House Bill 321

AN ACT TO REQUIRE THAT CERTAIN HEALTH INSURANCE POLICIES PROVIDE COVERED BENEFITS FOR A PREGNANCY AND COUNSELING RELATED TO A PREGNANCY; TO AMEND SECTION 83-9-49, MISSISSIPPI CODE OF 1972, TO PROHIBIT A PREGNANCY FROM BEING DEEMED A PREEXISTING CONDITION; AND FOR RELATED PURPOSES.

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

SECTION 1. (1) Every alternative delivery system, every individual and group health medical and hospitalization insurance policy, certificate, plan or program, and every subscriber contract provided by a nonprofit health service plan, corporation or health maintenance organization, that is regulated by the State of Mississippi and issued, renewed or continued after July 1, 2010, shall provide covered benefits for a pregnancy, including counseling related to a pregnancy, except for policies which only provide coverage for specified diseases and other limited benefit health insurance policies and negotiated labor contracts.

(2) Covered benefits for inpatient or outpatient treatment of a pregnancy, and counseling related to the pregnancy, in insurance policies and other contracts shall be limited to such inpatient or outpatient services, as the case may be, that are certified as necessary by a health service provider.

(3) The benefits provided in this section shall be subject to the same annual deductibles or coinsurance established for all other covered benefits within a given policy or contract.

(4) All pregnancy treatment or services with respect to such treatment, including counseling related to the pregnancy, eligible for health insurance coverage, shall be subject to professional utilization and peer review procedures.

(5) The Commissioner of Insurance shall enforce the provisions of this section.

SECTION 2. Section 83-9-49, Mississippi Code of 1972, is amended as follows:

83-9-49. (1) Any group hospital, health or medical expense insurance policy, hospital or medical service contract, health and accident insurance policy or any other insurance contract of this type which is delivered or issued for delivery in this state on or after January 1, 1994, shall not deny, exclude or limit benefits for a covered individual for losses due to a preexisting condition incurred more than twelve (12) months following the effective date of the individual's coverage. Any group policy, contract or plan subject to this section shall not contain a definition of a preexisting condition more restrictive than the following:

(a) 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 date of coverage;

(b) 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.

(2) Any individual hospital, health or medical expense insurance policy, hospital or medical service contract, health and accident insurance policy or any other insurance contract of this type which is delivered or issued for delivery in this state on or after January 1, 1994, shall not deny, exclude or limit benefits for a covered individual for losses due to a preexisting condition incurred more than twelve (12) months following the effective date of the individual's coverage. Any individual policy, contract or plan subject to this section shall not contain a definition of a preexisting condition more restrictive than the following:

(a) A condition that would have caused an ordinary prudent person to seek medical advice, diagnosis, care or treatment during the twelve (12) months immediately preceding the effective date of coverage;

(b) A condition for which medical advice, diagnosis, care or treatment was recommended or received during the twelve (12) months immediately preceding the effective date of coverage;

(3) For the purposes of subsections (1) and (2) of this section, a pregnancy existing on the effective date of coverage shall not be a preexisting condition under any such policy or contract that is delivered or issued for delivery in this state on or after July 1, 2010.

(4) This section shall not apply to hospital daily indemnity plans, specified disease only policies, or other limited, supplemental benefit insurance policies.

SECTION 3. This act shall take effect and be in force from and after July 1, 2010.