Health Insurance Reform Act of 1996

TABLE OF CONTENTS:

Title I: Health Care Access, Portability, and Renewability

Subtitle A: Group Market Rules

Subtitle B: Individual Market Rules

Subtitle C: COBRA Clarifications

Subtitle D: Private Health Plan Purchasing Cooperatives

Title II: Application and Enforcement of Standards

Title III: Miscellaneous Provisions

Health Insurance Reform Act of 1996 - Title I: Health Care Access, Portability, and Renewability - Subtitle A: Group Market Rules - Prohibits insurers from declining to offer whole group coverage to a group purchaser. Allows plans to establish eligibility, continuation, enrollment, or premium requirements, provided the requirements are not based on health status, medical condition, or similar factors.

(Sec. 102) Mandates plan renewability, except for premium nonpayment, material misrepresentation, plan termination, or other specified reasons.

(Sec. 103) Regulates the circumstances in which a plan may impose a benefit limitation or exclusion because of a preexisting condition. Allows State laws (unless preempted by specified provisions of the Employee Retirement Income Security Act of 1974 (ERISA)) that: (1) limit preexisting conditions to shorter periods than the provisions of this paragraph; or (2) recognize previous qualifying coverage with a lapse period longer than provided for by the provisions of this paragraph.

(Sec. 104) Mandates special enrollment periods for individuals who have certain types of changes in family composition or employment status.

(Sec. 105) Regulates disclosures an insurer must make to a small employer (as defined in State law or, if not defined in State law, employers with not more than 50 employees).

Amends ERISA to modify requirements regarding disclosures to plan participants and beneficiaries.

Subtitle B: Individual Market Rules - Prohibits an insurer (for an individual in a period of previous qualifying coverage) from declining to offer coverage or denying enrollment based on health status, medical condition, or similar factors.

(Sec. 111) Mandates renewability of coverage for individuals, except for nonpayment of premiums, material misrepresentation, or plan termination.

(Sec. 112) Requires that State law in effect on, or enacted after, enactment of this Act apply in lieu of the standards above in this subtitle unless the Secretary of Health and Human Services determines that the State law does not achieve access goals described in this subtitle. Allows States to meet those goals by using a National Association of Insurance Commissioners (NAIC) model adopted using a consultation process the Secretary approves.

Subtitle C: COBRA Clarifications - Amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code to modify continuation coverage requirements.

Subtitle D: Private Health Plan Purchasing Cooperatives - Requires a State to certify health plan purchasing cooperatives (HPPCs) meeting the requirements of this paragraph. Provides for Federal certification if a State fails to do so. Regulates HPPC organization, duties, and activities. Preempts, for a HPPC meeting these requirements, State fictitious group laws. Preempts State premium rating requirement laws in certain circumstances. Requires compliance with State mandated benefit laws. Applies to HPPCs, for enforcement purposes only, the requirements of ERISA provisions relating to fiduciary responsibility and administration and enforcement.

Title II: Application and Enforcement of Standards - Deems a requirement or standard under this Act imposed on a plan to be imposed on the issuer.

(Sec. 202) Requires each State to mandate that each plan in the State meet the standards under this Act pursuant to an enforcement plan filed by the State with the Secretary of Labor, with employee plans enforced in the same manner as under specified ERISA provisions.

Provides for Federal enforcement if a State fails to do so.

Title III: Miscellaneous Provisions - Amends the Public Health Service Act to allow a health maintenance organization, if notified by a member that a medical savings account has been established for the member and if the member requests, to reduce the basic health services payment by requiring the payment of a deductible for basic health services.

Mandates a study and report to appropriate congressional committees on: (1) mechanisms to ensure the availability of reasonably priced health coverage to employers purchasing group and individuals purchasing non-group coverage; and (2) whether standards limiting premium variation will further the purposes of this Act.