2020 -- H 7830

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LC005128

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2020

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A N   A C T

RELATING TO INSURANCE -- LIFETIME LIMITS

     Introduced By: Representatives Kislak, Shekarchi, McNamara, Cassar, and Blazejewski

     Date Introduced: February 26, 2020

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18-73 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-73. Prohibition on annual and lifetime limits.

     (a) Annual limits.

     (1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health

insurance carrier and a health benefit plan subject to the jurisdiction of the commissioner under this

chapter may establish an annual limit on the dollar amount of benefits that are essential health

benefits provided the restricted annual limit is not less than the following:

     (A) For a plan or policy year beginning after September 22, 2011, but before September

23, 2012 -- one million two hundred fifty thousand dollars ($1,250,000); and

     (B) For a plan or policy year beginning after September 22, 2012, but before January 1,

2014 -- two million dollars ($2,000,000).

     (2) For plan or policy years beginning on or after January 1, 2014, a health insurance carrier

and a health benefit plan shall not establish any annual limit on the dollar amount of essential health

benefits for any individual, except:

     (A) A health flexible spending arrangement, as defined in Section 106(c)(2)(i) of the

Federal Internal Revenue Code, a medical savings account, as defined in section 220 of the federal

Internal Revenue Code, and a health savings account, as defined in Section 223 of the federal

Internal Revenue Code are not subject to the requirements of subdivisions (1) and (2) of this

subsection.

     (B) The provisions of this subsection shall not prevent a health insurance carrier and a

health benefit plan from placing annual dollar limits for any individual on specific covered benefits

that are not essential health benefits to the extent that such limits are otherwise permitted under

applicable federal law or the laws and regulations of this state.

     (3) In determining whether an individual has received benefits that meet or exceed the

allowable limits, as provided in subdivision (1) of this subsection, a health insurance carrier and a

health benefit plan shall take into account only essential health benefits.

     (b) Lifetime limits.

     (1) A health insurance carrier and health benefit plan offering group or individual health

insurance coverage shall not establish a lifetime limit on the dollar value of essential health benefits

for any individual.

     (2) Notwithstanding subdivision (1) above, a health insurance carrier and health benefit

plan is not prohibited from placing lifetime dollar limits for any individual on specific covered

benefits that are not essential health benefits, in accordance with federal laws and regulations.

     (c)(1) The provisions of this section relating to lifetime limits apply to any health insurance

carrier providing coverage under an individual or group health plan, including grandfathered health

plans.

     (2) The provisions of this section relating to annual limits apply to any health insurance

carrier providing coverage under a group health plan, including grandfathered health plans, but the

prohibition and limits on annual limits do not apply to grandfathered health plans providing

individual health insurance coverage.

     (d) This section shall not apply to a plan or to policy years prior to January 1, 2014 for

which the Secretary of the U.S. Department of Health and Human Services issued a waiver pursuant

to 45 C.F.R. § 147.126(d)(3). This section also shall not apply to insurance coverage providing

benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long

term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8)

sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.

     (e) If the commissioner of the office of the health insurance commissioner determines that

the corresponding provision of the federal Patient Protection and Affordable Care Act has been

declared invalid by a final judgment of the federal judicial branch or has been repealed by an act

of Congress, on the date of the commissioner's determination this section shall have its

effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this

section. Nothing in this subsection shall be construed to limit the authority of the Commissioner to

LC005128 - Page 2 of 8

regulate health insurance under existing state law.

     SECTION 2. Section 27-19-63 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-63. Prohibition on annual and lifetime limits.

     (a) Annual limits.

     (1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health

insurance carrier and health benefit plan subject to the jurisdiction of the commissioner under this

chapter may establish an annual limit on the dollar amount of benefits that are essential health

benefits provided the restricted annual limit is not less than the following:

     (A) For a plan or policy year beginning after September 22, 2011, but before September

23, 2012 -- one million two hundred fifty thousand dollars ($1,250,000); and

     (B) For a plan or policy year beginning after September 22, 2012, but before January 1,

2014 -- two million dollars ($2,000,000).

     (2) For plan or policy years beginning on or after January 1, 2014, a health insurance carrier

and health benefit plan shall not establish any annual limit on the dollar amount of essential health

benefits for any individual, except:

     (A) A health flexible spending arrangement, as defined in Section 106(c)(2) of the federal

Internal Revenue Code, a medical savings account, as defined in Section 220 of the federal Internal

Revenue Code, and a health savings account, as defined in Section 223 of the federal Internal

Revenue Code, are not subject to the requirements of subdivisions (1) and (2) of this subsection.

