Commissioner of Insurance; require to establish a state health insurance exchange.

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To: State Affairs
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Zuber

HOUSE BILL NO. 605
(As Passed the House)

AN ACT TO AMEND SECTION 83-9-253, MISSISSIPPI CODE OF 1972, 1
TO REQUIRE THE COMMISSIONER OF INSURANCE TO ESTABLISH AND 2
IMPLEMENT A STATE HEALTH INSURANCE EXCHANGE; TO BRING FORWARD 3
SECTIONS 83-9-251, 83-9-255 AND 83-9-257, MISSISSIPPI CODE OF 4
1972, WHICH PROVIDE FOR CERTAIN DEFINITIONS AND ADDITIONAL 5
AUTHORITY RELATED TO A STATE HEALTH INSURANCE EXCHANGE, FOR THE 6
PURPOSE OF POSSIBLE AMENDMENT; TO AMEND SECTION 83-9-214, 7
MISSISSIPPI CODE OF 1972, TO PROVIDE THAT ANY FUNDS HELD BY THE 8
COMPREHENSIVE HEALTH INSURANCE RISK POOL ASSOCIATION ON JUNE 30, 9
2026, SHALL BE TRANSFERRED TO THE MISSISSIPPI HEALTH INSURANCE 10
STATE EXCHANGE TRUST FUND; TO BRING FORWARD SECTIONS 83-9-201, 11
83-9-203, 83-9-205, 83-9-207, 83-9-209, 83-9-211, 83-9-211.1, 12
83-9-212, 83-9-213, 83-9-215, 83-9-217, 83-9-219, 83-9-221 AND 13
83-9-222, MISSISSIPPI CODE OF 1972, WHICH ESTABLISH THE 14
COMPREHENSIVE HEALTH INSURANCE RISK POOL ASSOCIATION AND PROVIDE 15
FOR ITS DUTIES AND RESPONSIBILITIES, FOR THE PURPOSE OF POSSIBLE 16
AMENDMENT; AND FOR RELATED PURPOSES. 17
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 18
SECTION 1. Section 83-9-253, Mississippi Code of 1972, is 19
amended as follows: 20
83-9-253. The Commissioner of Insurance shall have the 21
authority to: 22
(a) Establish any program, promulgate any rule, policy, 23
guideline, or plan; or change any program, rule, policy or 24
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guideline to implement, establish, create, administer, or 25
otherwise operate an exchange; 26
(b) Apply for, accept or expend federal monies related 27
to the creation, implementation or operation of an exchange; 28
(c) Establish any advisory board or committee the 29
Commissioner deems necessary for providing recommendations on the 30
creation, implementation or operation of an exchange; 31
(d) Use the services and funds of the Comprehensive 32
Health Insurance Risk Pool Association and the Comprehensive 33
Health Insurance Risk Pool Board to fulfill the purposes of this 34
section; and 35
(e) Engage such actuarial and other assistance as shall 36
be necessary to carry out the duties of the department under 37
Sections 83-9-251 through 83-9-257. The engagement of such 38
services shall not be subject to the procurement provisions of 39
Section 31-7-13. 40
The Commissioner of Insurance * * * shall, immediately 41
after * * * the effective date of this act, begin action to carry 42
out the authority provided in this section. 43
SECTION 2. Section 83-9-251, Mississippi Code of 1972, is 44
brought forward as follows: 45
83-9-251. For the purposes of Sections 83-9-251 through 46
83-9-257, the following words and phrases shall have the meanings 47
as defined in this section unless the context clearly indicates 48
otherwise: 49
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(a) "Exchange" means a state, federal, or partnership 50
exchange or marketplace operating in Mississippi pursuant to 51
Section 1311 of the Federal Patient Protection and Affordable Care 52
Act (Public Law 111-148), as amended by the federal Health Care 53
and Education Reconciliation Act of 2010 (Public Law 111-152), and 54
regulations and guidance issued under those acts. 55
(b) "Comprehensive Health Insurance Risk Pool 56
Association" means the mechanism as established in Sections 57
83-9-201 through 83-9-223. 58
(c) "Comprehensive Health Insurance Risk Pool Board" 59
shall have the same meaning as provided in Section 83-9-205(b). 60
SECTION 3. Section 83-9-255, Mississippi Code of 1972, is 61
brought forward as follows: 62
83-9-255. There is created in the State Treasury a special 63
fund to be designated as the "Mississippi Health Insurance State 64
Exchange Trust Fund." The Commissioner of Insurance is authorized 65
to expend monies from this fund for the payment of the expenses 66
incurred in the creation, implementation or operation of an 67
exchange. The amount to be contributed annually to the special 68
fund shall be fixed each year by the commissioner as a percentage 69
of fees assessed on the gross premiums charged on all policies 70
sold on the exchange. This percentage shall not be more than 71
three and a half percent (3.5%), unless otherwise approved by the 72
Legislature. The user fees shall be collected directly by the 73
exchange on all policies sold and remitted to the special fund on 74
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a monthly basis. Unexpended amounts remaining in the fund at the 75
end of a fiscal year shall not lapse into the State General Fund, 76
and any interest earned on amounts in the special fund shall be 77
deposited to the credit of the special fund. 78
SECTION 4. Section 83-9-257, Mississippi Code of 1972, is 79
brought forward as follows: 80
83-9-257. The Comprehensive Health Insurance Risk Pool 81
Association shall have the authority to develop and fund an online 82
portal that shall be available to all Mississippians to assist 83
consumers in selection of a health plan. This program shall have 84
the capacity to aggregate information regarding providers, drug 85
coverage and pricing that would allow consumers to make informed 86
decisions in selecting a health plan. 87
SECTION 5. Section 83-9-214, Mississippi Code of 1972, is 88
amended as follows: 89
83-9-214. * * * Any funds held by the Comprehensive Health 90
Insurance Risk Pool Association * * * on June 30, 2026, 91
shall * * * be transferred to the Mississippi Health Insurance 92
State Exchange Trust Fund. 93
SECTION 6. Section 83-9-201, Mississippi Code of 1972, is 94
brought forward as follows: 95
83-9-201. Sections 83-9-201 through 83-9-222 shall be known 96
and may be cited as the "Comprehensive Health Insurance Risk Pool 97
