Bill Text: MS HB546 | 2014 | Regular Session | Engrossed

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Bill Title: Health insurance; prohibit policies from denying prescription drugs based solely on network distinctions of provider.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2014-03-04 - Died In Committee [HB546 Detail]

Download: Mississippi-2014-HB546-Engrossed.html

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MISSISSIPPI LEGISLATURE

2014 Regular Session

To: Insurance; Appropriations

By: Representative Chism

House Bill 546

(As Passed the House)

AN ACT TO AMEND SECTION 83-9-3, MISSISSIPPI CODE OF 1972, TO PROHIBIT HEALTH INSURANCE POLICIES FROM INCLUDING ANY PROVISIONS THAT DENY COVERAGE OF MEDICALLY NECESSARY PRESCRIPTION DRUGS BASED SOLELY ON NETWORK DISTINCTIONS OF THE LICENSED HEALTH CARE PROVIDER ORDERING OR DISPENSING THE PRESCRIPTION DRUG; AND FOR RELATED PURPOSES.

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

     SECTION 1.  Section 83-9-3, Mississippi Code of 1972, is amended as follows:

     83-9-3.  (1)  No policy of accident and sickness insurance shall be delivered or issued for delivery to any person in this state unless:

          (a)  The entire money and other considerations therefor are expressed therein; and

          (b)  The time at which the insurance takes effect and terminates is expressed therein; and

          (c)  It purports to insure only one (1) person, except that a policy may insure, originally or by subsequent amendment, upon the application of an adult member of a family who shall be deemed the policyholder, any two (2) or more eligible members of that family, including husband, wife, dependent children or any children under a specified age which shall not exceed nineteen (19) years, and any other person dependent upon the policyholder; and

          (d)  The style, arrangement and overall appearance of the policy give no undue prominence to any portion of the text, and unless every printed portion of the text of the policy and of any endorsements or attached papers is plainly printed in lightfaced type of a style in general use, the size of which shall be uniform and not less than ten-point with a lowercase unspaced alphabet length not less than one-hundred-twenty-point (the "text" shall include all printed matter except the name and address of the insurer, name or title of the policy, the brief description if any, and captions and subcaptions); and

          (e)  The exceptions and reductions of indemnity are set forth in the policy and, except those which are set forth in Section 83-9-5, are printed, at the insurer's option, either with the benefit provision to which they apply, or under an appropriate caption such as "Exceptions" or "Exceptions and Reductions," provided that if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of such exception or reduction shall be included with the benefit provision to which it applies; and

          (f)  Each such form, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page thereof; and

          (g)  It contains no provision purporting to make any portion of the charter, rules, constitution or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks, or short-rate table filed with the commissioner.

     (2)  No individual or group policy covering health and accident insurance (including experience-rated insurance contracts, indemnity contracts, self-insured plans and self-funded plans), or any group combinations of these coverages, shall be issued by any commercial insurer doing business in this state which, by the terms of such policy, limits or excludes payment because the individual or group insured is eligible for or is being provided medical assistance under the Mississippi Medicaid Law.  Any such policy provision in violation of this section shall be invalid.

     (3)  No individual or group policy covering health and accident insurance (including experience-rated insurance contracts, indemnity contracts, self-insured plans and self-funded plans) or any group combinations of these coverages, shall be issued by any commercial insurer doing business in this state, which, by the terms of such policy, limits or restricts the insured's ability to assign the insured's benefits under the policy to a licensed health care provider that provides health care services to the insured.  Any such policy provision in violation of this subsection shall be invalid.

     (4)  No individual or group policy covering health and accident insurance (including experience-rated insurance contracts, indemnity contracts, self-insured plans and self-funded plans) or any group combinations of these coverages, shall be issued by any commercial insurer doing business in this state, which, by the terms of such policy, denies coverage of medically necessary prescription drugs based solely on network distinctions of the licensed health care provider ordering or dispensing the prescription drug.  Any such policy provision in violation of this subsection shall be invalid.

     (5)  If any policy is issued by an insurer domiciled in this state for delivery to a person residing in another state, and if the official having responsibility for the administration of the insurance laws of such other state shall have advised the commissioner that any such policy is not subject to approval or disapproval by such official, the commissioner may, by ruling, require that such policy meet the standards set forth in subsection (1) of this section and in Section 83-9-5.

     ( * * *56)  The commissioner shall collect and pay into the Special Fund in the State Treasury designated as the "Insurance Department Fund" the following fees for services provided under this section:

               FORM                                           FEE

     Each individual policy contract, including

revisions.............................................. $15.00

     Each group master policy or contract, including

revisions.............................................. 15.00

     Each rider, endorsement or amendment, etc......... 10.00

     Each insurance application where written application

is required and is to be made a part of the policy or

contract............................................... 10.00

     Each questionnaire................................   7.00

     Charge for resubmission where payment is not included

with original submission...............................   5.00

     Additional charge for tentative approval same as above.

     ( * * *67)  In order to expedite and become more efficient in reviewing and approving accident and health form and rate filings, the commissioner may establish an expedited form and rate review procedure whereby insurers may elect to pay reasonable actuarial fees directly to a department-approved actuarial service in exchange for an expedited review of form and rate filings by the  actuarial service.  The commissioner may make such reasonable rules and regulations concerning the expedited procedure, and may set reasonable fees for the actuarial services provided.  This provision shall not abridge any other authority granted to the commissioner by law, including the authority to collect the filing fees prescribed by this section.

     SECTION 2.  This act shall take effect and be in force from and after July 1, 2014.

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