     (B) The provisions of this subsection shall not prevent a health insurance carrier and health

benefit plan from placing annual dollar limits for any individual on specific covered benefits that

are not essential health benefits to the extent that such limits are otherwise permitted under

applicable federal law or the laws and regulations of this state.

     (3) In determining whether an individual has received benefits that meet or exceed the

allowable limits, as provided in subdivision (1) of this subsection, a health insurance carrier and

health benefit plan shall take into account only essential health benefits.

     (b) Lifetime limits.

     (1) A health insurance carrier and health benefit plan offering group or individual health

insurance coverage shall not establish a lifetime limit on the dollar value of essential health benefits

for any individual.

     (2) Notwithstanding subdivision (1) above, a health insurance carrier and health benefit

plan is not prohibited from placing lifetime dollar limits for any individual on specific covered

benefits that are not essential health benefits in accordance with federal laws and regulations.

LC005128 - Page 3 of 8

     (c)(1) The provisions of this section relating to lifetime limits apply to any health insurance

carrier providing coverage under an individual or group health plan, including grandfathered health

plans.

     (2) The provisions of this section relating to annual limits apply to any health insurance

carrier providing coverage under a group health plan, including grandfathered health plans, but the

prohibition and limits on annual limits do not apply to grandfathered health plans providing

individual health insurance coverage.

     (d) This section shall not apply to a plan or to policy years prior to January 1, 2014 for

which the Secretary of the U.S. Department of Health and Human Services issued a waiver pursuant

to 45 C.F.R. § 147.126(d)(3). This section also shall not apply to insurance coverage providing

benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4)

Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease

indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit

policies.

     (e) If the commissioner of the office of the health insurance commissioner determines that

the corresponding provision of the federal Patient Protection and Affordable Care Act has been

declared invalid by a final judgment of the federal judicial branch or has been repealed by an act

of Congress, on the date of the commissioner's determination this section shall have its

effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this

section. Nothing in this subsection shall be construed to limit the authority of the Commissioner to

regulate health insurance under existing state law.

     SECTION 3. Section 27-20-59 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-59. Annual and lifetime limits.

     (a) Annual limits.

     (1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health

insurance carrier and health benefit plan subject to the jurisdiction of the commissioner under this

chapter may establish an annual limit on the dollar amount of benefits that are essential health

benefits provided the restricted annual limit is not less than the following:

     (A) For a plan or policy year beginning after September 22, 2011, but before September

23, 2012 -- one million two hundred fifty thousand dollars ($1,250,000); and

     (B) For a plan or policy year beginning after September 22, 2012, but before January 1,

2014 -- two million dollars ($2,000,000).

     (2) For plan or policy years beginning on or after January 1, 2014, a health insurance carrier

LC005128 - Page 4 of 8

and health benefit plan shall not establish any annual limit on the dollar amount of essential health

benefits for any individual, except:

     (A) A health flexible spending arrangement, as defined in section 106(c)(2)(i) of the federal

Internal Revenue Code, a medical savings account, as defined in section 220 of the federal Internal

Revenue Code, and a health savings account, as defined in section 223 of the federal Internal

Revenue Code are not subject to the requirements of subdivisions (1) and (2) of this subsection.

     (B) The provisions of this subsection shall not prevent a health insurance carrier from

placing annual dollar limits for any individual on specific covered benefits that are not essential

health benefits to the extent that such limits are otherwise permitted under applicable federal law

or the laws and regulations of this state.

     (3) In determining whether an individual has received benefits that meet or exceed the

allowable limits, as provided in subdivision (1) of this subsection, a health insurance carrier shall

take into account only essential health benefits.

     (b) Lifetime limits.

     (1) A health insurance carrier and health benefit plan offering group or individual health

insurance coverage shall not establish a lifetime limit on the dollar value of essential health benefits

for any individual.

     (2) Notwithstanding subdivision (1) above, a health insurance carrier and health benefit

plan is not prohibited from placing lifetime dollar limits for any individual on specific covered

benefits that are not essential health benefits, as designated pursuant to a state determination and in

accordance with federal laws and regulations.

     (c)(1) Except as provided in subdivision (2) of this subsection, this section applies to any

health insurance carrier providing coverage under an individual or group health plan.

     (2)(A) The prohibition on lifetime limits applies to grandfathered health plans.