Association Act." 98
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SECTION 7. Section 83-9-203, Mississippi Code of 1972, is 99
brought forward as follows: 100
83-9-203. It is the purpose of the Legislature to establish 101
a mechanism to allow the availability of a health insurance 102
program and to allow the availability of health and accident 103
insurance coverage to those citizens of this state who (a) because 104
of health conditions cannot secure such coverage, or (b) desire to 105
obtain or continue health insurance coverage under any state or 106
federal program designed to enable persons to obtain or maintain 107
health insurance coverage. It is further the purpose of the 108
Legislature to establish a mechanism to assist the Commissioner of 109
Insurance with the creation, implementation or operation of an 110
exchange. 111
SECTION 8. Section 83-9-205, Mississippi Code of 1972, is 112
brought forward as follows: 113
83-9-205. As used in Sections 83-9-201 through 83-9-222, the 114
following words shall have the meaning ascribed herein unless the 115
context clearly requires otherwise: 116
(a) "Association" means the Comprehensive Health 117
Insurance Risk Pool Association. 118
(b) "Board" means the board of directors of the 119
association. 120
(c) "Church plan" has the meaning given such term under 121
Section 3(33) of the Employee Retirement Income Security Act of 122
1974. 123
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(d) "Commissioner" means the Commissioner of Insurance 124
of this state. 125
(e) "Creditable coverage" has the meaning set forth in 126
the federal Health Insurance Portability and Accountability Act of 127
1996 (26 USCS Section 9801(c)(1)). A period of creditable 128
coverage shall not be counted, with respect to the enrollment of 129
an individual who seeks coverage under the plan, if, after such 130
period and before the enrollment date, the individual experiences 131
a significant break in coverage. 132
(f) "Dependent" means a resident spouse or resident 133
unmarried child under the age of nineteen (19) years, a child who 134
is a student under the age of twenty-three (23) years and who is 135
financially dependent upon the parent or a child of any age who is 136
disabled and dependent upon the parent. 137
(g) "Excess or stoploss coverage" means an arrangement 138
whereby an insurer insures against the risk that any one (1) claim 139
will exceed a specific dollar amount or that the entire loss of a 140
self-insurance plan will exceed a specific amount. 141
(h) "Federally defined eligible individual" means an 142
individual: 143
(i) For whom, as of the date on which the 144
individual seeks coverage under the plan, the aggregate of the 145
periods of creditable coverage is eighteen (18) or more months; 146
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(ii) Whose most recent prior creditable coverage 147
was under a group health plan, governmental plan, church plan or 148
health insurance coverage offered in connection with such a plan; 149
(iii) Who is not eligible for coverage under a 150
group health plan, Part A or Part B of Title XVIII of the Social 151
Security Act (Medicare), or a state plan under Title XIX of the 152
act (Medicaid) or any successor program, and who does not have 153
other health insurance coverage; 154
(iv) With respect to whom the most recent coverage 155
within the period of aggregate creditable coverage was not 156
terminated based on a factor relating to nonpayment of premiums or 157
fraud; 158
(v) Who, if offered the option of continuation 159
coverage under a COBRA continuation provision or under a similar 160
state program, elected this coverage; and 161
(vi) Who has exhausted continuation coverage under 162
this provision or program, if the individual elected the 163
continuation coverage described in subparagraph (v). 164
(i) "Governmental plan" has the meaning given such term 165
under Section 3(32) of the Employee Retirement Income Security Act 166
of 1974 and any federal governmental plan. 167
(j) "Group health plan" means an employee welfare 168
benefit plan as defined in Section 3(1) of the Employee Retirement 169
Income Security Act of 1974 to the extent that the plan provides 170
medical care to employees or their dependents as defined under the 171
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terms of the plan directly or through insurance, reimbursement or 172
otherwise. 173
(k) "Health insurance coverage" means any hospital and 174
medical expense incurred policy, nonprofit health care services 175
plan contract, health maintenance organization subscriber contract 176
or any other health care plan or arrangement that pays for or 177
furnishes medical or health care services whether by insurance or 178
otherwise. 179
(i) "Health insurance coverage" shall not include 180
one or more, or any combination of, the following: 181
1. Coverage only for accident, or disability 182
income insurance, or any combination thereof; 183
2. Coverage issued as a supplement to 184
liability insurance; 185
3. Liability insurance, including general 186
liability insurance and automobile liability insurance; 187
4. Workers' compensation or similar 188
insurance; 189
5. Automobile medical payment insurance; 190
6. Credit-only insurance; 191
7. Coverage for on-site medical clinics; and 192
8. Other similar insurance coverage, 193
specified in federal regulations issued pursuant to Public Law 194
104-191, under which benefits for medical care are secondary or 195
incidental to other insurance benefits. 196
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(ii) "Health insurance coverage" shall not include 197
the following benefits if they are provided under a separate 198
policy, certificate or contract of insurance or are otherwise not 199
an integral part of the coverage: 200
1. Limited scope dental or vision benefits; 201
2. Benefits for long-term care, nursing home 202
