75 or any other state laws regulating agents and agencies with no less than ten (10) years' experience in the health insurance industry, one (1) of which shall be appointed from the Second Supreme Court District for a term that ends on June 30, 2013, and one (1) of which shall be appointed from the First Supreme Court District for a term that ends on June 30, 2014;
(c) One (1) consumer representative who shall be appointed from the state at large for a term that ends on June 30, 2012;
(d) Two (2) members who are representatives of business owners from a list of nominees submitted to the Governor by the National Federation of Independent Business, one (1) of which shall be appointed from the Third Supreme Court District for a term that ends on June 30, 2013, and one (1) of which shall be appointed from the Second Supreme Court District for a term that ends on June 30, 2014.
(2) At the expiration of the terms of the initial members, all members of the board shall be appointed by the Governor, in the same manner and from the same districts prescribed above, for terms of six (6) years from the expiration of the previous term and thereafter until his successor is duly appointed. An appointment to fill a vacancy other than by expiration of a term of office shall be for the balance of the unexpired term and thereafter until his successor is duly appointed.
(3) There shall be a chairman and vice chairman of the board of directors elected by and from its membership at the first meeting of the board, and annually thereafter, and the chairman shall be the presiding officer of the board. The board shall adopt rules and regulations governing times and places for meetings, and the manner of conducting its business. The board shall meet not less frequently than once each quarter, and at such other times as determined to be necessary. The first meeting of the initial members of the board shall be called by the Governor and subsequent meetings shall be called by the chairman.
(4) The members of the board shall receive no annual salary but shall be entitled to reimbursement for all actual and necessary expenses incurred in the discharge of their duties, including mileage, as authorized by Section 25-3-41.
(5) The board shall appoint an executive director who shall:
(a) Be a full-time employee of the exchange;
(b) Administer all of the exchange's activities and contracts;
(c) Supervise the staff of the exchange; and
(d) Serve at the pleasure of the board.
(6) The executive director shall have the following duties and responsibilities:
(a) Be a full-time employee of the exchange;
(b) Administer all of the exchange's activities and contracts; and
(c) Supervise the staff of the exchange.
SECTION 5. Responsibilities. The exchange shall:
(a) Publicize the existence of the exchange and disseminate information on eligibility requirements and enrollment procedures for the exchange.
(b) Establish and administer procedures for enrolling eligible individuals in the exchange, including:
(i) Creating a standard application form to collect information necessary to determine the eligibility and previous coverage history of an applicant; and
(ii) Preparing and distributing certificate of eligibility forms and application forms to insurance producers and the general public.
(c) Establish and administer procedures for the election of coverage by participating individuals, in accordance with Section 7 of this act, during open season periods and outside of open season periods upon the occurrence of any qualifying event specified in Section 7 of this act, including preparing and distributing to participating individuals:
(i) Descriptions of the coverage, benefits, limitations, copayments, and premiums for all participating plans; and
(ii) Forms and instructions for electing coverage and arranging payment for coverage.
(d) Collect and transmit to the applicable participating plans all premium payments or contributions made by or on behalf of participating individuals, including developing mechanisms to:
(i) Receive and process automatic payroll deductions for participating individuals enrolled in participating employer plans;
(ii) Enable participating individuals to pay, in whole or part, for coverage through the exchange by electing to assign to the exchange any federal Earned Income Tax Credit payments due the participating individual; and
(iii) Receive and process any federal or state tax credits or other premium support payments for health insurance, as may be established by law.
(e) Upon request, issue certificates of previous coverage in accordance with the provisions of HIPAA to all such individuals who cease to be covered by a participating insurance plan.
(f) Establish procedures to account for all funds received and disbursed by the exchange, including:
(i) Maintaining a separate, segregated management account for the receipt and disbursement of monies allocated to fund the administration of the exchange.
(ii) Maintaining a separate, segregated operations account for:
1. The receipt of all premium payments or contributions made by or on behalf of participating individuals; and
2. The distribution of premium payments to participating plans, and of commissions or payments to licensed insurance producers and such other organizations as are permitted under Section 13 of this act to receive payments for their services in enrolling eligible individuals or groups in the exchange.
(g) Submit to the commissioner, following the end of each plan year, the report of an independent audit of the exchange's accounts for the plan year.
(h) Submit to a triannual financial examination by the Commissioner of Insurance.
SECTION 6. Powers. The exchange shall have the power to:
(a) Contract with vendors to perform one or more of the functions specified in Section 5 of this act. However, the exchange shall not contract with a vendor for administrative services that will offer any supplemental benefits to any member of the exchange by any organization or entity that is controlled, owned or affiliated by the vendor.
