WILLIAM DONALD SCHAEFER, Governor                        H.B. 1563

(II) IN DETERMINING THE LENGTH OF TIME THAT A PREEXISTING
CONDITION PROVISION APPLIES TO AN INDIVIDUAL, A HEALTH BENEFIT PLAN
SHALL CREDIT THE TIME THE INDIVIDUAL WAS PREVIOUSLY COVERED BY PUBLIC
OR PRIVATE HEALTH INSURANCE OR BY ANOTHER HEALTH BENEFIT
ARRANGEMENT. AN INDIVIDUAL IS DEEMED TO HAVE BEEN PREVIOUSLY COVERED

IF:

1. AN INTERRUPTION OF NO MORE THAN 60 DAYS HAD
OCCURRED FROM THE TIME THE INDIVIDUAL WAS COVERED BY ANY PUBLIC OR
PRIVATE HEALTH INSURANCE OR BY ANOTHER HEALTH BENEFIT ARRANGEMENT
UNTIL THE EFFECTIVE DATE OF THE NEW COVERAGE; OR

2. AN INTERRUPTION OF NO MORE THAN 60 DAYS HAD
OCCURRED FROM THE TIME THE INDIVIDUAL WAS COVERED BY ANY PUBLIC OR
PRIVATE HEALTH INSURANCE OR BY ANOTHER HEALTH BENEFIT ARRANGEMENT
UNTIL THE INDIVIDUAL ELECTED TO ENROLL BUT AGAINST WHOM A HEALTH
BENEFIT PLAN IMPOSED A WAITING PERIOD PRIOR TO ENROLLMENT.

(4) AN EXCLUSION OF COVERAGE FOR PREEXISTING CONDITIONS MAY
NOT BE APPLIED TO HEALTH CARE SERVICES FURNISHED FOR NEWBORNS.

(B) NOTWITHSTANDING SUBSECTION (A) OF THIS SECTION, FOR EMPLOYEES
OF EMPLOYERS WITH MORE THAN 50 EMPLOYEES AND FOR INDIVIDUALS, A LATE
ENROLLEE MAY BE SUBJECT TO A 12 MONTH PREEXISTING CONDITION PROVISION.

(C) A HEALTH BENEFIT PLAN THAT DOES NOT USE A PREEXISTING
CONDITION PROVISION MAY IMPOSE ON ENROLLEES A WAITING PERIOD NOT TO
EXCEED 30 DAYS BEFORE THE COVERAGE UNDER THE HEALTH BENEFIT PLAN IS
EFFECTIVE. DURING THE WAITING PERIOD, THE HEALTH BENEFIT PLAN IS NOT
REQUIRED TO PROVIDE HEALTH CARE SERVICES OR BENEFITS AND A PREMIUM
MAY NOT BE CHARGED TO THE ENROLLEE.

(D) FOR ENROLLMENT IN A HEALTH CARE PLAN AS AN EMPLOYEE OF A
MEMBER EMPLOYER, FOR A PERIOD NOT TO EXCEED 6 MONTHS FROM THE DATE AN
INDIVIDUAL BECOMES AN EMPLOYEE, A HEALTH BENEFIT PLAN MAY REQUIRE
DEDUCTIBLES AND COST SHARING FOR BENEFITS FOR A PREEXISTING CONDITION
OF THE EMPLOYEE IN AMOUNTS NOT EXCEEDING ONE AND ONE HALF TIMES THE
AMOUNT OF THE STANDARD DEDUCTIBLES AND COST SHARING OF OTHER
EMPLOYEES, IF THE EMPLOYEE WAS NOT PREVIOUSLY COVERED BY PUBLIC OR
PRIVATE HEALTH INSURANCE OR BY ANOTHER HEALTH BENEFIT ARRANGEMENT,
AND THE EMPLOYEE WAS NOT PREVIOUSLY EMPLOYED BY THAT EMPLOYER.

745. COMMUNITY RATING.

(A) (1) IN ESTABLISHING A COMMUNITY RATE FOR THE COMPREHENSIVE
STANDARD HEALTH BENEFIT PLAN AND FOR EACH SUPPLEMENTAL BENEFIT, A
CARRIER SHALL USE A RATING METHODOLOGY THAT IS BASED ON THE
EXPERIENCE OF THE ENTIRE POOL OF RISKS COVERED BY THE PLAN ON A
STATEWIDE BASIS WITHOUT REGARD TO HEALTH STATUS OR OCCUPATION OR ANY
OTHER FACTOR NOT SPECIFICALLY AUTHORIZED UNDER THIS SUBSECTION.

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