care, home health care, community-based care, or any combination 203
thereof; or 204
3. Other similar, limited benefits specified 205
in federal regulations issued pursuant to Public Law 104-191. 206
(iii) "Health insurance coverage" shall not 207
include the following benefits if the benefits are provided under 208
a separate policy, certificate or contract of insurance, there is 209
no coordination between the provision of the benefits and any 210
exclusion of benefits under any group health plan maintained by 211
the same plan sponsor, and the benefits are paid with respect to 212
an event without regard to whether benefits are provided with 213
respect to such an event under any group health plan maintained by 214
the same plan sponsor: 215
1. Coverage only for a specified disease or 216
illness; or 217
2. Hospital indemnity or other fixed 218
indemnity insurance. 219
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(iv) "Health insurance coverage" shall not include 220
the following if offered as a separate policy, certificate or 221
contract of insurance: 222
1. Medicare supplemental health insurance as 223
defined under Section 1882(g)(1) of the Social Security Act; 224
2. Coverage supplemental to the coverage 225
provided under Chapter 55, Title 10, United States Code (Civilian 226
Health and Medical Program of the Uniformed Services (CHAMPUS)); 227
or 228
3. Similar supplemental coverage provided to 229
coverage under a group health plan. 230
(l) "Health maintenance organization" means any 231
organization authorized under the Health Maintenance Organization, 232
Preferred Provider Organization and Other Prepaid Health Benefit 233
Plans Protection Act, Section 83-41-301 et seq., to operate a 234
health maintenance organization in this state. 235
(m) "Insurer" means any entity that is authorized in 236
this state to write health insurance coverage or that provides 237
health insurance coverage in this state or any third-party 238
administrator. For the purposes of Sections 83-9-201 through 239
83-9-222, insurer includes an insurance company, nonprofit health 240
care services plan, fraternal benefit society, health maintenance 241
organization, to the extent consistent with federal law any 242
self-insurance arrangement covered by the Employee Retirement 243
Income Security Act of 1974, as amended, that provides health care 244
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benefits in this state, any other entity providing a plan of 245
health insurance coverage or health benefits subject to state 246
insurance regulation and any reinsurer reinsuring health insurance 247
coverage in this state. 248
(n) "Medicare" means coverage under both Parts A or B 249
of Title XVIII of the Social Security Act, 42 USC, Section 1395 et 250
seq., as amended. 251
(o) "Plan" means the health insurance plan adopted by 252
the board under Sections 83-9-201 through 83-9-222. 253
(p) "Resident" means an individual who is legally 254
located in the United States and has been legally domiciled in 255
this state for a period to be established by the board and subject 256
to the approval of the commissioner but in no event shall such 257
residency requirement be greater than one (1) year, except that 258
for a federally defined eligible individual, there shall not be a 259
prior residency requirement. 260
(q) "Agent" means a person who is licensed to sell 261
health insurance in this state or a third-party administrator. 262
(r) "Covered person" means any individual resident of 263
this state (excluding dependents) who is eligible to receive 264
benefits from any insurer. 265
(s) "Third-party administrator" means any entity who is 266
paying or processing health insurance claims for any Mississippi 267
resident. 268
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(t) "Reinsurer" means any insurer from whom any person 269
providing health insurance coverage for any Mississippi resident 270
procures insurance for itself in the insurer, with respect to all 271
or part of the health insurance coverage risk of the person. 272
(u) "Significant break in coverage" means a period of 273
sixty-three (63) consecutive days during all of which the 274
individual does not have any creditable coverage, except that 275
neither a waiting period nor an affiliation period is taken into 276
account in determining a significant break in coverage. 277
(v) "Exchange" means a state, federal, or partnership 278
exchange or marketplace operating in Mississippi pursuant to 279
Section 1311 of the Federal Patient Protection and Affordable Care 280
Act (Public Law 111-148), as amended by the federal Health Care 281
and Education Reconciliation Act of 2010 (Public Law 111-152), and 282
regulations and guidance issued under those acts. 283
SECTION 9. Section 83-9-207, Mississippi Code of 1972, is 284
brought forward as follows: 285
83-9-207. (1) Every insurer shall participate in the 286
association. 287
(2) The requirements of this plan shall become effective 288
April 15, 1991. The policies shall be available for sale January 289
1, 1992. 290
SECTION 10. Section 83-9-209, Mississippi Code of 1972, is 291
brought forward as follows: 292
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83-9-209. (1) Any individual who is and continues to be a 293
resident shall be eligible for coverage under this plan if 294
evidence is provided of: 295
(a) A notice of rejection or refusal to issue health 296
insurance coverage for health reasons by one (1) insurer; 297
(b) A refusal by an insurer to issue health insurance 298
coverage except with material underwriting restriction; or 299
(c) A refusal by an insurer to issue health insurance 300
coverage except at a rate exceeding the plan rate. 301
(2) The board shall develop a procedure for eligibility for 302
coverage by the association for any natural person who changes his 303
domicile to this state and who at the time domicile is established 304
