Patients' Health Care Choice Act of 1999

TABLE OF CONTENTS:

Title I: HealthMarts

Title II: Health Care Access and Choice Through Individual

Membership Associations (IMAs)

Title III: Federal Matching Funding for State Insurance

Expenditures

Title IV: Small Business Access and Choice for Entrepreneurs

Act of 1999

Title V: Improvement to Access and Choice of Health Care

Title VI: Patient Access to Information

Patients' Health Care Choice Act of 1999 - Title I: HealthMarts - Amends the Public Health Service Act to create a new title on HealthMarts. Requires that HealthMarts: (1) be nonprofit entities composed of employers, employees, other individuals eligible to participate in the HealthMart, health care providers, and entities that underwrite or administer health benefits coverage; and (2) make available health coverage to all employers, eligible employees, and individuals at rates established by the insurance issuer on a policy or product specific basis. Deems HealthMarts group health plans for purposes of specified provisions of the Employee Retirement Income Security Act of 1974 (ERISA) and the Internal Revenue Code. Requires that coverage made available to an eligible employee or individual in a geographic area be offered to all eligible employees or individuals in the same area.

Declares that the HealthMart: (1) provides coverage only through contracts with issuers and does not assume insurance risk; (2) provides administrative services for purchasers; and (3) collects and disseminates consumer information on all offered coverage options.

Requires that HealthMart coverage provide full portability of creditable coverage for individuals who remain members of the same HealthMart, notwithstanding that they change employers, and notwithstanding that they terminate the employment, if the HealthMart permits individual enrollment.

Allows HealthMart coverage to include coverage through a health maintenance organization (HMO), a preferred provider or licensed provider-sponsored organization, an insurance company, a medical savings or flexible spending account, a point-of-service option, or any combination of those coverages.

Requires a HealthMart to permit any employer or individual to contract for coverage, and prohibits varying eligibility conditions. Prohibits the purchaser from obtaining or sponsoring coverage other than through the HealthMart. Prohibits enrollment discrimination based on health.

Requires HealthMarts to make at least two coverage options available, at least one of which is a non-network option.

Supersedes certain related State laws.

Provides for the application of: (1) certain existing ERISA and Public Health Service Act requirements; and (2) renewability requirements when the contract between a HealthMart and an issuer is terminated.

Title II: Health Care Access and Choice Through Individual Membership Associations (IMAs) - Creates a new Public Health Service Act title on Individual Membership Associations (IMAs), defining IMA to mean an entity that: (1) has been in existence for at least five years for purposes other than obtaining insurance; (2) does not condition membership an health factors; (3) makes health coverage available to all IMA members and their dependents through an HMO, a preferred provider or licensed provider-sponsored organization, an insurance company, a medical savings or flexible spending account, a point-of-service option, or any combination of those coverages; and (4) does not make coverage available other than in connection with an IMA member. Supersedes certain related State laws.

Title III: Federal Matching Funding for State Insurance Expenditures - Requires that each State receive from the Secretary of Health and Human Services an amount equal to 50 percent of the funds expended by the State for a health benefits high risk pool, reinsurance pool, or other risk adjustment mechanism to subsidize the purchase of private health insurance.

Title IV: Affordable Health Coverage for Employees of Small Businesses - Small Business Access and Choice for Entrepreneurs Act of 1999 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to establish rules governing health plans sponsored by certain associations, including requirements for: (1) certification; (2) sponsors and boards of trustees, and treatment of franchised networks and collectively bargained plans; (3) participation and coverage of employers and individuals and of previously uninsured employees; (4) plan documents, contribution rates, and benefit options; (5) maintenance of reserves, excess-stop loss insurance, and solvency indemnification for plans providing health benefits in addition to health insurance coverage; (6) applications and related reporting; (7) notice for voluntary termination; and (8) corrective actions and mandatory termination.

(Sec. 402) Directs the Secretary of Labor to apply, to the appropriate Federal district court, to be appointed trustee of certain insolvent association health plans which provide health benefits in addition to health insurance coverage.

