S.Amdt. 3933

SA 3933. Mr. GREGG submitted an amendment intended to be proposed to amendment SA 3924 submitted by Ms. Snowe (for herself, Mr. Byrd, Mr. Talent, and Mr. Domenici) and intended to be proposed to the bill S. 1955, to amend title I of the Employee Retirement Security Act of 1974 and the Public Health Service Act to expand health care access and reduce costs through the creation of small business health plans and through modernization of the health insurance marketplace; which was ordered to lie on the table; as follows:

Strike all after the part heading in the amendment and insert the following:

“SEC. 2921. DEFINITIONS.

“In this part:

“(1) Adopting state.--The term ‘adopting State' means a State that has enacted the Benefit Choice Standards in their entirety and as the exclusive laws of the State that relate to benefit, service, and provider mandates in the group and individual insurance markets.

“(2) Benefit choice standards.--The term ‘Benefit Choice Standards' means the Standards issued under section 2922.

“(3) Eligible insurer.--The term ‘eligible insurer' means a health insurance issuer that is licensed in a nonadopting State and that--

“(A) notifies the Secretary, not later than 30 days prior to the offering of coverage described in this subparagraph, that the issuer intends to offer health insurance coverage consistent with the Benefit Choice Standards in a nonadopting State;

“(B) notifies the insurance department of a nonadopting State (or other State agency), not later than 30 days prior to the offering of coverage described in this subparagraph, that the issuer intends to offer health insurance coverage in that State consistent with the Benefit Choice Standards, and provides with such notice a copy of any insurance policy that it intends to offer in the State, its most recent annual and quarterly financial reports, and any other information required to be filed with the insurance department of the State (or other State agency) by the Secretary in regulations; and

“(C) includes in the terms of the health insurance coverage offered in nonadopting States (including in the terms of any individual certificates that may be offered to individuals in connection with such group health coverage) and filed with the State pursuant to subparagraph (B), a description in the insurer's contract of the Benefit Choice Standards and that adherence to such Standards is included as a term of such contract.

“(4) Health insurance coverage.--The term ‘health insurance coverage' means any coverage issued in the group or individual health insurance markets, except that such term shall not include excepted benefits (as defined in section 2791(c)).

“(5) Nonadopting state.--The term ‘nonadopting State' means a State that is not an adopting State.

“(6) Small group insurance market.--The term ‘small group insurance market' shall have the meaning given the term ‘small group market' in section 2791(e)(5).

“(7) State law.--The term ‘State law' means all laws, decisions, rules, regulations, or other State actions (including actions by a State agency) having the effect of law, of any State.

“SEC. 2922. OFFERING AFFORDABLE PLANS.

“(a) Benefit Choice Options.--

“(1) Development.--Not later than 6 months after the date of enactment of this title, the Secretary shall issue, by interim final rule, Benefit Choice Standards that implement the standards provided for in this part.

“(2) Basic options.--The Benefit Choice Standards shall provide that a health insurance issuer in a State, may offer a coverage plan or plan in the small group market, individual market, large group market, or through a small business health plan, that does not comply with one or more mandates regarding covered benefits, services, or category of provider as may be in effect in such State with respect to such market or markets (either prior to or following the date of enactment of this title), if such issuer also offers in such market or markets an enhanced option as provided for in paragraph (3) of the List of Required Benefits option as provided for in paragraph (5).

“(3) Enhanced option.--A health insurance issuer issuing a basic option as provided for in paragraph (2) shall also offer to purchasers (including, with respect to a small business health plan, the participating employers of such plan) an enhanced option, which shall at a minimum include such covered benefits, services, and categories of providers as are covered by a State employee coverage plan in one of the 5 most populous States as are in effect in the calendar year in which such enhanced option is offered.

“(4) Publication of benefits.--Not later than 3 months after the date of enactment of this title, and on the first day of every calendar year thereafter, the Secretary shall publish in the Federal Register such covered benefits, services, and categories of providers covered in that calendar year by the State employee coverage plans in the 5 most populous States.

“(5) List of required benefits option.--

“(A) In general.--Not later than 3 months after the date of enactment of this title, the Secretary, in consultation with the National Association of Insurance Commissioners, shall issue by interim final rule a list (to be known as the ‘List of Required Benefits') of covered benefits, services, or categories of providers that are required to be provided by health insurance issuers, in each of the small group and large group markets, in at least 26 States as a result of the application of State covered benefit, service, and category of provider mandate laws. With respect to plans sold to or through small business health plans, the List of Required Benefits applicable to the small group market shall apply.

“(B) Application.--The provision of paragraph (2) relating to the offering of a basic option plan under this part shall, in addition to allowing such option to be offered if the enhanced option under paragraph (3) is offered, permit such basic option to be offered if the health insurance issuer also offers an option providing coverage for the List of Required Benefits under subparagraph (A).

“(b) Effective Dates.--

“(1) Small business health plans.--With respect to health insurance provided to participating employers of small business health plans, the requirements of this part (concerning lower cost plans) shall apply beginning on the date that is 12 months after the date of enactment of this title.

“(2) Non-association coverage.--With respect to health insurance provided to groups or individuals other than participating employers of small business health plans, the requirements of this part shall apply beginning on the date that is 15 months after the date of enactment of this title.”.