This bill would require that health insurance providers in the individual and group markets accept individuals with pre-existing conditions who apply for coverage. Insurers could only charge beneficiaries higher premiums based on age, tobacco use, the plan’s rating (e.g. a silver plan), and whether the plan covers an individual or family. It would also prohibit insurers from discriminating against participants in a health plan based on their health status and other factors described below.
Specifically, a health insurance plan couldn’t discriminate against participants by charging them higher premiums based on their:
Medical condition (both physical and mental illnesses);
Receipt of healthcare;
Evidence of insurability (including conditions arising out of acts of domestic violence);
Any other health status-related factor considered appropriate by the Health and Human Services Secretary.
A health insurance issuer would only be allowed to deny coverage to an individual or employer if it has demonstrated to state regulators that it doesn’t have capacity to deliver services adequately to those enrolled. The issuer would have to apply that standard uniformly to all employers and individuals without regard to their claims history or any health status-related factor.
Group health plans and health insurers would be prohibited from requesting or requiring a plan participant or their family member to undergo a genetic test. An exception would be made to ask a beneficiary to participate in voluntary genetic research, but that information would be prohibited from impacting their policy or premiums and the research would have to be in compliance with all relevant regulations.
Health plans would be able to offer premium discounts or rebates to participants in wellness programs that reimburse their memberships at fitness centers, reward participation in a diagnostic testing program, encourages preventive care through deductible waivers, or cover the costs of smoking cessation.