Policy Documents

The Health Insurance Reform Act for Individual Coverage

January 9, 2001

In this model legislation, the bill's purpose is, 

to reform the individual health insurance market and, therefore, make individual and family medical insurance more available to people without group coverage. The bill accomplishes this by establishing predictable rate regulation standards for over-regulated state markets. Such regulatory reform encourages insurers to re-enter the individual insurance market with competitive pricing to reach portions of the uninsured population.

[It] would allow an insurer to guarantee the payment of a certain percentage of its premium income in benefits to policy holders. This percentage would be negotiated with state regulators. If total payout on claims at the end of a year fall short of the guaranteed percentage, policyholders would be refunded the difference. If payout exceeded the guarantee, the insurer would lose the difference, but could adjust its rates to avoid future losses and guard against insolvency. Refunds of less than $10.00 would be aggregated by the insurer and paid to the State Insurance Department. Refunds above $10.00 would be sent directly to the policy holders.