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SF 1615 Senate Long Description

Providing for greater flexibility and simplifying regulation of health care coverage products ARTICLE 1 PRODUCT FLEXIBILITY Providing for greater flexibility in health maintenance organization (HMO) enrollee cost sharing; specifying certain copayment and deductible limits and certain annual out of pocket and lifetime benefit maximums; excepting certain small employer plans, certain preventive care and public health care programs from the regulations; noncovered services out of pocket costs not to count toward deductibles or maximums ARTICLE 2 IMPROVED CONSUMER CHOICE AND REDUCED REGULATORY BURDENSModifying a certain provision regulating the continuation of accident and health insurance benefits to disabled employees; authorizing termination of continuation coverage for survivors, terminated or laid off employees and current or former spouses and children for failing to pay premiums or fees or upon eligibility for medicare, extending the time limit for employer notice of continuation coverage options to terminated or laid off employees, restricting the right to terminate upon survivor, spouse or child medicare eligibility and authorizing termination of survivors and former spouses and children after a certain enrollment period; eliminating the premium rate limit for individual health plans offered to persons previously covered by group plans; reducing the frequency requirement for commissioner of commerce examination of the financial condition of nonprofit health service plan corporations; conforming nonprofit health service plan corporation and health maintenance organization continuing coverage requirements for former spouses and children to the included requirement changes for accident and health insurers; eliminating the requirement for HMOs to notify the commissioner of health of certain changes and increasing the time limit for notice to the commissioner of provider terminations; exempting medicare choice products offered by HMOs from state laws and rules; authorizing HMOs to cancel or fail to renew coverage for intentional provision of false health status information at the time of enrollment, specifying a cancellation or nonrenewal time limit; reducing the frequency requirement for commissioner examination of the affairs of health maintenance organizations and clarifying the data classification requirement; clarifying policy conversion rights under the comprehensive health insurance plan (MCHA); clarifying the definition of utilization review organization; providing for the recognition of health plan company accreditation or certification by private accreditation organizations; eliminating certain health plan company action plan content requirements; clarifying the general authority of health plan companies to cancel health plans; requiring the commissioner of health to amend certain rules ARTICLE 3 REGULATORY REFORM AND CONFORMANCE TO FEDERAL ERISA STANDARDSRequiring the commissioners of health and commerce to report to the legislature by a certain date with recommendations for health plan regulatory reform including proposed legislation to create a uniform set of state regulations for all health plan companies and products based on certain regulatory principles; requiring the commissioners of commerce, health, human services and employee relations (DOER) to jointly convene an interagency task force to coordinate state agency activities relating to health plan regulation, contracting and purchasing to avoid duplication, inconsistency and excessive administrative and reporting burdens on health plans(ra)