Comprehensive Health Care Improvement Act of 1989

Comprehensive Health Care Improvement Act of 1989 - Title I: Qualified Health Insurance Plans - Part A: Definitions and Standards for Qualified Plans - Defines a "plan of health coverage" as any plan or combination of plans, including combinations of self-insurance, individual accident and health insurance policies, group accident and health insurance policies, coverage under a nonprofit health service plan, or coverage under a health maintenance organization (HMO) subscriber contract.

Directs the Secretary of Health and Human Services to establish standards for qualified plans and procedures for the review and certification of plans of health coverage as qualified plans. Provides that a plan shall be certified as an "A" qualified plan if it meets State requirements and meets the following minimum standards: (1) the minimum benefits for a covered individual equal at least 80 percent of the covered expenses in excess of an annual deductible not exceeding $250 per person or $250 for each of two members of a covered family; (2) the coverage includes a limitation of $3,000 per person and $6,000 for a covered family on total annual out-of-pocket expenses for covered expenses; (3) the coverage is subject to a $1,000,000 maximum life-time benefit; and (4) the $3,000, $6,000, and $1,000,000 limitations are not subject to change or substitution by use of an actuarially equivalent benefit. States that covered expenses are the usual and customary charges of a physician or chiropractor.

Lists covered and excluded services.

Deems HMOs providing certain services to be providing an "A" qualified plan.

Certifies as a "B" qualified plan a plan which meets the requirements of an "A" plan, except that the annual deductible does not exceed $1,000 per person.

Directs the Secretary, to the extent feasible, to provide for the review and certification by the insurance commissioner of each State of qualified plans to be offered in the State.

States that the sale of plans is in and affects interstate commerce and that, in order to properly regulate such sales, it is necessary to regulate such sales in intrastate, as well as interstate, commerce. Requires every plan of health coverage sold to be labelled as "qualified" or "nonqualified" on the front of the policy. Requires each advertisement or promotion for a plan to specify whether the plan is "qualified" or "nonqualified."

Part B: Requiring Offering of Certain Qualified Plans - Requires each employer employing an average of ten or more employees annually to make available a plan or combination of plans of health coverage which: (1) has been certified as an "A" or supplemental plan; (2) is a qualified convertible plan; and (3) permits coverage of an employee's spouse and children. Defines a "qualified convertible plan" as a plan of health coverage which: (1) permits each enrolled individual to continue coverage for one year and then to convert the plan to any individual qualified plan without the addition of underwriting restrictions if, for any reason, the individual leaves the group; and (2) permits, in the case of the death of the individual in whose name the contract was issued, other individuals covered under the plan to continue coverage without the addition of underwriting restrictions. Sets forth civil penalties for noncompliance. Excludes from the term "employee," for purposes of this provision, certain new, part time, part year, young, bargaining unit, and nonresident alien employees.

Part C: Offering of Comprehensive Health Insurance by States - Amends title XIX (Medicaid) of the Social Security Act to require the establishment and operation of a comprehensive health association in each State and a comprehensive health plan in each State, in accordance with this part of this Act. Defines a "comprehensive health insurance plan" to mean policies of insurance and contracts of HMO coverage offered by an association through the writing carrier in the State. Defines the "writing carrier" as the insurers and HMOs approved to administer the comprehensive health insurance plan.

Provides that each State commissioner of insurance, consistent with any regulations the Secretary may promulgate: (1) may formulate general policies to advance the purposes of this title; (2) shall supervise the creation of the State comprehensive health association; (3) shall approve the selection of the writing carrier by the association in the State and approve the association's contract with the writing carrier, including the State plan coverage and premiums to be charged; (4) may appoint advisory committees with respect to implementation of this part; (5) shall conduct periodic audits to assure the general accuracy of the financial data submitted by the writing carrier and the association in the State; (6) shall contract with the Federal Government and may contract with any other unit of government to ensure coordination of the State plan of the association with other governmental assistance programs; (7) may undertake, directly or through contracts with other persons, studies or demonstration programs to develop awareness of the benefits provided under this Act, so that residents of the State may best avail themselves of the health care benefits provided hereunder; (8) may contract with insurers and others for administrative services; and (9) may adopt, amend, suspend, and repeal rules as reasonably necessary to carry out and make effective the provisions and purposes of this part.

Requires each State to provide for the establishment of a comprehensive health association with membership consisting of all insurers, fraternal beneficiary associations, other entities offering health policies, and HMOs authorized or licensed to do business in the State. Exempts each association from State taxation. Provides for a board of directors of each association. Requires that all members of an association: (1) maintain their membership in the association as a condition of doing accident and health insurance, self-insurance, or HMO business in the State; and (2) enter into a reinsurance contract with the association as required by this part.

