H. R. 3824
IN THE HOUSE OF REPRESENTATIVES
October 15, 2009
Mr. Deal of Georgia (for himself, Mr. Burgess, Mr. Pitts, Mr. Blunt, Mr. Barton of Texas, and Mr. Buyer) introduced the following bill; which was referred to the Committee on Energy and Commerce
To allow States to establish interstate compacts for the purpose of expanding health insurance options.
This Act may be cited as the
Expanded Health Insurance Options Act
Expanding health insurance options
More affordable health coverage through State compacts
States may enter into arrangements with other States for the purposes of forming one or more interstate compacts—
that meet the requirements of this subsection; and
under which health insurance issuers would offer health insurance coverage meeting the requirements of this subsection under a unified regulatory structure to residents of the States that are parties to the compact.
The regulatory structure under such a compact may include regulations relating to the issuance, renewal, rating, mandated benefits, and similar items with respect to health insurance coverage.
Health insurance coverage offered in a State that is a party to such a compact shall be regulated by the State involved in the manner specified in the compact and any grievances with respect to such coverage shall be handled in the State in which the covered individual resides.
Continuation of anti-fraud activities
Nothing in this section shall be construed to prohibit a State from engaging in anti-fraud activities for the purposes of enforcing regulations or other provisions within such a compact.
Independent external appeals
Each interstate compact shall ensure that individuals who are insured in a State that participates in an interstate compact are able to access an independent external appeals process to review decisions made by health insurance issuers relating to the health insurance coverage of such individual.
Responsibility of primary state
In the case of an activity described in paragraph (1)(A) that occurs in a State that is participating in an interstate compact, the primary State, or the State in which the insurance issuer is licensed, is responsible for the enforcement of applicable laws, regulations, agreements, and orders governing the health insurance issuers and health insurance coverage involved, including laws relating to the following:
The offer, sale, rating, renewal, and issuance of individual health insurance coverage.
The coverage of health care and insurance related services.
Management, operations, and investment activities of a health insurance issuer.
Liability loss control and claims administration.
Responsibility of secondary state
The secondary State that is participating in an interstate compact, or the State in which the individual resides, may require a health insurance issuer—
to pay premiums and taxes;
to submit to examination of financial condition;
to comply with State laws regarding fraud and abuse; and
to comply with laws regarding unfair claims practices.
The health insurance issuer must provide a clear disclosure to the individual that the issuer is in a secondary State and all laws and regulations of the secondary State are applicable.
This subsection shall apply beginning 1 year after the date of the enactment of this Act.
In this section:
health insurance coverage and
issuer have the meanings given such terms in section 2791 of the Public
Health Service Act.
State means each of the 50 States and the District of