in this state is insured by an organization similar to the 305
association. The eligible maximum lifetime benefits for such 306
covered person shall not exceed the lifetime benefits available 307
through the association, less any benefits received from a similar 308
organization in the former domiciliary state. 309
(3) The board may promulgate a list of medical or health 310
conditions for which a person shall be eligible for plan coverage 311
without applying for health insurance coverage under subsection 312
(1) of this section. Persons who can demonstrate the existence or 313
history of any medical or health conditions on such list 314
promulgated by the board may not be required to provide the 315
evidence specified in subsection (1) of this section. Any such 316
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list previously promulgated by the board may be amended or 317
repealed by the board from time to time as may be appropriate. 318
(4) A person shall not be eligible for coverage under this 319
plan if: 320
(a) The person has or obtains health insurance 321
coverage, or would be eligible to have coverage if the person 322
elected to obtain it; except that: 323
(i) A person may maintain other coverage for the 324
period of time the person is satisfying a preexisting condition 325
waiting period under a plan policy; and 326
(ii) A person may maintain plan coverage for the 327
period of time the person is satisfying a preexisting condition 328
waiting period under another health insurance policy intended to 329
replace the plan policy. 330
(b) The person is determined to be eligible for health 331
care benefits under the Mississippi Medicaid Law, Section 332
43-13-101 et seq., or Medicare. 333
(c) The person previously terminated plan coverage 334
unless twelve (12) months have elapsed since the person's latest 335
termination. 336
(d) The plan has paid out One Million Dollars 337
($1,000,000.00) in benefits on behalf of the person. The lifetime 338
maximum shall be One Million Dollars ($1,000,000.00). 339
(e) The person is an inmate or resident of a public 340
institution. 341
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(f) The person's premiums are paid for or reimbursed 342
under any government sponsored program or by any government agency 343
or health care provider, except as an otherwise qualifying 344
full-time employee, or dependent thereof, of a government agency 345
or health care provider. 346
(5) The coverage of any person shall cease: 347
(a) On the date a person is no longer a resident of 348
this state; 349
(b) Upon the death of the covered person; 350
(c) On the date state law requires cancellation of the 351
policy; or 352
(d) At the option of the association, thirty (30) days 353
after the association makes any inquiry concerning the person's 354
eligibility or place of residence to which the person does not 355
reply. 356
(6) The coverage of any person who ceases to meet the 357
eligibility requirements of this section may be terminated 358
immediately. 359
(7) It shall constitute an unfair trade practice for any 360
insurer, insurance agent or broker, employer or third-party 361
administrator to refer an individual employee or a dependent of an 362
individual employee to the association, or to arrange for an 363
individual employee or a dependent of an individual employee to 364
apply to the program, for the purpose of separating such employee 365
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or dependent from a group health benefits plan provided in 366
connection with the employee's employment. 367
SECTION 11. Section 83-9-211, Mississippi Code of 1972, is 368
brought forward as follows: 369
83-9-211. (1) There is created a nonprofit legal entity to 370
be known as the "Comprehensive Health Insurance Risk Pool 371
Association." All insurers, as a condition of doing business, 372
shall be members of the association. 373
(2) (a) The association shall operate subject to the 374
supervision and approval of an eleven-member board of directors 375
consisting of: 376
(i) Six (6) members appointed by the Insurance 377
Commissioner. Two (2) of the commissioner's appointees shall be 378
chosen from the general public and shall not be associated with 379
the medical profession, a hospital or an insurer. Two (2) 380
appointees shall be representatives of medical providers. One (1) 381
appointee shall be a representative of businesses employing fewer 382
than one hundred (100) employees. One (1) appointee shall be a 383
representative of health insurance agents. Any board member 384
appointed by the commissioner may be removed and replaced by him 385
at any time without cause. 386
(ii) Three (3) members appointed by the 387
participating insurers, at least one (1) of whom is a domestic 388
insurer. 389
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(iii) The Chair of the Senate Insurance Committee 390
and the Chair of the House Insurance Committee, or their 391
designees, who shall be nonvoting, ex officio members of the 392
board. 393
(iv) Of those initial members appointed by the 394
Insurance Commissioner, one (1) shall serve for a term of one (1) 395
year, two (2) for a term of two (2) years, and one (1) for a term 396
of three (3) years. Of those initial members appointed by the 397
participating insurers, one (1) shall serve for a term of one (1) 398
year, one (1) shall serve for a term of two (2) years, and one (1) 399
shall serve for a term of three (3) years. The appointing 400
authority shall designate the period of service of each initial 401
appointee at the time of appointment. 402
(v) All appointments after the initial term shall 403
be for a term of three (3) years. 404
(b) The board of directors shall elect one (1) of its 405
members as chairman. 406
(c) Board members may be reimbursed from monies of the 407
association for actual and necessary expenses incurred by them as 408
members in the manner and amount provided in Section 25-3-41, 409