(b) Contract with private or public social service agencies to administer application, eligibility verification, enrollment, and premium payments for specified groups or populations of eligible individuals or participating individuals.
(c) Contract with employers to act as the plan administrator for participating employer plans, subject to the provisions of Section 12 of this act, and to undertake the obligations required by federal law of a plan administrator.
(d) Set and collect fees from participating individuals and participating employer plans sufficient to fund the cost of administering the exchange.
(e) Seek and directly receive grant funding from the United States government, departments or agencies of the Mississippi state government, Mississippi county or municipal governments, or private philanthropic organizations to defray the costs of operating the exchange.
(f) Establish and administer rules and procedures, subject to the Mississippi Administrative Procedures Law, Section 25-43-1.101 et seq., governing the operations of the exchange.
(g) Establish one or more service centers within Mississippi to facilitate enrollment.
(h) Sue and be sued or otherwise take any necessary or proper legal action in accordance with state and federal laws.
(i) Establish bank accounts and borrow money subject to the laws of the State of Mississippi.
SECTION 7. Enrollment and coverage election. (1) Any eligible individual may apply to participate in the exchange. Upon determination by the exchange that an individual is eligible in accordance with the provisions of this act to participate in the exchange, he or she may enroll, or, when applicable, be enrolled by the individual's parent or legal guardian, in a participating insurance plan offered through the exchange during the next open season period or, when applicable, at such other times as are specified in Section 8(12) of this act.
(2) The exchange shall determine and administer an open season during which any eligible individual may enroll in any health benefit plan offered through the exchange, subject to the provisions of Sections 7 and 9 of this act, without a waiting period. Participating carriers, pursuant to state and federal laws, may not decline coverage to any employer or self-employed individual applying for coverage through the Mississippi Health Insurance Exchange.
(3) The first ninety (90) days after the exchange first begins to accept applications shall be considered the initial open season, provided that the board of directors shall not accept an application for coverage prior to July 1, 2010.
SECTION 8. Participation of plans in the exchange. (1) No health benefit plan may be offered through the exchange unless the commissioner has first certified to the exchange that:
(a) The carrier seeking to offer the plan is licensed to issue health insurance in Mississippi and is in good standing with the Mississippi Department of Insurance;
(b) The plan meets the requirements of this section and the plan and the carrier are in compliance with all other applicable Mississippi health insurance laws.
(2) The certification of plans to be offered through the exchange shall not be subject to any Mississippi law requiring competitive bidding.
(3) Any insurance carriers in Mississippi which offer health plans in the group and/or individual markets must also offer those health plans through the Mississippi Health Insurance exchange.
(4) Each certification shall be valid for a uniform term of at least one (1) year, but may be made automatically renewable from term to term in the absence of notice of either:
(a) Withdrawal by the commissioner; or
(b) Discontinuation of participation in the exchange by the plan or carrier.
(5) Certification of a plan may be withdrawn only after notice to the carrier and opportunity for hearing. The commissioner may, however, decline to renew the certification of any carrier at the end of a certification term.
(6) Each plan certified by the commissioner as eligible to be offered through the exchange shall contain a detailed description of benefits offered, including maximums, limitations, exclusions, and other benefit limits.
(7) Each plan certified by the commissioner as eligible to be offered through the exchange shall provide, subject to the plan's deductibles and coinsurance or copayment schedule, major medical coverage that includes the following:
(a) Hospital benefits;
(b) Surgical benefits;
(c) In-hospital medical benefits;
(d) Ambulatory patient benefits;
(e) Prescription drug benefits;
(f) Compliance with all applicable coverage requirements under HIPAA.
(8) Carriers shall offer plans through the exchange at standard rates that are based on criteria including, but not limited to, age, geography and family composition and that are determined to be actuarially sound in the judgment of the commissioner.
(9) The rates determined for the first plan year for which the plan is offered through the exchange may be adjusted by the carrier for subsequent plan years based on experience and any later modifications to plan benefits, provided that any adjustments in rates shall be made in advance of the plan year for which they will apply and on a basis which, in the judgment of the commissioner, is consistent with the general practice of carriers that issue health benefit plans to large employers.
(10) The exchange shall not sponsor any insurance or benefit plan, or contract with any carrier to offer any insurance or benefit plan, as a participating plan that has not first been certified by the commissioner in accordance with the provisions of this section.
(11) The exchange shall not impose on any participating plan or on any carrier or plan seeking to participate in the exchange, any terms or conditions, including any requirements or agreements with respect to rates or benefits, beyond, or in addition to, those terms and conditions established and imposed by the commissioner in certifying plans under the provisions of this section.