Exempts members of an association, in the performance of their duties as members, from Federal and State antitrust laws.

Authorizes each association to provide for the reinsuring of risks incurred as a result of issuing qualified plans by members of the association. Requires each member which elects to reinsure its risks to determine the categories of coverage it elects to reinsure in the association. Provides that the categories consist of: (1) individual qualified plans, excluding group conversions; (2) group conversions; (3) group qualified plans with fewer than 50 employees or members; and (4) major medical coverage.

Requires each association through its comprehensive health insurance plan to offer: (1) policies which provide the benefits of "A" and "B" qualified plans; and (2) HMO contracts in those areas of the State where an HMO has agreed to make the coverage available and has been selected as a writing carrier.

Requires the comprehensive health insurance plan for a State to be open for enrollment by individuals residing in the State, who can enroll by submitting a certificate of eligibility to the writing carrier which certifies the applicant's name, address, age, length of residence, dependents to be insured, and type of coverage desired. Provides that upon certification the individual can enroll in a State's comprehensive health insurance plan by payment of the State plan premium to the writing carrier.

Requires each member of an association to share the claims expenses for approved plans and the operating and administrative expenses incurred by the association, pursuant to the terms of the individual reinsurance contracts executed by the association with each member. Sets forth a method to determine each member's share of expenses.

Authorizes any member of an association in a State to submit for approval to the State commissioner the policies of accident and health insurance or the HMO contracts which are being proposed to serve in the comprehensive health insurance plan. Authorizes the association to select approved policies and a contract to be the comprehensive health insurance plan based upon the member's proven ability to handle large group accident and health insurance cases, claims paying capacity, and estimate of total charges for plan administration. Requires each writing carrier to: (1) perform all required administrative and claims payment functions; and (2) report monthly to the association and State commissioner. Exempts premiums received by a writing carrier for the comprehensive health insurance plan from State taxation.

Requires each association in a State to disseminate information to State residents regarding the existence of the comprehensive health insurance plan and the means of enrollment. Requires each writing carrier to pay an agent's referral fee, in an amount to be determined by the association, to each insurance agent referring an applicant to the State comprehensive health insurance plan, if the application is accepted.

Title II: Program of Assistance to States for Assisting Low-Income Individuals to Purchase Comprehensive Health Insurance - Comprehensive Health Insurance Assistance Act of 1989 - Adds a new title XXI to the Social Security Act entitled "Grants to States for Assistance to Low-Income Individuals in the Purchase of Comprehensive Health Insurance." Authorizes appropriations under title XXI to enable each State to provide assistance to low-income individuals in the purchase of comprehensive health insurance under title XXI. Specifies the amount authorized for each fiscal year. Requires the sums made available under this title to be used to make payments to States which have submitted, and have been approved by the Secretary, State plans for comprehensive health insurance assistance to low-income individuals.

Directs the Secretary to pay each State with an approved plan, from the sums appropriated, an amount equal to 50 percent of the sums expended which are attributable either to assistance under the plan to low-income individuals or to plan administration. Prohibits such amount, during any quarter, from exceeding the product of $2.50 and the State's population.

Requires a State plan for comprehensive health insurance assistance to low-income individuals, in order to be approved by the Secretary, to meet specified criteria.

Title III: Program of Assistance to States for Assisting Individuals Who Incur Catastrophic Expenses for Health Care - Catastrophic Health Care Expenses Assistance Act of 1989 - Amends the Social Security Act to add a new title XXII entitled "Grants to States for Assistance to Individuals Incurring Catastrophic Expenses for Health Care." Authorizes appropriations for each fiscal year to enable each State to furnish medical assistance for catastrophic illness. Requires a State to have submitted and have approved by the Secretary a plan for medical assistance for catastrophic illness.

Directs the Secretary to pay each State with an approved plan, from the sums appropriated, an amount equal to 50 percent of the sums expended which are attributable either to payments made under the plan to eligible individuals or to plan administration. Prohibits such amount, during any quarter, from exceeding the product of $0.625 and the State's population.

Sets forth circumstances in which payment with respect to expenses is prohibited.

Lists requirements for a State plan to be approved by the Secretary.

Defines an "eligible individual" as an individual who incurs an obligation to pay, in a consecutive 12-month period, expenses (including dependent's expenses) exceeding the greater of $3,000 (or such lower amount as the State may establish) or 30 percent of household income up to $25,000, plus 40 percent of household income between $25,000 and $40,000, plus 50 percent of household income in excess of $40,000 (or such lower respective percentages of such incomes, or of such higher incomes as the State may establish).