Allows a State to impose a contribution tax on an association health plan that begins operations in such State after the enactment of this Act.

(Sec. 403) Revises requirements for treatment of single employer arrangements.

(Sec. 404) Revises requirements for certain collectively bargained arrangements.

(Sec. 405) Sets forth enforcement requirements relating to association health plans.

(Sec. 406) Sets forth State responsibilities, and requirements for cooperation between Federal and State authorities, with respect to association health plans.

(Sec. 407) Prescribes special rules for certain existing health benefits programs.

Title V: Improvement to Access and Choice of Health Care - Amends the Internal Revenue Code to exclude any compensating coverage employer payment from the gross income of an eligible employee who elects not to participate in an employer-subsidized health plan.

(Sec. 501) Defines compensating coverage payment as: (1) any payment made by the employer for qualified health insurance specified by the employee which covers all of the individuals who, but for such election, would be covered under the employer's subsidized health plan; and (2) any payment made by the employer to any medical savings account (MSA) of such employee or spouse.

Defines employer health plan contribution as the applicable premium for the employee reduced by the employee's share of such premium, as determined by the employer on an actuarial basis taking into account the employee's age, sex, and geography and similarly situated beneficiaries.

Specifies conditions on employer participation in a compensating coverage payment program. Excludes from such a program: (1) any employee covered under a subsidized health plan of another employer or of an employer of the employee's spouse; (2) any employee who normally works less than 25 hours per week; (3) any employee who normally works during not more than six months during any year; (4) any employee under age 21; and (5) any employee covered by a collective bargaining agreement.

Requires an employer to report health plan contributions on an employee's W-2 form.

(Sec. 502) Allows a tax credit to an individual for a portion of the amount paid during the taxable year for qualified health insurance for coverage of the taxpayer, his spouse, and dependents. Specifies a formula for determination of such credit. Disallows the credit for: (1) any amounts paid for coverage under any subsidized health plan maintained by any employer of the taxpayer or of the taxpayer's spouse; or (2) any taxable year for which any compensating coverage payment is excluded from the taxpayer's gross income.

Sets forth requirements for qualified health insurance, including no exclusion from, or limitation on, coverage for any preexisting medical condition of certain applicants.

Terminates such credit as of December 31, 2002.

(Sec. 503) - Medical Savings Account Effectiveness Act of 1999 - Amends the Internal Revenue Code to repeal: (1) the limitations on the number of taxpayers having MSAs; and (2) the limitation of MSAs to small employers (thus permitting all employers to offer them).

Revises the amount of deduction allowed for contributions to MSAs to set the monthly limitation at one-12th of the annual deductible of the individual's coverage under the high deductible health plan.

Revises the denial of an employee's MSA contribution deduction if an employer makes income-excludible contributions to the employee's MSA. Reduces the limitation on such a deduction by the amount of an employer's contribution (thus allowing both employers and employees to contribute to the employee's MSA).

Reduces the minimum deductibles under a high deductible health plan: (1) from $1,500 to $1,000 for self-only coverage; and (2) from $3,000 to $2,000 for family coverage.

Allows MSAs to be offered under cafeteria plans.

(Sec. 504) Increases the maximum deductibles under a high deductible health plan: (1) from $2,250 to $5,000 for self-only coverage; and (2) from $4,500 to $10,000 for family coverage.

Title VI: Patient Access to Information - Amends the Public Health Service Act to require each health insurance issuer offering coverage in connection with a group plan to provide: (1) the plan's Administrator with specified information on plan benefits, a participant's financial responsibilities, legal recourse options available for participants and beneficiaries, and a summary of information available on request; (2) to a participant or to an employee eligible to participate, in certain circumstances, the summary plan description (if requested, in an electronic format); and (3) prior notice to participants of exclusion of a specific drug or biological from any drug formulary that is used in the treatment of a chronic illness or disease.