(12) The commissioner shall establish and administer, in accordance with the Mississippi Administrative Procedures Law, Section 25-43-1.101 et seq., regulations and procedures for certifying plans to participate in the exchange, in accordance with the provisions of this section. These regulations shall also address enrollment of eligible individuals during periods outside the open season.
SECTION 9. Underwriting rules. The following rules shall govern the imposition by carriers of any preexisting condition provisions and rating surcharges with respect to any participating individual covered by any participating insurance plan:
(a) Current participants. Except as otherwise specified in paragraphs (c) and (d) of this section, during any open season a participating individual who elects to choose a different participating insurance plan or plan option for the next plan year, shall not be subject to any preexisting condition provisions and shall be charged the standard rate of the new participating insurance plan or plan option for persons of the participating individual's age and geographic area. The same shall apply to any election by a participating individual of coverage for any dependent who is also a participating individual.
(b) New participants with creditable coverage. A new participating individual with eighteen (18) months or more of creditable coverage who enrolls in a participating insurance plan shall not be subject to any preexisting condition provisions and shall be charged the applicable age and geography adjusted standard rate for the participating insurance plan.
(c) New participants with partial creditable coverage. A new participating individual with creditable coverage of between two (2) and seventeen (17) months may enroll in a participating insurance plan, but the participating individual may be subject to one or more preexisting condition provisions, for a period not to exceed twelve (12) months, the number of such months to be reduced by the number of months of creditable coverage, or charged a premium not to exceed one hundred twenty-five percent (125%) of the otherwise applicable age and geography adjusted standard rate for the participating insurance plan, or both. Any such rate surcharge shall not be applied during the third or subsequent years of the individual's enrollment in any participating insurance plan.
(d) New participants without creditable coverage. A new participating individual with two (2) months or less of creditable coverage may enroll in a participating insurance plan, but the participating individual may be subject to one or more preexisting condition provisions, for a period not to exceed twelve (12) months, the number of such months to be reduced by the number of months of creditable coverage, or charged a premium not to exceed one hundred fifty percent (150%) of the otherwise applicable age and geography adjusted standard rate for the participating insurance plan, or both. Any such rate surcharge shall not be applied during the third or subsequent years of the individual's enrollment in any participating insurance plan.
(e) Newly eligible dependents. In cases where an individual is enrolled in a plan offered through the exchange as a newly eligible dependent of a participating individual, by reason of birth, adoption, court order or a change in custody arrangement, either during open season or outside of open season in accordance with Section 7 of this act, a carrier shall not impose any preexisting condition provisions or any change in the rate charged to the participating individual, except for such difference, if any, in the participating insurance plan's standard rates that reflect the addition of a new dependent to the participating individual's coverage.
(f) Creditable coverage. Periods of creditable coverage with respect to an individual shall be established through presentation of certifications or in such other manner as may be specified in federal or Mississippi law.
(g) Waiver of preexisting condition exclusion. For new participating individuals without creditable coverage, or with only limited creditable coverage as defined in paragraphs (c) and (d) of this section, a carrier may elect to waive the imposition of preexisting condition provisions and instead extend the applicable rate surcharge for an additional year beyond the time provided for in those subsections.
(h) Individuals in participating employer sponsored plans. For purposes of this section, any individual who is a participating individual by reason of enrollment in a participating employer plan shall be deemed to have eighteen (18) months of creditable coverage.
(i) Federal health coverage tax credit eligible individuals. For purposes of this section, any federal health coverage tax credit eligible individual shall be deemed to have eighteen (18) months of creditable coverage.
SECTION 10. Continuation of coverage. (1) Any participating individual may continue to participate in any participating insurance plan as long as the individual remains an eligible individual, subject to the carrier's rules regarding cancellation for nonpayment of premiums or fraud, and shall not be cancelled or nonrenewed because of any change in employer or employment status, marital status, health status, age, membership in any organization or other change that does not affect eligibility as defined in this act.
(2) A participating individual who is not a resident of Mississippi and who ceases to be an eligible individual due to a qualifying event shall be deemed to remain an eligible individual and shall be deemed to remain a participating individual for a period not to exceed thirty-six (36) months from the date of the qualifying event, if:
(a) The qualifying event consists of a loss of eligible individual status due to:
(i) Voluntary or involuntary termination of employment for reasons other than gross misconduct; or
(ii) Loss of qualified dependent status for any reason; and
(b) The participating individual elects to remain a participating individual and notifies the exchange of such election within sixty-three (63) days of the qualifying event.
