Comprehensive Health Care Improvement Act of 1979

Comprehensive Health Care Improvement Act of 1979 - Title I: Qualified Health Insurance Plans - Directs the Secretary of Health, Education, and Welfare to establish standards for qualified health insurance plans and procedures for the review and certification of such plans.

Certifies a plan as an "A" qualified plan if it meets any applicable State requirements with respect to accident and health insurance plans or nonprofit health service plans and meets or exceeds the following minimum standards: (1) benefits equal to at least 80 percent of the covered expenses in excess of an annual deductible not exceeding $150 per person; (2) a $3,000 annual limit on total out-of-pocket expenses for covered services; (3) a maximum lifetime benefit of at least $250,000; and (4) the $3,000 and $250,000 limits are not subject to change by use of an actuarially equivalent benefit.

Includes as "covered services": (1) hospital and physician services; (2) prescription drugs; (3) nursing home care; (4) home care services; (5) use of radium or other radioactive materials; (6) oxygen and anesthetics; (7) prosthesis, other than dental; (8) medical equipment (excluding eyeglasses and hearing aids); (9) x-rays; (10) certain oral surgery; (11) physical therapy; (12) ambulance service; (13) well baby care; (14) routine physicals; (15) multiphasic screening and other diagnostic testing; (16) a second opinion on surgical procedures costing more than $500; and (17) chiropractic services. Enumerates services and items not covered, such as injuries subject to workers' compensation laws and cosmetic surgery.

Deems a health maintenance organization (HMO) providing services pursuant to title XIII of the Public Health Service Act to be providing an "A" qualified plan.

Certifies as a "B" plan a plan which meets the minimum standards of an "A" plan except that the annual deductible does not exceed $500 per person. Certifies as a "C" plan a plan which meets the minimum standards of an "A" plan except that the annual deductible does not exceed $1,000 per person.

Certifies a plan which provides benefits to persons over 65 as a qualified Medicare supplement plan if it: (1) provides complementary or supplemental benefits to the benefits provided under title XVIII (Medicare) of the Social Security Act; (2) provides coverage of 50 percent of the deductibles and copayments required under title XVIII, 80 percent of the charges for services covered under this Act and is not subject to a maximum lifetime benefit of less than $100,000; and (3) limits to not more than $1,000 the total annual out-of-pocket expenses for services covered under this Act.

Directs the Secretary to provide for the review and certification, by the Commissioner of each State, of qualified plans offered in the State, upon assurance that such review and certification will comply with this Act.

Prohibits any entity from describing for purposes of sale a plan of health coverage as: (1) a qualified plan unless such plan is qualified under this Act; or (2) a particular type of qualified plan unless such plan meets the standards for such type under this Act. Makes any violations of this prohibition an unfair practice under the Federal Trade Commission Act.

Requires an employer having an average of not less than ten employees annually to make available a plan of health coverage which: (1) has been certified as an "A" or "B" or supplemental health benefits plan; (2) is a qualified convertible plan; and (3) provides for the option of coverage of the employee's spouse and children. Defines the term "qualified convertible plan" to mean a plan of health coverage which permits each individual in the plan to convert to an individual coverage qualified plan and which provides that in the case of the death of the individual in whose name the contract was issued every other individual covered may elect to continue their coverage.

Subjects any employer who knowingly fails to comply with such requirements to a civil penalty. Allows an employee to enjoin such violation in State or Federal court.

Amends title XIX (Medicaid) of the Social Security Act to require a State Medicaid plan to provide for the establishment and operation of a comprehensive health association in the State and a comprehensive health insurance plan. Defines the term "comprehensive health insurance plan" to mean qualified policies of insurance and contracts of HMO coverage offered in the State.

Directs each State commissioner of insurance to supervise the creation of the comprehensive health association in the State and to formulate policies to advance the purposes of this title.

Requires each State to establish a comprehensive health association with membership consisting of all insurers, self-insurers, fraternal beneficiary associations, and HMOs licensed in the State. Requires such entities to maintain their membership as a condition of doing accident and health insurance, self-insurance, or HMO business in the State.

Allows an association to provide for the reinsuring of risks incurred as a result of issuing qualified plans by members. Requires any member electing to reinsure risks of specified categories of coverage to: (1) enter into a contract with the association, which may provide for the pooling of members' risks reinsured through the association; and (2) reinsure the risk of the coverage of every life covered under every health policy issued in that category.

Requires each association through its comprehensive health insurance plan to offer: (1) policies which provide the benefits of an "A", "B", and "C" qualified plans and of a qualified Medicare supplement plan; and (2) HMO contracts in those areas of the State where a HMO has agreed to make the coverage available and has been selected as a writing carrier. Specifies formulas for setting the premiums of such plans for the first 18 months of operation of each comprehensive health insurance plan. Requires each association to design premium schedules thereafter which are self-supporting and based on generally accepted actuarial principles.

Directs each writing carrier to submit to the association and commissioner in the State a monthly report on the operation of the State comprehensive health insurance plan.

Requires such plan to be open for enrollment by residents of the State, who may enroll by submitting a certificate of eligibility containing specified information to the writing carrier.

Directs each association in a State to disseminate appropriate information to 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 who refers an applicant to the plan (if the application is accepted), but limits the amount paid for such purposes to 12.5 percent of the premiums paid to the carrier.

Title II: Program of Assistance to States for Assisting Low-Income Individuals to Purchase Comprehensive Health Insurance - Comprehensive Health Insurance Assistance Act of 1979 - Amends the Social Security Act by adding a new title XXI: Grants to States for Assistance to Low-Income Individuals in the Purchase of Comprehensive Health Insurance.

Provides grants to States for assisting low-income individuals in the purchase of comprehensive health insurance. Sets forth requirements for a State plan to receive such assistance, including that a plan make partial or full assistance available to low-income individuals, as determined by the State, for purchasing "A" or "B" qualified plans or qualified Medicare supplement plans.

Directs the Secretary to pay to a State which has a plan approved under this title an amount equal to 50 percent of the sums expended each quarter which are attributable to such assistance or administrative expenses, but prohibits such amount from exceeding the product of $1.25 and the population.

Amends title XIX (Medicaid) of the Social Security Act to authorize the Secretary to approve a State plan which allows a portion of the income and resources of a married couple, one spouse of which is in a skilled nursing or intermediate care facility, to be disregarded for the purpose of determining such couple's income.

Title III: Program of Assistance to States for Assisting Individuals Who Incur Catastrophic Expenses for Health Care - Catastrophic Health Care Expenses Assistance Act of 1979 - Amends the Social Security Act by adding a new title XXII: Grants to States for Assistance to Individuals Incurring Catastrophic Expenses for Health Care.

Provides grants to States for furnishing medical assistance for catastrophic illness. Sets forth requirements for a State plan to receive such assistance, including that a plan provide for paying: (1) at least 90 percent of all qualified expenses of an eligible individual in excess of the greater of (A) the sum of (i) 40 percent of his or her income under $15,000, (ii) 50 percent of income between $15,000 and $25,000, and (iii) 60 percent of income over $25,000, of (B) $2,500 (or a lower amount as the State may establish), for the 12-consecutive-month period in which the applicant becomes an eligible person; and (2) 100 percent of all qualified nursing home expenses of an eligible individual in excess of 20 percent (or a lower percentage as the State may establish) of his or her household income.

Directs the Secretary to pay to a State which has a plan approved under this title an amount equal to 50 percent of the sums expended each quarter which are attributable to such assistance or administrative expenses, but prohibits such amount from exceeding the product of $.25 and the population.

Prohibits payment under this title with respect to specified expenses.