     (B) The prohibition and limits on annual limits apply to grandfathered health plans

providing group health insurance coverage, but the prohibition and limits on annual limits do not

apply to grandfathered health plans providing individual health insurance coverage.

     (d) This section shall not apply to a plan or to policy years prior to January 1, 2014 for

which the Secretary of the U.S. Department of Health and Human Services issued a waiver pursuant

to 45 C.F.R. § 147.126(d)(3). This section also shall not apply to insurance coverage providing

benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4)

Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease

indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit

policies.

LC005128 - Page 5 of 8

     (e) If the commissioner of the office of the health insurance commissioner determines that

the corresponding provision of the federal Patient Protection and Affordable Care Act has been

declared invalid by a final judgment of the federal judicial branch or has been repealed by an act

of Congress, on the date of the commissioner's determination this section shall have its

effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this

section. Nothing in this subsection shall be construed to limit the authority of the Commissioner to

regulate health insurance under existing state law.

     SECTION 4. Section 27-41-76 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-76. Prohibition on annual and lifetime limits.

     (a) Annual limits.

     (1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health

maintenance organization subject to the jurisdiction of the commissioner under this chapter may

establish an annual limit on the dollar amount of benefits that are essential health benefits provided

the restricted annual limit is not less than the following:

     (A) For a plan or policy year beginning after September 22, 2011, but before September

23, 2012 -- one million two hundred fifty thousand dollars ($1,250,000); and

     (B) For a plan or policy year beginning after September 22, 2012, but before January 1,

2014 -- two million dollars ($2,000,000).

     (2) For plan or policy years beginning on or after January 1, 2014, a health maintenance

organization shall not establish any annual limit on the dollar amount of essential health benefits

for any individual, except:

     (A) A health flexible spending arrangement, as defined in section 106(c)(2)(i) of the federal

Internal Revenue Code, a medical savings account, as defined in section 220 of the federal Internal

Revenue Code, and a health savings account, as defined in section 223 of the federal Internal

Revenue Code are not subject to the requirements of subdivisions (1) and (2) of this subsection.

     (B) The provisions of this subsection shall not prevent a health maintenance organization

from placing annual dollar limits for any individual on specific covered benefits that are not

essential health benefits to the extent that such limits are otherwise permitted under applicable

federal law or the laws and regulations of this state.

     (3) In determining whether an individual has received benefits that meet or exceed the

allowable limits, as provided in subdivision (1) of this subsection, a health maintenance

organization shall take into account only essential health benefits.

     (b) Lifetime limits.

LC005128 - Page 6 of 8

     (1) A health insurance carrier and health benefit plan offering group or individual health

insurance coverage shall not establish a lifetime limit on the dollar value of essential health benefits

for any individual.

     (2) Notwithstanding subdivision (1) above, a health insurance carrier and health benefit

plan is not prohibited from placing lifetime dollar limits for any individual on specific covered

benefits that are not essential health benefits in accordance with federal laws and regulations.

     (c)(1) The provisions of this section relating to lifetime limits apply to any health

maintenance organization or health insurance carrier providing coverage under an individual or

group health plan, including grandfathered health plans.

     (2) The provisions of this section relating to annual limits apply to any health maintenance

organization or health insurance carrier providing coverage under a group health plan, including

grandfathered health plans, but the prohibition and limits on annual limits do not apply to

grandfathered health plans providing individual health insurance coverage.

     (d) This section shall not apply to a plan or to policy years prior to January 1, 2014 for

which the Secretary of the U.S. Department of Health and Human Services issued a waiver pursuant

to 45 C.F.R. § 147.126(d)(3). This section also shall not apply to insurance coverage providing

benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4)

Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease

indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit

policies.

     (e) If the commissioner of the office of the health insurance commissioner determines that

the corresponding provision of the federal Patient Protection and Affordable Care Act has been

declared invalid by a final judgment of the federal judicial branch or has been repealed by an act

of Congress, on the date of the commissioner's determination this section shall have its

effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this

section. Nothing in this subsection shall be construed to limit the authority of the Commissioner to

regulate health insurance under existing state law.

     SECTION 5. This act shall take effect upon passage.

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LC005128

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- LIFETIME LIMITS

***

     This act would revoke the authority of the health insurance commissioner's ability to

enforce a ruling of the federal government or federal court that revokes the prohibition on limits on

health insurance.

     This act would take effect upon passage.

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LC005128

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