Children and Pregnant Women Health Insurance Act of 1991

Children and Pregnant Women Health Insurance Act of 1991 - Title I: Requiring Employers To Provide Health Insurance Coverage For Pregnant Women And Children - Amends the Social Security Act to: (1) add a new title XXI under which employers are required to either enroll their employees and family members in a qualified employer health plan or provide information to the State in which such individuals reside for enrollment instead in the new universal State health insurance plan (the State plan) created below. Amends the Internal Revenue Code to: (1) impose a premium tax on employers who fail to enroll their employees and family members in a qualified employer health plan and on such employers' employees, with employers paying as their portion of such tax 3.2 percent of each individual employee's wages and employees paying as their portion one percent of their wages for coverage provided under the State plan; (2) impose an excise tax (set at $100 per day) on those employers who fail to provide to the applicable State the information for enrollment under the State plan; and (3) set forth special rules and exceptions applicable in the imposition of such premium and excise taxes.

Sets forth, under new title XXI of the Social Security Act, the rules for the enrollment of full- and part-time, seasonal, and temporary employees, including rules applicable in cases of families with more than one worker and where both employers offer enrollment under a qualified employer health plan.

Phases in implementation of enrollment requirements and tax payments beginning on January 1, 1993 for employers with more than 100 employees. Requires that as of January 1, 1996 all employers must provide coverage or pay the premium tax for coverage under the State plan.

Allows the qualified employer health plan under which the employer must provide coverage to be either a private health plan or a self-insured plan, dependent upon the employer's size.

Outlines requirements for qualified employer health plan premiums and cost-sharing, including limitations on the amount that may be charged for premiums.

Sets forth in the next two paragraphs below the requirements for which the Secretary must develop standards to certify a health plan as a qualified employer health plan. Requires the Secretary to: (1) establish procedures for the periodic review and recertification of plans as qualified employer health plans; and (2) terminate the certification of any such plan that no longer meets such requirements.

Requires employers to provide their employees and family members with a health benefit package that at least mirrors the services mandated under the State plan.

Outlines plan requirements respecting: (1) treatment of employee families; (2) period of coverage; (3) health plan cards; (4) limits on pre-existing condition exclusions and coverage standards for required health services; (5) limits on cost-sharing; (6) payment rates; (7) coordination and portability of health insurance coverage; (8) notification of premium subsidies for low-income individuals and other disclosures for consumers; (9) expense accounting; (10) grievance procedures; (11) certain physician incentive plans; (12) enrollee financial protection; and (13) use of uniform claims forms.

Prohibits certain State benefit and coverage rules under a qualified employer health plan.

Sets forth the definitions of terms used in this title.

Makes the provisions of this title inapplicable to an employee who is not a resident of one of the 50 States or the District of Columbia.

Title II: Provision of Health Insurance For Pregnant Women And Children Through State Children And Pregnant Women Health Plans - Amends the Social Security Act to add a new title XXII under which each State is required to establish and maintain a health insurance plan (the State plan) under which pregnant women and children and other individuals lawfully residing in the State who have not already been enrolled as a result of their connection to the work force or are not already covered under a qualified employer or Federal health plan are eligible to enroll for the health and other services outlined below.

Requires each State to also establish and maintain a program under which low-income individuals enrolled in any of the health plans mentioned above will be eligible to apply for assistance to limit or eliminate their financial obligations for premiums, deductibles, and co-payments, depending upon the type of plan in which such individuals are enrolled.

Provides that if a State fails to establish and maintain the plan mandated above under new title XXII, the Secretary of Health and Human Services shall establish and maintain one for it and the State shall be liable to the Secretary for a specified portion of the amount the Secretary determines the State would have been required to expend to establish and maintain such a health insurance plan.

Sets forth provisions detailing the application process for enrollment under the State plan.

Requires the State plan to provide for a coverage period that mirrors the coverage period specified for qualified employer health plans.

Requires individuals who are eligible to enroll in the State plan but have not applied for enrollment by January 1, 1996 to be automatically enrolled on a retroactive basis and subjected to a penalty of twice any premiums otherwise due.

Requires the State plan to provide for payments for the following services: (1) specified preventive care services, including routine immunizations and prenatal care, for children and pregnant women, furnished in accordance with applicable periodicity schedules to be established by the Secretary and without application of deductibles or co-payments; (2) specified major medical services, subject to such deductibles and co-payments as the State may impose in accordance with specified limitations; (3) specified extended medical services, including mental health services, provided only in accordance with a plan of care and subject to such deductibles and co-payments as the State may impose in accordance with specified limitations; (4) outreach services to link low-income enrolled individuals with such required health services without application of deductibles or copayments; and (5) at the option of the State, social services without application of deductibles or co-payments. Directs the Secretary to establish standards with respect to such required health services for application under new titles XXI and XXII of the Social Security Act. Prohibits a State from imposing any limitation on the amount, duration, or scope for such required health services. Allows individuals covered under the State plan to choose any qualified plan provider or practitioner to obtain such required health services.

