Basic Health Benefits for All Americans Act

Basic Health Benefits for All Americans Act - Title I: Amendments to Public Health Service Act - Amends the Public Health Service Act to add provisions which require each employer to enroll each of its employees and their families in a health benefit plan. Makes State and local employers which do not so enroll their employees and their families ineligible to receive grants, contracts, loans, or loan guarantees under such Act.

Title II: Amendments to Fair Labor Standards Act of 1938 and Employee Retirement Income Security Act of 1974 - Amends the Fair Labor Standards Act of 1938 to add provisions which require each employer to enroll each of its employees and their families in a health benefit plan.

Amends the Employee Retirement Income Security Act of 1974 (ERISA) regarding supersedure of State laws relating to contracts or policies of insurance issued to or under a health benefit plan under title III of this Act.

Title III: Requirements for Health Benefit Plans for Employees and Their Families - Subtitle A: Requirement and Definitions - Applies this title to employers required to enroll employees in health benefit plans under certain provisions of the Public Health Service Act or the Fair Labor Standards Act of 1938.

Requires each small and certain large employers to use a regional insurer, subject to certain exceptions and conditions.

Requires that enrollment of an employee in a health benefit plan under this title includes enrollment of the employee's family in the plan. Prohibits the employee from waiving personal or family enrollment. Provides exceptions: (1) to avoid duplicate family coverage; and (2) in the case of multiple employers.

Prohibits employers from discriminating against any individual because such individual has a spouse or child required under this title to be enrolled in a health benefit plan.

Subtitle B: Requirements for Health Benefit Plans - Sets forth general requirements for plans. Permits a health benefit plan to be considered as meeting such requirements provided the actuarial benefits under the plan are not less than would have applied if the plan met the requirements of this subtitle. Sets forth minimum requirements, including a limit on out-of-pocket expenses. Mandates inclusion of certain mental health benefits. Directs the Secretary of Health and Human Services to: (1) establish an advisory board to advise the Secretary on development of actuarial equivalency standards; and (2) publish, at least three months before the effective date of this Act, a table of actuarial equivalency describing as many variations as feasible. Declares a plan using variations not included in the table to be in compliance with this Act if it meets certain requirements. Directs the Secretary to establish streamlined procedures regarding employers with multiple plans. Allows new small businesses to use a tailored health benefit plan, as defined in this title.

Specifies benefits which a plan must provide, including inpatient and outpatient hospital care and physician services, tests, prenatal and well-baby care, and inpatient and outpatient care for mental disorders. Prohibits placing limits on the amount, scope, or duration of benefits for hospital care, physician services, or tests, but allows plan limits on prenatal and well-baby care under regulations prescribed by the Secretary.

Declares that nothing in this Act: (1) prohibits a health plan from providing benefits through a panel or other form of managed care system or establishing a different level of payments for reimbursement for different health care providers furnishing benefits; or (2) requires a plan to use a provider to provide benefits provided before the effective date of this Act other than the providers being utilized by the plan on that date or make payments to any provider that is excluded from participation in any Federal health care program.

Allows an insurer to establish a fee schedule or other basis of payment that is different from actual charges if the schedule meets certain requirements.

Specifies requirements regarding the date of initial coverage. Prohibits pre-existing condition provisions. Provides special requirements regarding certain part-time employees.

Allows a plan to require an employee to pay for premiums, deductibles, copayments, and coinsurance not to exceed certain limits. Provides for adjustments for covered spouses with other coverage and for employed retirees. Requires each employer with an employee whose hourly wage is less than a specified amount to offer each such employee at least one plan that does not require a premium for the employee. Prohibits State laws from preventing employers from using payroll withholding for premiums due by employees. Sets forth special rules for the calculation of premiums for part-time employees. Sets limitations on: (1) deductibles, to be increased for increases in the consumer price index; (2) copayments and coinsurance, subject to exception; and (3) out-of-pocket expenses.

Subtitle C: Certification of Regional Insurers - Directs the Secretary of Health and Human Services (Secretary) to designate six to eight health insurance regions and to establish procedures for the periodic certification of insurers for each region. Sets forth certification eligibility requirements. Specifies requirements for application for and consideration of applications for such certification. Directs the Secretary to periodically evaluate the performance of regional insurers and, under certain circumstances, allows the Secretary to terminate the certification of the insurer. Allows the Secretary, if the Secretary determines that there is a failure of competition among regional insurers in the region and that other conditions are met, to restrict certification, based on a competitive bidding or other system, to those qualified insurers which offer plans at lower rates.

Sets forth requirements regarding the types of plans each regional insurer must offer.

Requires each regional insurer to fix premiums under a community rating system. Prohibits adjustment of such premiums based on age, gender, other factors relating to the projected or actual use of services, or, subject to exception, on geographical location within the region.

Permits regional insurers to enter into subcontracts.

Directs the Secretary to encourage regional insurers to enter into arrangements with entities representing groups of small businesses for the provision of administrative services. Requires such insurers to reduce the premiums charged by an amount which reflects the value of such services.