Mississippi Code of 1972, but shall not otherwise be compensated 410
for their services. 411
(3) The association shall adopt a plan in accordance with 412
Sections 83-9-201 through 83-9-222 and submit its articles, bylaws 413
and operating rules to the State Department of Insurance for 414
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approval. If the association fails to adopt such plan and 415
suitable articles, bylaws and operating rules within ninety (90) 416
days after the appointment of the board, the State Department of 417
Insurance shall adopt rules to effectuate the provisions of 418
Sections 83-9-201 through 83-9-222; and such rules shall remain in 419
effect until superseded by a plan and articles, bylaws and 420
operating rules submitted by the association and approved by the 421
State Department of Insurance. 422
(4) Individual board members shall not be liable and shall 423
be immune from suit at law or equity for any conduct performed in 424
good faith and which is within the subject matter over which they 425
have been given jurisdiction. 426
SECTION 12. Section 83-9-211.1, Mississippi Code of 1972, is 427
brought forward as follows: 428
83-9-211.1. The Comprehensive Health Insurance Risk Pool 429
Association shall have the authority to develop and fund an online 430
portal that shall be available to all Mississippians to assist 431
consumers in selection of a health plan. This program shall have 432
the capacity to aggregate information regarding providers, drug 433
coverage and pricing that would allow consumers to make informed 434
decisions in selecting a health plan. 435
SECTION 13. Section 83-9-212, Mississippi Code of 1972, is 436
brought forward as follows: 437
83-9-212. Neither the board nor its employees shall be liable for 438
any obligations of the association. There shall be no liability 439
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on the part of and no cause of action shall arise against any 440
member insurer or its agents or employees, the association or its 441
agents or employees, members of the board of directors or the 442
commissioner or his representatives for any action or omission by 443
them in the performance of their powers and duties under Sections 444
83-9-201 through 83-9-222. The board may provide in its bylaws or 445
rules for indemnification of, and legal representation for, its 446
members and employees. 447
SECTION 14. Section 83-9-213, Mississippi Code of 1972, is 448
brought forward as follows: 449
83-9-213. (1) The association shall: 450
(a) Establish administrative and accounting procedures 451
for the operation of the association. 452
(b) Establish procedures under which applicants and 453
participants in the plan may have grievances reviewed by an 454
impartial body and reported to the board. 455
(c) Select an administering insurer in accordance with 456
Section 83-9-215. 457
(d) Collect the assessments provided in Section 458
83-9-217 from insurers and third-party administrators for claims 459
paid under the plan and for administrative expenses incurred or 460
estimated to be incurred during the period for which the 461
assessment is made. The level of payments shall be established by 462
the board. Assessments shall be collected pursuant to the plan of 463
operation approved by the board. In addition to the collection of 464
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such assessments, the association shall collect an organizational 465
assessment or assessments from all insurers as necessary to 466
provide for expenses which have been incurred or are estimated to 467
be incurred prior to receipt of the first calendar year 468
assessments. Organizational assessments shall be equal in amount 469
for all insurers, but shall not exceed One Hundred Dollars 470
($100.00) per insurer for all such assessments. Assessments are 471
due and payable within thirty (30) days of receipt of the 472
assessment notice by the insurer. 473
(e) Require that all policy forms issued by the 474
association conform to standard forms developed by the 475
association. The forms shall be approved by the State Department 476
of Insurance. 477
(f) Develop and implement a program to publicize the 478
existence of the plan, the eligibility requirements for the plan, 479
and the procedures for enrollment in the plan and to maintain 480
public awareness of the plan. 481
(2) The association may: 482
(a) Exercise powers granted to insurers under the laws 483
of this state. 484
(b) Take any legal actions necessary or proper for the 485
recovery of any monies due the association under Sections 83-9-201 486
through 83-9-222. There shall be no liability on the part of and 487
no cause of action of any nature shall arise against the 488
Commissioner of Insurance or any of his staff, the administrator, 489
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the board or its directors, agents or employees, or against any 490
participating insurer for any actions performed in accordance with 491
Sections 83-9-201 through 83-9-222. 492
(c) Enter into contracts as are necessary or proper to 493
carry out the provisions and purposes of Sections 83-9-201 through 494
83-9-222, including the authority, with the approval of the 495
commissioner, to enter into contracts with similar organizations 496
of other states for the joint performance of common administrative 497
functions or with persons or other organizations for the 498
performance of administrative functions. 499
(d) Sue or be sued, including taking any legal actions 500
necessary or proper to recover or collect assessments due the 501
association. 502
(e) Take any legal actions necessary to: 503
(i) Avoid the payment of improper claims against 504
the association or the coverage provided by or through the 505
association. 506
(ii) Recover any amounts erroneously or improperly 507
paid by the association. 508
(iii) Recover any amounts paid by the association 509
