Wyoming health insurance pool-2.

WORKING DRAFT

ORIGINAL SENATE

FILE

NO.
0115

ENROLLED ACT NO. 93, SENATE

FIFTY-NINTH LEGISLATURE OF THE STATE OF
WYOMING
2007 GENERAL SESSION

AN ACT relating to the Wyoming Health Insurance Pool Act; providing for separate eligibility classifications and premium rates as specified; amending insurance carrier assessments; providing an appropriation;
requiring a report;
and providing for an effective date.

Be It Enacted by the Legislature of the State of
Wyoming
:

Section 1.

W.S. 26
‑
43
‑
114 is created to read:

26
‑
43
‑
114.

Enrollment capacity planning.

The board shall annually estimate the funds available to the plan through premiums, assessments and legislative appropriations for the subsequent fiscal year and shall determine the maximum number of individuals who may be enrolled for that year without incurring total costs of operation in excess of estimated available funds. The board shall take steps necessary to assure that plan enrollment does not exceed the maximum enrollment capacity determined for that year. In determining enrollment capacity for purposes of this section, the board shall provide for the enrollment in the pool of all federally eligible individuals.

Section 2.

W.S. 26
‑
43
‑
101(a) by creating a new paragraph (xix) and by
amending and
renumbering (xix) as (xx), 26
‑
43
‑
102(d)(iv), 26
‑
43
‑
103(a)(intro), 26
‑
43
‑
105(d) and 26
‑
43
‑
107(c) are amended to read:

26
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43
‑
101.

Definitions.

(a)

As used in this act:

(xix)

"Eligibility level" means a percentage of the federal poverty guideline for level of coverage under the plan of operation;

(xix)
(xx)

"This act" means W.S. 26
‑
43
‑
101 through
26
‑
43
‑
113

26
‑
43
‑
114
.

26
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43
‑
102.

Operation of the pool; board membership; board powers and duties.

(d)

The board shall:

(iv)

Establish
for each eligibility level
appropriate rates, rate schedules, rate adjustments, expense allowances, agents' referral fees, claim reserve formulas and any other actuarial functions appropriate to the operation of the pool. Rates and rate schedules may be adjusted for appropriate risk factors such as age and area variation in claim cost and shall take into consideration appropriate risk factors in accordance with established actuarial and underwriting practices;

26
‑
43
‑
103.

Eligibility.

(a)

Except as provided in subsection (b) of this section, any individual person who is a resident of this state is eligible for pool coverage
under eligibility level one (1) or eligibility level two (2)
if evidence of the following is provided:

26
‑
43
‑
105.

Assessments; premium tax credit.

(d)

For the total amount of assessments due from all members in any one (1) calendar year pursuant to this section up to
two million five hundred thousand dollars ($2,500,000.00)
f
our
million dollars ($
4
,000,000
.00
)
, eighty percent (80%) of each member's proportionate contribution to the first
one million two hundred fifty thousand dollars ($1,250,000.00)
two million dollars ($2,
0
00,000.00)
and fifty percent (50%) of the next
one million two hundred fifty thousand dollars ($1,250,000.00)
two million dollars ($
2
,
0
00,000.00)
shall be allowed as a credit against any premium tax owed by the member under this code in the year for which the assessment is payable.
The board shall not make a total assessment against all members of more than
six
million dollars ($
6
,000,000.00) in any one (1) fiscal year. Assessments received shall be used to defray the total cost of
level one (1) pool operations first. Assessment amounts not required to support level one (1) pool operations will be used to support level two (2) operations before any general fund appropriation is used. The general fund appropriation shall only be used to support level two (2) operations.
The board shall ensure that all expenses directly attributable to level one (1) individuals are paid from premiums, assessments and any withdrawals from previous reserves.

26
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43
‑
107.

Premiums; standard risk rate.

(c)

Initial rates for pool coverage in the first year coverage is provided pursuant to this act shall not be less than one hundred fifty percent (150%) of rates established as applicable for individual standard risks. Subsequent rates may provide for the expected costs of claims including recovery of prior losses, expenses of operation, investment income of claim reserves, and any other costs factors subject to the limitations provided by this subsection.
For the period from July 1, 1995 through June 30, 2001, rates for pool coverage shall not be less than one hundred twenty-five percent (125%) nor greater than one hundred fifty percent (150%) of rates established as applicable for individual standard risks for comparable coverage. Subsequent pool rates shall not exceed
Beginning July 1, 2007, there shall be two (2) levels of eligibility. Level one (1) eligibility applies to persons with income equal to or greater than
two
hundred
fifty
percent (
25
0%) of the federal poverty guideline. Level two (2) eligibility applies to persons with income below
two
hundred
fifty
percent (
25
0%) of the federal poverty guideline. Premium rates for level one (1) eligibility shall be set at one hundred fifty percent (150%) to
two hundred percent (200%) of rates applicable to individual standard risks.
Premium rates for level two (2) eligibility shall be set at one hundred percent (100%) to one hundred
thirty-five
percent (1
35
%) of rates applicable to individual standard risks.
All rates and rate schedules shall be submitted to the commissioner for approval.
T
he rates shall be set as close as practical to the lower end of the range provided
.
by this subsection without undue risk of shifting more than fifty percent (50%) of the burden of assessments to private health insurance.

Section 2.

There is appropriated to the insurance department for the purposes of this act
three
million dollars ($
3
,000,000.00) from the general fund for the remainder of the fiscal biennium ending June 30, 2008.

Section 3.
The Wyoming health insurance pool board of directors and the insurance commissioner shall provide a report to the joint labor, health and social services interim committee by September 1, 2008 regarding the effectiveness of this act, including the number of additional participants enrolled, a projection of additional enrollees for the fiscal period beginning July 1, 2008 and ending June 30, 2010, an analysis of the usage of all assessment and general fund monies, including a projection of a potential increase in general fund appropriations for the fiscal period beginning July 1, 2008 and ending June 30, 2010 and any recommended modifications to the Wyoming health insurance pool operations or funding. The report shall further illustrate the proportionate share of total funding provided by enrolled members, premium tax credits and insurer assessments not allowed as premium tax credits.

Section
4
.

This act is effective July 1, 2007.

(END)

Speaker of the House

President of the Senate

Governor

TIME APPROVED: _________

DATE APPROVED: _________

I hereby certify that this act originated in the Senate.

Chief Clerk

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