Emergency clause. In view of the emergency cited in the preamble, this Act takes effect when approved.

SUMMARY

This bill clarifies the definition of "basic health care services" for purposes of defining the scope of health care services to be provided by all health maintenance organizations. Under the Bureau of Insurance Rule, Chapter 850, Section 7(B)(1), all health maintenance organizations are presently required to include in each of their health plans the specific coverages set forth in the health maintenance organization basic plan, which in turn is set forth in the Bureau of Insurance Rule, Chapter 750, Section 6(B). Together, these rule provisions have the effect of imposing upon health maintenance organizations as mandated benefits, certain benefits that go beyond the present scope of mandated benefits. In addition, these rules impose very specific requirements governing the applicability of copayments, or prohibitions on copayments, that are contrary to the coverages historically provided by health maintenance organizations and are inconsistent with the types of plans employers have traditionally sought.

This bill focuses the definition of "basic health care services" upon a list of medical services required to be covered and includes all statutory mandates. It recognizes and preserves the Bureau of Insurance's authority to adopt rules further defining the services all health maintenance organizations must provide. At the same time, it precludes the bureau from relying on all particulars of the standard or basic plans in Chapter 750 for this purpose and leaves to employers and health maintenance organizations the task of determining the nature and scope of copayments and related requirements that they desire to flesh out this scope of services.