as a result of mistake of fact or law. 510
(iv) Recover other amounts due the association. 511
(f) Establish, and modify from time to time as 512
appropriate, rates, rate schedules, rate adjustments, expense 513
allowances, agents' referral fees, claim reserve formulas and any 514
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other actuarial function appropriate to the operation of the 515
association. Rates and rate schedules may be adjusted for 516
appropriate factors such as age, sex and geographic variation in 517
claim cost and shall take into consideration appropriate factors 518
in accordance with established actuarial and underwriting 519
practices. 520
(g) Issue policies of insurance in accordance with the 521
requirements of Sections 83-9-201 through 83-9-222. 522
(h) Appoint appropriate legal, actuarial and other 523
committees as necessary to provide technical assistance in the 524
operation of the plan, policy and other contract design, and any 525
other function within the authority of the association. 526
(i) Borrow money to effect the purposes of the 527
association. Any notes or other evidence of indebtedness of the 528
association not in default shall be legal investments for insurers 529
and may be carried as admitted assets. 530
(j) Establish rules, conditions and procedures for 531
reinsuring risks of member insurers desiring to issue plan 532
coverages to individuals otherwise eligible for plan coverages in 533
their own name. Provision of reinsurance shall not subject the 534
association to any of the capital or surplus requirements, if any, 535
otherwise applicable to reinsurers. 536
(k) Prepare and distribute application forms and 537
enrollment instruction forms to insurance producers and to the 538
general public. 539
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(l) Provide for reinsurance of risks incurred by the 540
association. 541
(m) Issue additional types of health insurance policies 542
to provide optional coverages, including Medicare supplemental 543
health insurance. 544
(n) Provide for and employ cost containment measures 545
and requirements including, but not limited to, disease management 546
programs and incentives for participation therein, preadmission 547
screening, second surgical opinion, concurrent utilization review 548
and individual case management for the purpose of making the 549
benefit plan more cost-effective. 550
(o) Design, utilize, contract or otherwise arrange for 551
the delivery of cost-effective health care services, including 552
establishing or contracting with preferred provider organizations, 553
health maintenance organizations and other limited network 554
provider arrangements. 555
(p) Serve as a mechanism to provide health and accident 556
insurance coverage to citizens of this state under any state or 557
federal program designed to enable persons to obtain or maintain 558
health insurance coverage. 559
(3) The commissioner may, by rule, establish additional 560
powers and duties of the board and may adopt such rules as are 561
necessary and proper to implement Sections 83-9-201 through 562
83-9-222. 563
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(4) The State Department of Insurance shall examine and 564
investigate the association and make an annual report to the 565
Legislature thereon. Upon such investigation, the Commissioner of 566
Insurance, if he deems necessary, shall require the board: (a) to 567
contract with an outside independent actuarial firm to assess the 568
solvency of the association and for consultation as to the 569
sufficiency and means of the funding of the association, and the 570
enrollment in and the eligibility, benefits and rate structure of 571
the benefits plan to ensure the solvency of the association; and 572
(b) to close enrollment in the benefits plan at any time upon a 573
determination by the outside independent actuarial firm that funds 574
of the association are insufficient to support the enrollment of 575
additional persons. In no case shall the commissioner require 576
such actuarial study any less than once every two (2) years. 577
SECTION 15. Section 83-9-215, Mississippi Code of 1972, is 578
brought forward as follows: 579
83-9-215. (1) The board shall select an insurer, through a 580
competitive bidding process, to administer the plan. The board 581
shall evaluate bids submitted under this subsection based on 582
criteria established by the board, which criteria shall include: 583
(a) The insurer's proven ability to handle large group 584
accident and health insurance. 585
(b) The efficiency of the insurer's claims-paying 586
procedures. 587
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(c) An estimate of total charges for administering the 588
plan. 589
(2) The administering insurer shall serve for a period of 590
three (3) years. At least one (1) year prior to the expiration of 591
each three-year period of service by an administering insurer, the 592
board shall invite all insurers, including the current 593
administering insurer, to submit bids to serve as the 594
administering insurer for the succeeding three-year period. The 595
selection of the administering insurer for the succeeding period 596
shall be made at least six (6) months prior to the end of the 597
current three-year period. 598
(3) The administering insurer shall: 599
(a) Perform all eligibility and administrative 600
claims-payment functions relating to the plan. 601
(b) Pay an agent's referral fee as established by the 602
board to each insurance agent who refers an applicant to the plan, 603
if the applicant's application is accepted. The selling or 604
marketing of plans shall not be limited to the administering 605
insurer or its agents. The referral fees shall be paid by the 606
administering insurer from monies received as premiums for the 607
plan. 608
(c) Establish a premium-billing procedure for 609
