Health insurance; association health plans.

Health insurance; association health plans. Providesthat for policies of group accident and sickness insurance issued to anassociation, members of such an association may include (i) a self-employedindividual and (ii) an employer member (a) with at least one employee that isdomiciled in the Commonwealth or (b) that has a principal place of businessthat does not exceed the boundaries of a metropolitan area that is at leastpartially in the Commonwealth. The bill provides that for such policies issuedto an association that covers at least 51 members and employees of employermembers of such association on the first day of the plan year the policiesshall be considered a large group market plan and are required to meet variousprovisions in the bill. The bill provides that to determine the size of anassociation all of the members and employees of employer members are aggregatedand treated as employed by a single employer.The bill requires an insurer issuing a policy to anassociation to (1) treat all of the members and employees of employer memberswho are enrolled in coverage under the policy as a single risk pool; (2) setpremiums based on the collective group experience of the members and employeesof employer members who are enrolled in coverage under the policy; (3) varypremiums by age, except that the rate shall not vary by more than 5 to 1 foradults; (4) not vary premiums based on gender; (5) not establish discriminatoryrules based on the health status of an employer member, an individual employeeof an employer member, or a self-employed individual for eligibility orcontribution.The bill requires the Commissioner of Insurance to, within 90days of the enactment of the bill, apply to the U.S. Secretary of Health andHuman Services for a state innovation waiver under the federal PatientProtection and Affordable Care Act, P.L. 111-148, to implement the provisionsof the bill. The provisions of the bill regarding association health plans willbecome effective 30 days following the date the Commissioner of Insurancenotifies the Governor and the Chairs of the House and Senate Committees onCommerce and Labor of federal approval of such waiver.