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SPONSOR: |
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DATE TYPED: |
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HB |
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SHORT TITLE: |
Amend Minimum Health Care Protection |
SB |
547/aSPAC/aSFl#1 |
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ANALYST: |
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APPROPRIATION
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Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
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FY03 |
FY04 |
FY03 |
FY04 |
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See Narrative |
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Responses
Received From
Attorney
General’s Office (AGO)
Public
Regulation Commission (PRC)
Public
School Insurance Authority (PSIA)
Department
of Health (DOH)
Health
Policy Commission (HPC)
Synopsis
of SFl #1Amendment
The Senate Floor # 1 amendment to Senate Bill
547 requires an insurer, fraternal benefit society, health maintenance organization
or nonprofit healthcare plan that chooses to offer a policy or plan pursuant to
the Minimum Healthcare Protection Act to also offer a catastrophic coverage
policy.
Synopsis
of SPAC Amendment
The Senate Public Affairs Amendment to Senate Bill
547 increases the maximum limit of health care services covered under this bill
from $50,000 to $60,000. The amendment also adds the requirement for a policy
or plan to disclose “in a conspicuous font the type of policy or plan and its
associated benefits with a reference to the pages where discussed.”
Synopsis
of Original Bill
Senate Bill 547 amends the Minimum Healthcare Protection
Act (MHPA) by expanding the size of the group that can obtain coverage from
less than 20 members to less than 50 members. SB 547 eliminates the hardship
requirements for participation by individuals or groups.
SB
547 deletes requirements that premiums meet adjusted community rating requirements
and
eliminates the requirement that policies issued
pursuant to (MHPA) are subject to the Small Group Rate and Renewability Act.
SB 547 requires coverage for not less than 48
hours of inpatient care following a mastectomy and not less than 24 hours of
inpatient care following a lymph node dissection for the treatment of breast
cancer.
Significant
Issues
The provisions of SB 547 could increase the
number of New Mexicans able to obtain health insurance under the provisions of
the MHPA, thereby decreasing the number of uninsured.
The 1999 Census Bureau Population Survey estimates
that 463,000 New Mexicans are uninsured at any given time. It is unclear how many of the uninsured would
be affected by the provisions of SB 547.
Nevertheless, the provisions of SB 547 would expand the eligibility
policies and plans under the MHPA, and would reduce the number of uninsured in
Proponents of SB 547 believe that this coverage
should not be limited to only those eligible by hardship but this lower cost
limited benefit insurance should be available to all. Proponents also believe that adjusted
community rating and the Small Group Rate and Renewability Act cause premiums
to be higher than necessary in some cases.
Opponents point out that these plans eliminate
some of the mandated benefit in order to lower costs. They also point out that there are clear
benefits to adjusted community rating and the Small Group Rate and Renewability
Act that should apply to these policies.
Lastly, opponents point out that the hardship requirement being
eliminated is already substantially broad.
SB 547 requires insurers to file new or revised policy
forms with the Insurance Division of the PRC.
This will have a minimal impact on the PRC.
ADMINISTRATIVE IMPLICATIONS
There
will be an increase in form and rate filings with the Insurance Division, but
no additional staff is required.
The
limited benefits policy restricts coverage with both maximum calendar year benefits
of $50,000 and also limits on certain expenses:
·
inpatient
hospitalization is limited to 25 days,
·
primary
and preventive care is limited to seven office visits per calendar year.
Additionally,
the following “mandated benefits” are not included in the minimum benefits:
·
Craniomandibular
and temporomandibular joint disorders,
·
Maternity
transport required,
·
Home
health case service option required,
·
Coverage
for individuals with diabetes,
·
Coverage
for prescription contraceptive drugs or devices, or
·
Required
coverage of patient costs incurred in cancer clinical trials.
Are
the requirements of MHPA subject to mental health parity or other requirements
of the Health Insurance Portability Act?
DW/njw:yr