SECTION 11. (1) Dispute resolution. The commissioner shall establish procedures for resolving disputes arising from the operation of the exchange in accordance with the provisions of this act, including disputes with respect to:
(a) The eligibility of an individual to participate in the exchange;
(b) The imposition of a coverage surcharge on a participating individual by a participating plan; and
(c) The imposition of a preexisting condition provision on a participating individual by a participating plan.
(2) Appeals of carrier determinations. In cases where a carrier, in accordance with the provisions of this section, imposes a preexisting condition exclusion or a premium surcharge in connection with enrollment of a participating individual in a participating insurance plan offered by the carrier, and the participating individual disputes the imposition of such an exclusion or surcharge, the participating individual may request that the commissioner issue a determination as to the validity or extent of such exclusion or surcharge under the provisions of this act. The commissioner, or his designee, shall issue such a determination within thirty (30) days of the request being filed with the department. If either the participating individual or the carrier disagrees with the outcome, he or she may submit a request for a hearing to the commissioner.
SECTION 12. Participating employer plans. (1) Any employer may apply to the exchange to be the sponsor of a participating employer plan.
(2) Any employer seeking to be the sponsor of a participating employer plan shall, as a condition of participation in the exchange, enter into a binding agreement with the exchange, which shall include the following conditions:
(a) The sponsoring employer designates the executive director to be the plan's administrator for the employer's group health plan and the executive director agrees to undertake the obligations required of a plan administrator under federal law;
(b) Only the coverage and benefits offered by participating insurance plans shall constitute the coverage and benefits of the participating employer plan;
(c) That any individuals eligible to participate in the exchange by reason of their eligibility for coverage under the employer's participating employer plan, regardless of whether any such individuals would otherwise qualify as eligible individuals if not enrolled in the participating employer plan, may elect coverage under any participating insurance plan, and that neither the employer nor the exchange shall limit such individual's choice of coverage from among all the participating insurance plans;
(d) The employer reserves the right to offer benefits supplemental to the benefits offered through the exchange, but any supplemental benefits offered by the employer shall constitute a separate plan or plans under federal law, for which the executive director shall not be the plan administrator and for which neither the executive director nor the exchange shall be responsible in any manner;
(e) The employer agrees that, for the term of the agreement, the employer will not offer to individuals eligible to participate in the exchange by reason of their eligibility for coverage under the employer's participating employer plan any separate or competing group health plan offering the same or substantially similar benefits as those provided by participating insurance plans through the exchange, regardless of whether any such individuals would otherwise qualify as eligible individuals if not enrolled in the participating employer plan;
(f) The employer reserves the right to determine the criteria for eligibility, enrollment, and participation in the participating employer plan and the terms and amounts of the employer's contributions to that plan, so long as for the term of the agreement with the exchange, the employer agrees not to alter or amend any criteria or contribution amounts at any time other than during an annual period designated by the exchange for participating employer plans to make such changes in conjunction with the exchange's annual open season;
(g) The employer agrees to make available to the exchange any of the employer's documents, records, or information, including copies of the employer's federal and state tax and wage reports, that the exchange reasonably determines are necessary to verify:
(i) That the employer is in compliance with the terms of its agreement with the exchange governing the employer's sponsorship of a participating employer plan;
(ii) That the participating employer plan is in compliance with applicable laws relating to employee welfare benefit plans, particularly those relating to nondiscrimination in coverage; and
(iii) The eligibility, under the terms of the employer's plan, of those individuals enrolled in the participating employer plan.
(h) The employer agrees to also sponsor a "cafeteria plan" as permitted under federal law (26 USC, Section 125) for all employees eligible for coverage under the employer's participating employer plan.
(3) The exchange may not enter into any agreement with any employer with respect to any employer participating plan if such agreement does not, at a minimum, incorporate the conditions specified in subsection (2) of this section.
(4) The exchange may not enter into any agreement with any employer with respect to any participating employer plan for the exchange to provide the participating employer plan with any additional or different services or benefits not otherwise provided or offered to all other participating employer plans.
SECTION 13. Insurance producers. If a producer licensed in Mississippi enrolls in the exchange an eligible individual or group, the plan chosen by each individual shall pay the producer a commission. The Mississippi Health Insurance Exchange is given the authority to determine the rate of commission a producer is paid.
SECTION 14. Section 83-61-1, Mississippi Code of 1972, is brought forward as follows:
83-61-1. This chapter shall be known and may be cited as the "Voluntary Basic Health Insurance Coverage Law."
