S.B. 843

VETOES

(1)      AT LEAST 15% GREATER THAN THE ACTUARIAL VALUE OF THE LOW
LEVEL POLICY FORM COVERAGE OFFERED BY THE CARRIER IN THIS STATE; AND

(2)      AT LEAST 100% BUT NOT GREATER THAN 120% OF THE WEIGHTED
AVERAGE

(O) (1) "INDIVIDUAL HEALTH BENEFIT PLAN" MEANS:

(1) (I) A HEALTH BENEFIT PLAN OTHER THAN A CONVERTED POLICY
OR A PROFESSIONAL ASSOCIATION PLAN FOR ELIGIBLE INDIVIDUALS AND THEIR
DEPENDENTS; AND

(2) (II) A CERTIFICATE ISSUED TO AN ELIGIBLE INDIVIDUAL THAT
EVIDENCES COVERAGE UNDER A POLICY OR CONTRACT ISSUED TO A TRUST OR
ASSOCIATION OR OTHER SIMILAR GROUP OF INDIVIDUALS, REGARDLESS OF THE
SITUS OF DELIVERY OF THE POLICY OR CONTRACT, IF THE ELIGIBLE INDIVIDUAL
PAYS THE PREMIUM AND IS NOT BEING COVERED UNDER THE POLICY OR
CONTRACT UNDER EITHER FEDERAL OR STATE CONTINUATION OF BENEFITS
PROVISIONS.

(2)      "INDIVIDUAL HEALTH BENEFIT PLAN" DOES NOT INCLUDE
SHORT-TERM LIMITED DURATION INSURANCE.

(P) "LOW LEVEL POLICY FORM" MEANS A POLICY OR PLAN UNDER WHICH
THE ACTUARIAL VALUE OF THE BENEFIT UNDER THE COVERAGE IS AT LEAST 85%
BUT NOT GREATER THAN 100% OF THE WEIGHTED AVERAGE.

(Q) "PREEXISTING CONDITION" MEANS:

(1) A CONDITION EXISTING DURING A SPECIFIED PERIOD

IMMEDIATELY PRECEDING THE EFFECTIVE DATE OF COURAGE THAT WOULD
HAVE CAUSED AN ORDINARILY PRUDENT PERSON TO SEEK MEDICAL ADVICE,
DIAGNOSIS, CARE, OR TREATMENT, OR

(3)      A CONDITION FOR WHICH MEDICAL ADVICE, DIAGNOSIS, CARE, OR
TREATMENT WAS RECOMMENDED OR RECEIVED DURING A SPECIFIED PERIOD
IMMEDIATELY PRECEDING THE EFFECTIVE DATE OF THIS COVERAGE A CONDITION
THAT WAS PRESENT BEFORE THE DATE OF ENROLLMENT FOR COVERAGE,
WHETHER OR NOT ANY MEDICAL ADVICE, DIAGNOSIS, CARE. OR TREATMENT WAS
RECOMMENDED OR RECEIVED BEFORE THAT DATE.

(R) "PREEXISTING CONDITION PROVISION" MEANS A PROVISION IN A
HEALTH BENEFIT PLAN THAT DENIES, EXCLUDES, OR LIMITS BENEFITS FOR AN
ENROLLEE FOR EXPENSES OR SERVICES RELATED TO A PREEXISTING CONDITION.

(S) "WAITING PERIOD" MEANS THE PERIOD OF TIME THAT MUST PASS
BEFORE AN INDIVIDUAL IS ELIGIBLE TO BE COVERED FOR BENEFITS UNDER THE
TERMS OF A GROUP HEALTH BENEFIT PLAN.

(T) (1) "WEIGHTED AVERAGE" MEANS THE AVERAGE ACTUARIAL VALUE
OF THE BENEFITS PROVIDED BY:

- 4652 -