SB 546-FN - AS AMENDED BY THE SENATE
03/14/2018 0986s
2018 SESSION
18-2850
01/06
SENATE BILL 546-FN
AN ACT relative to purchasing alliances.
SPONSORS: Sen. Sanborn, Dist 9; Sen. Avard, Dist 12; Sen. Birdsell, Dist 19; Sen. Bradley, Dist 3; Sen. Carson, Dist 14; Sen. French, Dist 7; Sen. Gannon, Dist 23; Sen. Giuda, Dist 2; Sen. Innis, Dist 24; Sen. Reagan, Dist 17
COMMITTEE: Health and Human Services
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ANALYSIS
This bill declares that health coverage purchased through a qualified purchasing alliance shall be considered by the department of insurance to be large group coverage. The bill also clarifies certain laws relative to purchasing alliances.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/14/2018 0986s 18-2850
01/06
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Eighteen
AN ACT relative to purchasing alliances.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Coverage Purchased Through a Qualified Purchasing Alliance. Amend RSA 415 by inserting after section 19-c the following new section:
415:19-d Coverage Purchased Through a Qualified Purchasing Alliance. Health coverage purchased through a qualified purchasing alliance, as defined in RSA 420-M:2, X, shall be considered by the department of insurance to be large group coverage subject to all applicable laws and rules that generally apply to large group accident and health insurance coverage, notwithstanding the size of any individual member employer.
2 Purchasing Alliances; Qualified Purchasing Alliance. Amend the introductory paragraph and paragraph I of RSA 420-M:13 to read as follows:
A purchasing alliance that has a minimum of [3,000] 250 enrollees may elect to obtain certification from the commissioner as a qualified purchasing alliance. To obtain certification, a purchasing alliance shall demonstrate:
I. Either that membership in the alliance is open to all employers without discrimination or that the alliance has established membership criteria that limit membership in the alliance to [employers that are] members of [or affiliated with] an association, trade group, or other entity that has been in existence for at least 10 years and was established and maintained for purposes other than the provision of health coverage; and
3 Powers and Duties of Purchasing Alliances; Restrictions on Purchasing Alliances. Amend RSA 420-M:7, II(s) to read as follows:
(s) Negotiate the premium rates charged for coverage offered through the alliance [and, for small employer members, ensure that rates are consistent with the rating restrictions contained in RSA 420-G];
4 Purchasing Alliances; Powers and Duties of Purchasing Alliances; Restrictions on Purchasing Alliances. Amend RSA 420-M:7, III(a)-(e) to read as follows:
(a) [Purchase health care services directly, assume risk for the cost or provision of health care services, or otherwise contract with health care providers for the provision of health care services to enrollees.
(b)] Exclude from membership in the alliance an employer, eligible employee, or eligible dependent of an eligible employee who meets the alliance's membership criteria and who agrees to pay fees for membership and the premium for health coverage through the alliance and who abides by the bylaws and rules of the alliance.
[(c)] (b) As a condition of membership, require an employer, eligible employee, or eligible dependent to subscribe to limited health coverage or non-health coverage related products or services.
[(d)] (c) Engage in any act or practice that results in the selection of member employers and enrollees based on industry type, experience, gender, family status, education, health status, income, employer size, or other factors related to the risk profile of the group.
[(e)] (d) Require or take any action inconsistent or in conflict with state laws or regulations.
5 Portability, Availability, and Renewability of Health Coverage. Amend RSA 420-G:10, I(a)-(e) to read as follows:
(a) [Comply with the rating restrictions outlined in RSA 420-G:4 for all small employer members with 50 or fewer employees based upon the association's or alliance's group experience, except that for a qualified association trust, no rating factor shall be utilized without the express written consent of the association.
(b)] Offer all eligible members, as defined under the applicable trust or other documents, coverage and rates on a guaranteed issue and renewable basis.
[(c)] (b) Comply with the regulations concerning medical underwriting in RSA 420-G:5.