SECTION 15. Section 83-61-3, Mississippi Code of 1972, is brought forward as follows:
83-61-3. As used in this chapter the following words and phrases shall have the meanings ascribed herein unless the context clearly requires otherwise:
(a) "Carrier" means any insurance company, health maintenance association or hospital, medical or surgical services association that is authorized by the State of Mississippi to write accident and health insurance policies and contracts.
(b) "Program" means the Voluntary Basic Health Insurance Coverage Program.
(c) "Provider" means any provider of medical services as defined in the contract of insurance coverage.
(d) "Approved carrier" means any insurance company, health maintenance association or hospital, medical or surgical services association that meets the criteria established by this chapter to participate in the Voluntary Basic Health Insurance Coverage Program.
SECTION 16. Section 83-61-5, Mississippi Code of 1972, is brought forward as follows:
83-61-5. The Commissioner of Insurance is directed to promulgate rules and regulations to establish procedures for implementation of the provisions of this chapter and penalties for noncompliance.
SECTION 17. Section 83-61-7, Mississippi Code of 1972, is brought forward as follows:
83-61-7. (1) To be eligible for insurance coverage under the program, an individual shall provide evidence to the approved carrier that he or she:
(a) Is under sixty-five (65) years of age;
(b) Is acceptable to the approved carrier; and
(c) Has been without private health insurance coverage for the twelve (12) months immediately preceding application to the program, or that his or her family income does not exceed one hundred fifty percent (150%) of the federal poverty level.
(2) No person who is covered under the program and terminates the coverage is again eligible for coverage unless twelve (12) months have elapsed since the person's latest termination.
SECTION 18. Section 83-61-9, Mississippi Code of 1972, is brought forward as follows:
83-61-9. Participation by carriers and providers in policy authorization by this chapter shall be voluntary.
SECTION 19. Section 83-61-11, Mississippi Code of 1972, is brought forward as follows:
83-61-11. Contracts of insurance coverage offered by approved carriers that are approved by the Commissioner of Insurance shall be exempt from all state mandated benefits and from the premium tax required in Sections 27-15-103 and 27-15-109.
SECTION 20. Section 83-61-13, Mississippi Code of 1972, is brought forward as follows:
83-61-13. (1) Upon offering coverage under a minimum benefits or basic coverage contract issued in accordance with this chapter, the approved carrier shall provide the eligible individual with a written disclosure containing at least the following:
(a) An explanation that this is a minimum benefits or basic insurance coverage contract and that benefits otherwise mandated by state law are not covered in the minimum benefits contracts;
(b) An explanation of the benefits mandated by state law;
(c) An explanation of the cost control features of the minimum benefits or basic coverage contract; and
(d) A list of applicable addresses and telephone numbers for use by the eligible individual to obtain information on and authorization for participation in the program.
(2) Before issuing a minimum benefits or basic insurance coverage contract in accordance with this chapter, the approved carrier shall obtain from the eligible individual a signed written statement in which the individual:
(a) Certifies his or her eligibility for coverage under a minimum benefits or basic coverage contract in accordance with Section 83-61-7;
(b) Acknowledges the limited benefits provided under the basic coverage insurance contract.
(3) The State Health Department shall furnish information to approved carriers concerning the services, and the costs of such services, if any, available from the county and state health departments, and such information shall be included in contracts of insurance coverage.
(4) The carriers shall furnish information to their policyholders concerning the federal government's earned income credit for health insurance, and such information shall be included in contracts of insurance coverage issued under this chapter.
SECTION 21. Section 83-61-15, Mississippi Code of 1972, is brought forward as follows:
83-61-15. The Commissioner of Insurance may appoint an advisory committee, engage consultants or participate in grant programs to study and recommend the details of the program. The advisory committee shall be composed of the following: one (1) physician, one (1) hospital representative, one (1) small business representative, one (1) domestic insurer, one (1) member of the Health Insurance Agents Association, and one (1) nonprofit insurer. One (1) representative of the Department of Insurance shall serve as an ex officio member of the advisory committee. The advisory committee shall serve at the will and pleasure of the Commissioner of Insurance.
SECTION 22. Section 83-61-17, Mississippi Code of 1972, is brought forward as follows:
83-61-17. The Commissioner of Insurance may require carriers to file rates for informational purposes. Nothing in this chapter shall be construed to require the commissioner's approval before using such rates.
SECTION 23. Section 83-61-19, Mississippi Code of 1972, is brought forward as follows:
83-61-19. The Commissioner of Insurance may require a minimum loss ratio that carriers must meet in order to participate in the program.
SECTION 24. This act shall take effect and be in force from and after July 1, 2010.