Children and Pregnant Women Health Insurance Act of 1993

TITLE OF CONTENTS:

Title I: Requiring Employers to Provide Health Insurance

Coverage for Pregnant Women and Children

Title II: Provision of Health Insurance for Pregnant

Women and Children Through State Children and

Pregnant Women Health Plans

Title III: Health Insurance Reform for Small Employers

Children and Pregnant Women Health Insurance Act of 1993 - Title I: Requiring Employers to Provide Health Insurance Coverage for Pregnant Women and Children - (Secs. 101 and 102) Amends the Social Security Act to require employers either to enroll their employees and family members in a qualified employer health plan or to provide information to the State in which they reside for enrollment instead in the new universal State health insurance plan (the State plan) created by this Act.

Amends the Internal Revenue Code to impose: (1) a premium tax on employers who fail to enroll their employees and family members in a qualified employer health plan, as well as on such employees; and (2) an excise tax on employers who fail to provide to the applicable State information for enrollment under the State plan.

Phases in implementation of enrollment requirements and tax payments over four years.

Allows a qualified employer health plan to be either private or self-insured, depending 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.

Requires the Secretary of Health and Human Services to: (1) develop standards to certify a qualified employer health plan; (2) establish procedures for the periodic review and recertification of plans; and (3) 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.

Title II: Provision of Health Insurance for Pregnant Women and Children Through State Children and Pregnant Women Health Plans - (Sec. 201) Amends the Social Security Act to require each State to establish a health insurance plan (the State plan) for pregnant women and children and other lawful State residents who have not been enrolled or covered under a qualified employer or Federal health plan.

Requires each State also to establish a program under which low-income individuals enrolled in any such health plan may apply for assistance to limit or eliminate their financial obligations for premiums, deductibles, and co-payments.

Provides that if a State fails to establish a mandated plan, the Secretary shall establish one for it, and the State shall be liable for part of the start-up costs.

Requires the State plan to provide specified: (1) preventive care services, including routine immunizations and prenatal care; (2) major medical services; (3) extended medical services, including mental health services; (4) outreach services to link low-income enrolled individuals with such health services; and (5) social services (but only at the State's option).

Directs the Secretary to establish standards for such health services. Prohibits a State from imposing any limitation on their number, duration, or scope. Allows individuals covered under the State plan to choose any qualified plan provider or practitioner.

Incorporates the use of Medicare (title XVIII of the Social Security Act) or similar payment rates for reimbursing providers for required health services. Requires each State to establish adequate payment rates for outreach and social services.

Sets: (1) the maximum annual deductible and co-payment amount for major medical services and extended medical services; and (2) an overall annual limit on cost-sharing for such services.

Applies in the same manner to State plans qualified employer health plan requirements for the treatment of family members, coverage period, health plan cards, and coordination and portability of health care coverage.

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 as well as other specified revenues dedicated to the support of the State plan.

Details the assistance to be provided to low-income individuals and the application process to obtain it.

Provides for State 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.

Title III: Health Insurance Reform for Small Employers - (Sec. 302) Amends the Social Security Act to require health insurance plans provided by small employers (small employer plans) to meet the standards established below in order to be issued, avoid loss of their qualified status, and escape disqualification from State plan administration.

(Sec. 301) Amends the Internal Revenue Code to impose an excise tax (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 develop specific standards to implement the requirements which small employer plans must meet if the State has not established a regulatory program for applying such standards to such plans (program). Provides that if NAIC fails to develop such standards or the Secretary finds that they do not implement such requirements, the Secretary must develop them. Subjects programs to periodic review by the Secretary for determining compliance with such NAIC standards.

Requires any carrier which offers a small employer plan to register with the applicable State regulatory authority. Requires such carriers to 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. Requires a minimum 12-month term for any small employer plan, guaranteed renewable (with specified exceptions) for additional minimum 12-month terms. 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. Requires the premiums for all small employer plans of the same entity to be: (1) based on a single cohesive rating system applied consistently for all employer groups and designed not to differentiate groups by 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 variations among blocks of business. States that, with respect to premiums for small employer plans with similar coverage, a small employer plan carrier may establish blocks of business only on the basis of specified criteria.

Prohibits the issuance of any small employer plan unless it: (1) provides for a minimum benefit package mirroring the health services required under title II of this Act; (2) does not impose cost-sharing in excess of allowable limits; and (3) includes only such additional items and services as the carrier can demonstrate will facilitate appropriate hospital discharges or avoid unnecessary hospitalization.