[(d)] (c) Comply with the preexisting conditions provision of RSA 420-G:7.
[(e)] (d) Prohibit any employer that voluntarily discontinues participation in either a qualified association trust or a qualified purchasing alliance from rejoining for a period of at least 24 months.
6 Repeal. RSA 420-M:12, relative to purchasing alliance distinguished from multiple employer welfare arrangement, is repealed.
7 Effective Date. This act shall take effect upon its passage.
18-2850
Amended 3/21/18
SB 546-FN- FISCAL NOTE
AS AMENDED BY THE SENATE (AMENDMENT #2018-0986s)
AN ACT relative to purchasing alliances.
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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STATE: | FY 2019 | FY 2020 | FY 2021 | FY 2022 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
Expenditures | $0 | $0 | $0 | $0 |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ ] Other | |||
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COUNTY: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
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LOCAL: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
METHODOLOGY:
This bill provides that health coverage purchased through a qualified purchasing alliance shall be considered by the Insurance Department to be large group coverage and clarifies certain laws concerning purchasing alliances.
The Insurance Department indicates this bill would have an indeterminable impact on state revenue and county and local expenditures. This bill amends laws relative to purchasing alliances and the applicability of small group health insurance laws to small groups joining a purchasing alliance. Where health status or experience is currently permitted as a rating factor for large employers, it is prohibited for small employers. The Department assumes, under this bill, the small employers who would benefit from health status or experience rating would opt to join a purchasing alliance while the others would remain in the traditional market. The Department assumes this would lead to an anti-selection situation in which healthier small employers would leave the fully insured market to join a purchasing alliance leaving less healthy small employers in the fully insured market. The Department assumes coverage purchased through purchasing alliances must be fully-insured therefore, the impact on the premium tax base should be relatively small.
AGENCIES CONTACTED:
Insurance Department
| Date | Body | Type |
|---|---|---|
| Jan. 16, 2018 | Senate | Hearing |
| March 8, 2018 | Senate | Floor Vote |
| March 8, 2018 | Senate | Floor Vote |
| March 14, 2018 | Senate | Floor Vote |
| March 29, 2018 | House | Hearing |
| April 11, 2018 | House | Exec Session |
April 26, 2018: Refer for Interim Study: MA DV 263-66 04/26/2018
: Minority Committee Report: Ought to Pass
: Majority Committee Report: Refer for Interim Study (Vote 14-5; RC)
April 26, 2018: Majority Committee Report: Refer for Interim Study for 04/26/2018 (Vote 14-5; RC) HC 16 P. 9
April 11, 2018: Executive Session: 04/11/2018 01:15 PM LOB 302
April 4, 2018: Subcommittee Work Session: 04/04/2018 01:15 PM LOB 302
March 29, 2018: Public Hearing: 03/29/2018 01:45 PM LOB 302
March 15, 2018: Introduced 03/15/2018 and referred to Commerce and Consumer Affairs HJ 8 P. 70
March 14, 2018: Ought to Pass with Amendment 2018-0986s, RC 14Y-10N, MA; OT3rdg; 03/14/2018; SJ 7
March 14, 2018: Committee Amendment # 2018-0986s, AA, VV; 03/14/2018; SJ 7
March 14, 2018: Committee Report: Ought to Pass with Amendment # 2018-0986s, 03/14/2018; SC 11
March 8, 2018: Special Order to the next session, Without Objection, MA; 03/08/2018; SJ 6
March 8, 2018: Committee Report: Ought to Pass with Amendment # 2018-0986s, 03/08/2018; SC 10A
Jan. 16, 2018: Hearing: 01/16/2018, Room 101, LOB, 01:30 pm; SC 3
Jan. 18, 2018: Introduced 01/18/2018 and Referred to Health and Human Services; SJ 2
Jan. 3, 2018: Introduced 01/03/2018 and Referred to Health and Human Services; SJ 2