Directs the Secretary to provide technical assistance to employers, utilizing to the maximum extent feasible entities with experience in providing health insurance services to small businesses.

Subtitle D: Regulations and Enforcement - Directs the Secretary to promulgate rules to carry out this title by specified deadlines.

Provides for civil penalties for any nongovernmental employer who does not comply with certain provisions of this Act. Makes nongovernmental employers who knowingly fail to comply with certain provisions of this Act liable for damages, including health care costs incurred, to the employee or the employee's family. Allows any individual injured, adversely affected, or aggrieved by violation of certain requirements of this Act to bring an action for injunctive relief.

Subtitle E: Small Business Subsidy - Directs the Secretary of Labor to provide for payment to a small employer, whose compliance cost exceeded a specified percentage of the employer's gross revenues, of 75 percent of such excess. Allows adjustments for industries for which the specified percentage is not an appropriate measure of the financial burden of providing the insurance.

Title IV: Assuring Provision of Health Benefits to Under-Poverty, Near-Poverty, and Other Individuals - Amends title XIX (Medicaid) of the Social Security Act to state that any plan approved under the title: (1) must offer, starting in 1991, benefits to under-poverty individuals; (2) may offer, starting in 1991, and must offer, starting in 1996, benefits to near-poverty individuals; and (3) may offer, starting in 1996, and must offer, starting in 1999, benefits to all other individuals not covered under a health benefit plan under title III of this Act. Requires the benefits under the State benefits program to be the same as required of health benefit plans under such title plus coverage for items and services relating to early and periodic screening and diagnosis of children under the age of 21. Prohibits the benefits from including any other items or services.

Prohibits the imposition of premiums, deductibles, copayments, or cost-sharing on under-poverty individuals. Allows such features, subject to limitations, for near-poverty and other covered individuals.

Makes an individual who is enrolled in a health benefit plan under title III of this Act ineligible for benefits under a State benefits program, but requires or permits a State program to pay part or all of the premiums, deductibles, and other cost-sharing imposed by a title III plan on an individual who is under or near poverty. Allows a State to require an under-poverty or near-poverty individual who is eligible for but not required to be enrolled in a health benefit plan to enroll in the plan, but only if the individual's premiums and out-of-pocket expenses will be no greater than if the individual had not been required to enroll.

Requires the State to determine the eligibility of an individual within 30 days of application. Provides for enrollment periods and effective dates of coverage. Declares that an individual who is determined in a month to be eligible must remain eligible for not less than six months.

Requires reimbursement for physician services furnished on or after January 1, 1991, and other items and services furnished on or after January 1, 1996, to be made at rates that are not less than the rates recognized for payment of such items and services under title XVIII (Medicare) of the Social Security Act.

Directs the Secretary of Health and Human Services to provide for utilization and quality control peer review organizations under Part B (Peer Review) of such title.

Requires the use of such clinical practice guidelines as the Secretary may develop in determining whether items and services are medically necessary.

Prohibits a State from providing benefits through a plan that restricts the provider from whom an individual may obtain items and services unless the plan meets certain requirements.

Requires each State to administer its benefits program, unless the State elects to have the Secretary do so and pays for such services.

Specifies provisions of title XIX (Medicaid) of the Social Security Act which do not apply to the provisions of this title, including those relating to general comparability, payment rules, cost-sharing rules, general retroactive eligibility, transition rules, the State 209(b) section option, income limits, and lien provisions. Provides for the manner in which other specified provisions of such title shall be applied to the provisions of this title. Requires States that are operating under demonstration projects to meet the requirements of this title in the same manner as if the State had in effect a Medicaid plan. Applies this title only to the 50 States and the District of Columbia.

Amends title XIX to declare that, notwithstanding any other Medicaid provision, with respect to benefits described in this title, effective January 1, 1991, the State Medicaid plan may not impose any limitations on the amount, duration, or scope for individuals eligible for Medicaid benefits who are not described in specified provisions of this title.

Requires State Medicaid plans to provide for payment for items and services provided under this title on or after specified dates based on rates that are not less than the rates recognized under title XVIII (Medicare) of the Social Security Act.

Authorizes a State Medicaid plan, at the State's option and notwithstanding any other Medicaid provision, to make medical assistance available with respect to prescribed drugs to individuals eligible to receive benefits under this title, provided other requirements are met.

Title V: Effective Date for Titles I through III - Provides for the effective dates of titles I through III of this Act and transition rules for certain circumstances.

Declares that no employer will be required under title III of this Act to provide any health benefit in addition to the benefits required to be provided by specified provisions of this Act unless: (1) such additional benefit is for a service which State Medicaid plans (under title XIX of the Social Security Act) are required to cover for certain individuals; and (2) before the enactment of such requirement, the benefits and costs of requiring the provision of such additional health benefit have been analyzed and considered by the Congress, according to certain procedures.