Incorporates the use of Medicare (title XVIII of the Social Security Act) payment rates for reimbursing providers for required health services and requires the Secretary to adjust such rates to take into account differences in the Medicare population and the population receiving benefits under State or qualified employer plans. Provides that in the case of required health services for which payment may not be made under Medicare, the Secretary shall establish payment rules similar to those used under Medicare for application under State plans. Requires each State to establish adequate payment rates with respect to outreach and social services.

Sets the maximum annual deductible and co-payment amount for major medical services and extended medical services.

Sets an overall annual limit on cost-sharing for such medical services.

Applies new title XXI qualified employer health plan requirements relating to the treatment of family members, coverage period, health plan cards, and coordination and portability of health care coverage to State plans in the same manner as they apply to qualified employer plans.

Sets forth provisions for: (1) determining the amount of premiums to be charged individuals not connected to the work force and individuals who are employed on a part-time, seasonal, or temporary basis; and (2) collecting current and delinquent premium payments.

Creates in the Treasury the Federal Children and Pregnant Women Health Insurance Trust Fund (the Fund) to receive the funds generated from the premium and excise taxes imposed above as well as from other specified revenues dedicated to the support of the State plan. Outlines provisions regarding Fund transfer payments in the case of multiple employers.

Requires each State plan to provide for submission of claims based on uniform forms developed by the Secretary.

Requires that payments from the Fund to reimburse States for health and other service and administrative expenditures be made in accordance with rules similar to those used for reimbursement under Medicaid (title XIX of the Social Security Act).

Details the assistance mentioned above to be provided to low-income individuals and the application process to obtain such assistance.

Sets forth administrative provisions applicable to the State plan, including provisions authorizing States, subject to the approval of the Secretary, to conduct demonstration projects to: (1) improve the delivery and quality of health care services under new title XXII; and (2) increase the efficiency and effectiveness of the methods for paying for such services.

Sets forth the definitions of terms used in this title.

Makes the provisions of this title inapplicable to an individual who is not a resident of one of the 50 States or the District of Columbia.

Amends the Medicaid program to provide for coordination between State plans and Medicaid plans.

Title III: Health Insurance Reform For Small Employers - Amends the Social Security Act and the Internal Revenue Code to, respectively: (1) add a new title XXIII under which health insurance plans provided by small employers (small employer plans) must be ascertained as meeting the standards established below in order to be issued, avoid loss of their qualified status under new title XXI, and escape disqualification from State plan administration under new title XXII; and (2) impose an excise tax (set at 50 percent of all gross health plan premiums received during the taxable year) on the issuer of a small employer plan which fails to meet such standard, with specified exceptions.

Directs the Secretary to request the National Association of Insurance Commissioners (NAIC) to: (1) develop specific standards to implement the requirements set forth in the next paragraph below which small employer plans must be certified by the Secretary as meeting if the State has not established a regulatory program for applying such standards to such plans (program); and (2) report to the Secretary on such development. Provides that if NAIC fails to develop and report on such standards or the Secretary finds that such standards do not implement such requirements, the Secretary must develop such standards. Specifies additional program elements. Subjects programs to periodic review by the Secretary for determining their compliance with such elements and in applying such NAIC standards. Requires periodic program audits by the General Accounting Office.

Requires any carrier which offers a small employer plan to register with the applicable State regulatory authority. Requires that such carriers offer the same plans to all small employers within their individual service areas. Details separate requirements with respect to the treatment of health maintenance organizations. Prohibits a carrier from offering to, or issuing with respect to, a small employer a small employer plan with a term of less than 12 months. Requires that small employer plans be guaranteed renewable, with specified exceptions. Details notice and other requirements applicable to renewals, including the requirement that the period of renewal for each small employer plan shall be for a period of not less than 12 months. Declares that no small employer plans may discriminate on the basis of health status, claims experience, receipt of health care, medical history, or lack of evidence of insurability of an individual. Requires that the premiums for all small employer plans of the same entity be: (1) established based on a single cohesive rating system which is applied consistently for all employer groups and is designed not to treat groups differently based on health or risk status; and (2) actuarially certified each year. Requires small employer plan premiums within a block of business to be community-rated for a given geographical area. Sets limits on premium reference rate variation among blocks of business, with specified exceptions. Allows a small employer plan carrier, for purposes of establishing premiums for small employer plans with similar coverage, to establish blocks of business only on the basis of specified criteria. States that no small employer plan may be issued unless it: (1) provides for a minimum benefit package that mirrors the health services required under new title XXII; (2) prohibits cost-sharing with respect to such benefits in excess of allowable limits; and (3) includes such additional items and services as the carrier can demonstrate will facilitate appropriate hospital discharges or avoid unnecessary hospitalization. Sets forth miscellaneous disclosure and recordkeeping requirements for small employer health plans.

Makes this title inapplicable outside the 50 States or the District of Columbia.

Sets forth the definitions of terms used in this title.