Relating to preexisting condition protections and including applicability provisions

“Health carrier” is defined in the bill as an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, including an insurance company offering sickness and accident plans, a health maintenance organization, a nonprofit health service corporation, a plan established pursuant to Code chapter 509A for public employees, a plan offered or maintained by a multiple employer welfare association, or any other entity providing a plan of health insurance, health benefits, or health care services.20. The bill defines “preexisting condition exclusion” as a limitation or exclusion of benefits, or a denial of coverage, relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage or the date of denial of coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received for the condition before the date of enrollment or the date of denial of coverage. A health carrier that offers an individual plan or a group plan must develop premium rates for the individual or group plan based on age, whether the health benefit plan covers an individual or family, tobacco use, and the geographic rating area established in compliance with federal law. With respect to premium rates for family coverage under an individual plan or a group plan, a health carrier must apply those same factors, in accordance with rules adopted by the commissioner, based on the premium attributable to each family member covered under the plan. Premium rates can be adjusted no more frequently than annually and based only on those same factors, except that the health carrier may adjust the premium rates in specified circumstances as detailed in the bill. The bill directs the commissioner to adopt rules as necessary to implement and administer the provisions of the bill and to take any action within the commissioner’s authority to enforce compliance with the provisions of the bill. The bill applies to health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021.