SB 861

  • Virginia Senate Bill
  • 2020 Regular Session
  • Introduced in Senate Jan 08, 2020
  • Passed Senate Jan 24, 2020
  • Passed House Mar 02, 2020
  • Governor

Group health benefit plans; bona fide associations, benefits consortium.

Abstract

Group health benefit plans; bona fide associations; benefits consortium. Provides that certain trusts constitute a benefits consortium and are authorized to sell health benefits plans to members of a sponsoring association that (i) has been formed and maintained in good faith for purposes other than obtaining or providing health benefits; (ii) does not condition membership in the sponsoring association on any factor relating to the health status of an individual, including an employee of a member of the sponsoring association or a dependent of such an employee; (iii) makes any health benefit plan available to all members regardless of any factor relating to the health status of such members or individuals eligible for coverage through a member; (iv) does not make any health benefit plan available to any person who is not a member of the association; (v) makes available health plans or health benefit plans that meet requirements provided for in the bill; (vi) operates as a nonprofit entity under § 501(c)(5) or 501(c)(6) of the Internal Revenue Code; and (vii) has been in active existence for at least five years. The bill replaces references to "bona fide association," as used in provisions applicable to health care plans in the small employer market, with the term "sponsoring association."The bill requires any health benefit plan issued by a self-funded multiple employer welfare arrangement (MEWA) that covers one or more employees of one or more small employers to (a) provide essential health benefits and cost-sharing requirements; (b) offer a minimum level of coverage designed to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided under the plan; (c) not limit or exclude coverage for an individual by imposing a preexisting condition exclusion on that individual; (d) be prohibited from establishing discriminatory rules based on health status related to eligibility or premium or contribution requirements as imposed on health carriers; (e) meet the renewability standards set forth for health insurance issuers; (f) establish base rates formed on an actuarially sound, modified community rating methodology that considers the pooling of all participant claims; and (g) utilize each employer member's specific risk profile to determine premiums by actuarially adjusting above or below established base rates, and utilize either pooling or reinsurance of individual large claimants to reduce the adverse impact on any specific employer member's premiums.The bill prohibits a self-funded MEWA from issuing health benefit plans in the Commonwealth until it has obtained a license pursuant to regulations promulgated by the Commission. The bill authorizes the Commission to adopt regulations applicable to self-funded MEWAs, including regulations addressing financial condition, solvency requirements, and the exclusion of self-funded MEWAs from the Virginia Life, Accident and Sickness Insurance Guaranty Association.

Group health benefit plans; bona fide associations; benefits consortium. Provides that certain trusts constitute a benefits consortium and are authorized to sell health benefits plans to members of a sponsoring association that (i) has been formed and maintained in good faith for purposes other than obtaining or providing health benefits; (ii) does not condition membership in the sponsoring association on any factor relating to the health status of an individual, including an employee of a member of the sponsoring association or a dependent of such an employee; (iii) makes any health benefit plan available to all members regardless of any factor relating to the health status of such members or individuals eligible for coverage through a member; (iv) does not make any health benefit plan available to any person who is not a member of the association; (v) makes available health plans or health benefit plans that meet requirements provided for in the bill; (vi) operates as a nonprofit entity under § 501(c)(5) or 501(c)(6) of the Internal Revenue Code; and (vii) has been in active existence for at least five years. The bill replaces references to "bona fide association," as used in provisions applicable to health care plans in the small employer market, with the term "sponsoring association."The bill requires any health benefit plan issued by a self-funded multiple employer welfare arrangement (MEWA) that covers one or more employees of one or more small employers to (a) provide essential health benefits and cost-sharing requirements; (b) offer a minimum level of coverage designed to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided under the plan; (c) not limit or exclude coverage for an individual by imposing a preexisting condition exclusion on that individual; (d) be prohibited from establishing discriminatory rules based on health status related to eligibility or premium or contribution requirements as imposed on health carriers; (e) meet the renewability standards set forth for health insurance issuers; (f) establish base rates formed on an actuarially sound, modified community rating methodology that considers the pooling of all participant claims; and (g) utilize each employer member's specific risk profile to determine premiums by actuarially adjusting above or below established base rates, and utilize either pooling or reinsurance of individual large claimants to reduce the adverse impact on any specific employer member's premiums.

