Targeted Individual Health Insurance Reform Act of 1995

TABLE OF CONTENTS:

Title I: Definitions and Special Rules

Title II: Access to and Fair Rating of Health Insurance

Coverage for Individuals

Subtitle A: Increased Availability and Continuity of

Health Insurance Coverage for Individuals

Subtitle B: Establishment of Standards; Enforcement;

Effective Dates

Targeted Individual Health Insurance Reform Act of 1995 - Title I: Definitions and Special Rules - Sets forth definitions for this Act, including defining "medisave coverage" as consisting of: (1) coverage of expenses exceeding a catastrophic deductible amount; and (2) a cash benefit that accumulates while not used, to be used for deductibles, cost-sharing, and other expenses.

Title II: Access to and Fair Rating of Health Insurance Coverage for Individuals - Subtitle A: Increased Availability and Continuity of Health Insurance Coverage for Individuals - Regulates the periods during which insurers of individuals may deny, limit, or exclude coverage based on health status or related matters.

(Sec. 2002) Reduces any exclusion period by any time in continuous coverage. Considers newborns and adopted children as not having any preexisting condition.

(Sec. 2003) Prohibits cancellation (or denial of renewal) except for premium nonpayment, fraud, or plan noncompliance, or if the insurer is ceasing to provide any such coverage.

(Sec. 2011) Requires insurers of individuals to meet the standards of these provisions. Provides for determination by the Secretary of Health and Human Services that a private entity has established standards for provider networks.

(Sec. 2012) Prohibits coverage denial on the basis of a utilization review program unless the program meets the standards determined by the Secretary to have been established by a private entity.

(Sec. 2021) Requires insurers of individuals to make available general, catastrophic, and medisave coverage.

(Sec. 2022) Prohibits rates from varying except for specified factors.

Subtitle B: Establishment of Standards; Enforcement; Effective Dates - Provides for development: (1) by the National Association of Insurance Commissioners of standards regarding subtitle A; and (2) by a private entity regarding utilization review standards.

(Sec. 2102) Allows States to elect whether to enforce standards under this Act. Directs the Secretary to enforce them if a State does not.

(Sec. 2103) Preempts related State or local standards and laws, including certain State anti-managed care laws.