collection of premiums from insured persons. Billings shall be 610
made periodically as determined by the board. 611
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(d) Perform all necessary functions to assure timely 612
payment of benefits to covered persons under the plan, including: 613
(i) Making available information relating to the 614
proper manner of submitting a claim for benefits under the plan 615
and distributing forms upon which submissions shall be made. 616
(ii) Evaluating the eligibility of each claim for 617
payment under the plan. 618
(iii) Notifying each claimant within forty-five 619
(45) days after receiving a properly completed and executed proof 620
of loss whether the claim is accepted, rejected or compromised. 621
(iv) The board shall establish reasonable 622
reimbursement amounts for any services covered under the benefit 623
plans. 624
(e) Submit regular reports to the board regarding the 625
operation of the plan. The frequency, content and form of the 626
reports shall be as determined by the board. 627
(f) Following the close of each calendar year, 628
determine net premiums, reinsurance premiums less administrative 629
expense allowance, the expense of administration pertaining to the 630
reinsurance operations of the association, and the incurred losses 631
of the year and report this information to the association and the 632
State Department of Insurance. 633
(g) Pay claims expenses. If the payments by the 634
administering insurer for claims expenses exceed the portion of 635
premiums allocated by the board for payment of claims expenses, 636
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the board shall provide the administering insurer with additional 637
funds for payment of claims expenses. 638
(4) (a) The administering insurer shall be paid, as 639
provided in the contract of the association, for its direct and 640
indirect expenses incurred in the performance of its services. 641
(b) As used in this subsection, the term "direct and 642
indirect expenses" includes that portion of the audited 643
administrative costs, printing expenses, claims administration 644
expenses, management expenses, building overhead expenses and 645
other actual operating and administrative expenses of the 646
administering insurer which are approved by the board as allocable 647
to the administration of the plan and included in the bid 648
specifications. 649
SECTION 16. Section 83-9-217, Mississippi Code of 1972, is 650
brought forward as follows: 651
83-9-217. (1) For the purpose of providing the funds 652
necessary to carry out the powers and duties of the association, 653
the board of directors shall assess the member insurers at such 654
time and for such amounts as the board finds necessary. 655
Assessments shall be due not less than thirty (30) days after 656
prior written notice to the member insurers and shall accrue 657
interest at twelve percent (12%) per annum on and after the due 658
date. 659
(2) Each insurer shall be assessed an amount not to exceed 660
Three Dollars ($3.00) per covered person insured or reinsured by 661
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each insurer per month. There shall not be such assessment on any 662
insurer on policies or contracts insuring federal or state 663
employees. 664
(3) The board shall make reasonable efforts designed to 665
ensure that each covered person is counted only once with respect 666
to any assessment. For that purpose, the board shall require each 667
insurer that obtains excess or stoploss insurance to include in 668
its count of covered persons all individuals whose coverage is 669
insured (including by way of excess or stoploss coverage) in whole 670
or part. The board shall allow a reinsurer to exclude from its 671
number of covered persons those who have been counted by the 672
primary insurer or by the primary reinsurer or primary excess or 673
stoploss insurer for the purpose of determining its assessment 674
under this subsection. 675
(4) Each insurer's assessment may be verified by the board 676
based on annual statements and other reports deemed to be 677
necessary by the board. The board may use any reasonable method 678
of estimating the number of covered persons of an insurer if the 679
specific number is unknown. 680
(5) If assessments and other receipts by the association, 681
board or administering insurer exceed the actual losses and 682
administrative expenses of the plan, the excess shall be held at 683
interest and used by the board to offset future losses or to 684
reduce plan premiums. 685
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As used in this subsection, the term "future losses" includes 686
reserves for claims incurred but not reported. 687
(6) The commissioner may suspend or revoke, after notice and 688
hearing, the certificate of authority to transact insurance in 689
this state of any member insurer which fails to pay an assessment 690
or otherwise file any report or furnish information required to be 691
filed with the board pursuant to the board's direction that the 692
board determines is necessary in order for the board to perform 693
its duties under this section. As an alternative, the 694
commissioner may levy a forfeiture on any member insurer which 695
fails to pay an assessment when due. Such forfeiture shall not 696
exceed five percent (5%) of the unpaid assessment per month, but 697
no forfeiture shall be less than One Hundred Dollars ($100.00) per 698
month. 699
SECTION 17. Section 83-9-219, Mississippi Code of 1972, is 700
brought forward as follows: 701
83-9-219. The coverage provided by the plan shall be 702
directly insured by the association, and the policies shall be 703
issued through the administering insurer. Subject to the approval 704
of the commissioner, the association may close enrollment in, 705
and/or cease to offer the coverage provided by, the plan at any 706
time upon a determination by the board that the availability of 707
