Health Insurance Portability and Guaranteed Renewability Act of 1995

TABLE OF CONTENTS:

Title I: Amendments of Internal Revenue Code of 1986

Subtitle A: Medical Care Savings Accounts

Subtitle B: Expansion of COBRA Continuation Coverage

Title II: Insurance Reform

Subtitle A: Employer Insurance Protections

Subtitle B: Guaranteeing Portability of Health

Insurance for Individuals

Subtitle C: Assuring Health Insurance Coverage for

Uninsurable Individuals

Health Insurance Portability and Guaranteed Renewability Act of 1995 - Title I: Amendments of Internal Revenue Code of 1986 - Subtitle A: Medical Care Savings Accounts - Amends the Internal Revenue Code (IRC) to provide for medical care savings benefits, under which a portion of a premium would be credited to a participating employee to pay for medical care and amounts remaining (if any) at the end of the year would be deposited to a medical care savings account (medical IRA).

(Sec. 102) Defines a "medical care savings account" (MCSA) as a trust for the exclusive benefit of an individual and the individual's spouse and dependents and meeting certain requirements. Provides for the tax treatment of such accounts and their distributions. Treats custodial accounts as a trust if specified criteria are met.

Amends various provisions of the IRC (relating to old-age, survivors, and disability insurance, hospital insurance, railroad retirement, unemployment taxes, and withholding) and the Social Security Act (relating to old-age, survivors, and disability insurance) to exclude from the definition of "wages" (or, in the case of provisions relating to railroad retirement, the definition of "compensation") any payment to or for the benefit of an employee if the payment is excludable from gross income.

Amends the IRC to exempt MCSAs from provisions imposing a tax on certain prohibited transactions. Imposes a penalty for failure to file required report on a MCSA.

(Sec. 103) Allows cafeteria plan flexible spending arrangements to be contributed to a MCSA.

Subtitle B: Expansion of COBRA Continuation Coverage - Amends the IRC and the Employee Retirement Income Security Act of 1974 (ERISA) to exempt group health plans maintained by employers who all employ fewer than two (currently, 20) employees from continuation coverage requirements. Modifies requirements regarding the maximum required coverage period.

Amends the Public Health Service Act (PHSA) to exempt group health plans maintained by employers who all employ fewer than four (currently, 20) employees from continuation coverage requirements. Modifies requirements regarding the maximum required coverage period.

(Sec. 112) Amends the IRC, ERISA, and the PHSA to revise the type of continuation coverage required and general requirements for group health plan continuation coverage.

Title II: Insurance Reform - Subtitle A: Employer Insurance Protections - Prohibits any health benefit insurer providing or offering a small group health plan from cancelling or not renewing except for specified reasons or refusing to provide coverage based solely on the nature of the employer's business or industry. Limits premium rate increases and variation (across and within business classes) in index rates. Allows an insurer to use industry as a case characteristic in establishing rates.

(Sec. 202) Restricts preexisting condition limitations or exclusions. Requires insurers offering coverage to a small employer to offer coverage to all eligible employees of the small employer and their dependents.

(Sec. 203) Amends the IRC to impose a penalty on the failure of an insurer or group health plan to meet the requirements of this subtitle.

Subtitle B: Guaranteeing Portability of Health Insurance for Individuals - Declares that this subtitle applies only to health benefit plans delivered or issued to individuals in a State and does not apply to: (1) any employer-based plan; or (2) any eligible individual whose prior similar plan was provided by a State high risk pool, under titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act, or under another State or Federal program (unless the individual was previously covered as a State or Federal employee).

(Sec. 212) Requires an insurer, if an eligible individual or family applies for an individual plan, to either offer or deny coverage to all eligible individuals applying on the application. Regulates preexisting condition exclusions or limitations. Requires an insurer to offer, to a dependent who would otherwise lose eligibility because of certain events, continuation coverage identical to that previously issued.

(Sec. 213) Prohibits cancelling or not renewing plans except for specified reasons.

Subtitle C: Assuring Health Insurance Coverage for Uninsurable Individuals - Requires each health insurer, health service organization, and health maintenance organization to participate in a high risk health insurance pool in the State in which it operates. Requires that the pool assure the availability of qualified health insurance to uninsurable individuals. Funds the pool by an assessment against such entities on a pro rata basis of lives covered in the State. Allows the assessment to be added by those entities to the costs of their health insurance or coverage.

(Sec. 222) Outlines criteria for being considered: (1) uninsurable; and (2) eligible.

(Sec. 224) Limits premiums established under the pool.