Group health benefit plans; bona fide associations;benefits consortium. Provides that certain trusts constitute a benefitsconsortium and are authorized to sell health benefits plans to members of asponsoring association that (i) has been formed and maintained in good faithfor purposes other than obtaining or providing health benefits; (ii) does notcondition membership in the sponsoring association on any factor relating tothe health status of an individual, including an employee of a member of thesponsoring association or a dependent of such an employee; (iii) makes anyhealth benefit plan available to all members regardless of any factor relatingto the health status of such members or individuals eligible for coveragethrough a member; (iv) does not make any health benefit plan available to anyperson who is not a member of the association; (v) makes available health plansor health benefit plans that meet requirements provided for in the bill; (vi)operates as a nonprofit entity under ยง 501(c)(6) of the Internal Revenue Code;and (vii) has been in active existence for at least five years. The billreplaces references to "bona fide association," as used in provisionsapplicable to health care plans in the small employer market, with the term"sponsoring association."The bill requires any health benefit plan issued by aself-funded multiple employer welfare arrangement (MEWA) that covers one ormore employees of one or more small employers to (a) provide essential healthbenefits and cost-sharing requirements; (b) offer a minimum level of coveragedesigned to provide benefits that are actuarially equivalent to 60 percent ofthe full actuarial value of the benefits provided under the plan; (c) not limitor exclude coverage for an individual by imposing a preexisting conditionexclusion on that individual; (d) be prohibited from establishingdiscriminatory rules based on health status related to eligibility or premiumor contribution requirements as imposed on health carriers; (e) meet therenewability standards set forth for health insurance issuers; (f) establishbase rates formed on an actuarially sound, modified community ratingmethodology that considers the pooling of all participant claims; and (g) utilizeeach employer member's specific risk profile to determine premiums byactuarially adjusting above or below established base rates, and utilize eitherpooling or reinsurance of individual large claimants to reduce the adverseimpact on any specific employer member's premiums.

Bill Sponsors (4)

Votes


Actions


May 21, 2020

Office of the Governor

Vetoed by Governor

Apr 22, 2020

Office of the Governor

Governor's Action Deadline 11:59 p.m., May 22, 2020

Senate

Communicated to Governor

Senate

Senate rejected Governor's recommendation (7-Y 33-N)

Apr 11, 2020

Senate

Governor's recommendation received by Senate

Mar 12, 2020

Senate

Enrolled Bill Communicated to Governor on March 12, 2020

Office of the Governor

Governor's Action Deadline 11:59 p.m., April 11, 2020

Mar 09, 2020

Senate

Impact statement from SCC (SB861ER)

Mar 07, 2020

Senate

Signed by President

House

Signed by Speaker

Mar 06, 2020

Senate

Enrolled

Mar 03, 2020

Senate

Title replaced 20108216D-H1

Senate

House substitute agreed to by Senate (40-Y 0-N)

Mar 02, 2020

Senate

Impact statement from SCC (SB861H1)

House

VOTE: Passage (57-Y 41-N)

House

Passed House with substitute (57-Y 41-N)

House

Engrossed by House - committee substitute SB861H1

House

Committee substitute agreed to 20108216D-H1

House

Read third time

Feb 28, 2020

House

Passed by for the day

Feb 27, 2020

House

Read second time

Feb 25, 2020

House

Committee substitute printed 20108216D-H1

House

Reported from Labor and Commerce with substitute (8-Y 7-N)

Feb 24, 2020

Senate

Impact statement from SCC (SB861E)

Feb 20, 2020

House

House committee, floor amendments and substitutes offered

Feb 18, 2020

House

House subcommittee amendments and substitutes offered

House

Subcommittee recommends reporting with substitute (8-Y 0-N)

Feb 13, 2020

House

Placed on Calendar

House

Referred to Committee on Labor and Commerce

House

Read first time

Jan 24, 2020

Senate

Read third time and passed Senate (35-Y 2-N)

Jan 23, 2020

Senate

Reading of amendments waived

Senate

Printed as engrossed 20103816D-E

Senate

Engrossed by Senate as amended SB861E

Senate

Committee amendments agreed to

Senate

Read second time

Jan 22, 2020

Senate

Constitutional reading dispensed (40-Y 0-N)

Jan 20, 2020

Senate

Reported from Commerce and Labor with amendments (14-Y 0-N 1-A)

Jan 16, 2020

Senate

Impact statement from SCC (SB861)

Jan 15, 2020

Senate

Assigned C&L sub: Health Insurance

Jan 08, 2020

Senate

Referred to Committee on Commerce and Labor

Senate

Prefiled and ordered printed; offered 01/08/20 20103816D

Bill Text

Bill Text Versions Format
Impact statement from SCC (SB861) HTML
Engrossed by Senate as amended SB861E HTML
Impact statement from SCC (SB861H1) HTML
Bill text as passed Senate and House (SB861ER) HTML

Related Documents

Document Format
Amendment: SB861AS HTML
Amendment: SB861AG HTML

Sources

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