such coverage is no longer necessary. 708
SECTION 18. Section 83-9-221, Mississippi Code of 1972, is 709
brought forward as follows: 710
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83-9-221. (1) Coverage offered. (a) The plan shall offer 711
the coverage specified in this section for each eligible person 712
subject to the association's discretion to close enrollment and/or 713
cease offering coverage as authorized in Section 83-9-219. 714
(b) If an eligible person is also eligible for Medicare 715
coverage, the plan shall not pay or reimburse any person for 716
expenses paid by Medicare. 717
(c) Any person whose health insurance coverage is 718
involuntarily terminated for any reason other than nonpayment of 719
premium may apply for coverage under the plan. If such coverage 720
is applied for within sixty-three (63) days after the involuntary 721
termination and if premiums are paid for the entire period of 722
coverage, the effective date of the coverage shall be the date of 723
termination of the previous coverage. 724
(2) Major medical expense coverage. The coverage issued by 725
the plan, its schedule of benefits, exclusions and other 726
limitations shall be established by the board and may be amended 727
from time to time subject to the approval of the commissioner. 728
(3) In establishing the plan coverage, the board shall take 729
into consideration the levels of health insurance coverage 730
provided in the state and medical economic factors as may be 731
deemed appropriate; and promulgate benefit levels, deductibles, 732
coinsurance factors, exclusions and limitations determined to be 733
generally reflective of and commensurate with health insurance 734
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coverage provided through a representative number of large 735
employers in the state. 736
(4) Rates for coverages issued by the association may not be 737
unreasonable in relation to the benefits provided, the risk 738
experience and the reasonable expenses of providing the coverage. 739
(a) Separate schedules of premium rates based on age 740
may apply for individual risks. 741
(b) Rates are subject to approval by the State 742
Department of Insurance. 743
(c) Standard risk rates for coverages issued by the 744
association shall be established by the association, subject to 745
approval by the department, using reasonable actuarial techniques, 746
and shall reflect anticipated experiences and expenses of such 747
coverages for standard risks. 748
(d) The rating plan established by the association 749
shall initially provide for rates equal to one hundred fifty 750
percent (150%) of the average standard risk rates. Any changes in 751
the initial rates shall be based on experience of the plan and 752
shall reflect reasonably anticipated losses and expenses. 753
(e) No rate shall exceed one hundred seventy-five 754
percent (175%) of the standard risk rate. 755
(5) Preexisting conditions. An association policy may 756
contain provisions under which coverage is excluded during a 757
period of twelve (12) months following the effective date of 758
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coverage with respect to a given covered individual for any 759
preexisting condition, as long as: 760
(a) The condition manifested itself within a period of 761
six (6) months before the effective date of coverage; 762
(b) Medical advice or treatment was recommended or 763
received within a period of six (6) months before the effective 764
date of coverage. 765
(6) Other sources primary. (a) The association shall be 766
payer of last resort of benefits whenever any other benefit or 767
source of third-party payment is available. The coverage provided 768
by the association shall be considered excess coverage, and 769
benefits otherwise payable under association coverage shall be 770
reduced by all amounts paid or payable through any other health 771
insurance coverage and by all hospital and medical expense 772
benefits paid or payable under any workers' compensation coverage, 773
automobile medical payment or liability insurance whether provided 774
on the basis of fault or nonfault, and by any hospital or medical 775
benefits paid or payable by any insurer or insurance arrangement 776
or any hospital or medical benefits paid or payable under or 777
provided pursuant to any state or federal law or program. 778
(b) No amounts paid or payable by Medicare or any other 779
governmental program or any other insurance, or self-insurance 780
maintained in lieu of otherwise statutorily required insurance, 781
may be made or recognized as claims under such policy or be 782
recognized as or towards satisfaction of applicable deductibles or 783
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ST: Commissioner of Insurance; require to
establish a state health insurance exchange.
out-of-pocket maximums or to reduce the limits of benefits 784
available. 785
(c) The association shall have a cause of action 786
against a participant for the recovery of the amount of any 787
benefits paid to the participant which should not have been 788
claimed or recognized as claims because of the provisions of this 789
subsection or because otherwise not covered. Benefits due from 790
the association may be reduced or refused as a setoff against any 791
amount recoverable under this paragraph. 792
SECTION 19. Section 83-9-222, Mississippi Code of 1972, is 793
brought forward as follows: 794
83-9-222. Neither the participation in the association as 795
member insurers, the establishment of rates, forms or procedures 796
nor any other joint or collective action required by Sections 83-797
9-201 through 83-9-222 shall be the basis of any legal action, 798
criminal or civil liability or penalty against the association or 799
any member insurer. 800
SECTION 20. This act shall take effect and be in force from 801
and after July 1, 2026, and shall stand repealed on June 30, 2026. 802