National Health Insurance Act (644)

*An replacement to Article 3 under the The Public Hospitals and Healthcare Act (635) to ensure that all Kodiak citizens have absolute universal access to affordable health insurance. The National Health Service Amendment has the potential to improve individual health and ultimately population health by providing healthcare for citizens based on need and not the ability to pay while also slowing the rising cost of healthcare. The budget range is estimated to be 18000 - 22000 million.*

### **Article 1 - The Removal of Article 3 Under the Public Hospitals and Healtcare Act (635)**

1.1 - Hereby strikes said Article of said Act and render it null and void.

### **Article 2 - Mandatory Purchase of Private Comprehensive Health Insurance and Subsidization of Such Purchase**

1.1 - Mandates all Kodiak citizens to upgrade their insurance package from their choice of private insurer to a comprehensive package within thirty days.

* 1.1.1 - Regulations implemented under this act include dependents that no longer live with their parents, are not a dependent on a parent's tax return, are no longer a student, or are married.

* 1.1.2 - Should a Kodiak citizen choose to be insured by a health care association plan provided by their employer, their insurance contributions shall be deducted automatically from their salary.

1.2 - Mandates all non-residents residing in Kodiak for over a calendar year purchase comprehensive health insurance from their choice of private insurance for the duration of their stay.

1.3 - Allows residents who are citizens of nations with public health services maintaining an agreement of reciprocity with the Kodiak Republic Department of Health exemption from the mandates of this Article.

2.1 - Should any qualified person fail to oblige with the mandates of this Article, they are mandated to pay a fine. The fine will be either 1000 Kodiak Florins or 2.5% of a person’s annual income, whichever means of being fined is available to the person.

* 2.1.1 - A person who fails to pay the penalty shall not be subject to any criminal prosecution or penalty and cannot have liens or levies placed on their property, but the Ministry of Revenue and Treasury will be able to withhold future tax refunds from them.

3.1 - Mandates the Kodiak government subsidize the purchase of insurance for all consumers.

* 3.1.1 - Consumers within the lower-income bracket will have their purchase of health insurance subsidized fully by the Kodiak government.

* 3.1.2 - Consumers within the middle-income bracket will have their purchase of health insurance subsidized seventy five percent (75%) by the Kodiak government, with the consumer having to pay twenty five percent (25%) themselves.

* 3.1.3 - Consumers within the upper-income bracket will have their purchase of health insurance subsidized sixty percent (60%) by the Kodiak government, with the consumer having to pay forty percent (40%) themselves.

4.1 - A 1000 Kodiak Florin per employee penalty will be imposed on employers with more than fifty (50) full-time employees who do not offer health insurance to their full-time workers.

* 4.1.1 - "Full-time" is defined as, with respect to any month, an employee who is employed on average at least thirty (30) hours of service per calendar week.

5.1 - A Kodiak state may apply to the Ministry of Health and Education for a renewable five-year waiver. The decision of whether to grant the five-year waiver is up to the ministry. A state with the waiver would be exempt from the requirements of this act. However, the state will not receive compensation for any federal subsidies, tax credits and such for which its residents and employers would have been eligible under the amendment.

### **Article 2 - Government Regulation Upon Private Insurers**

1.1 - Mandates Ministry of Education and Health publish, annually, a document known as the mandate which specifies healthcare coverage requirements which insurers should seek to meet.

1.2 - Mandates regulations be published annually to give legal force to the mandate.

2.1 - Insurers are prohibited from imposing lifetime Kodiak Florin limits on essential benefits.

3.1 - Insurers are prohibited from excluding pre-existing medical conditions.

4.1 - All new insurance plans must cover preventive care and medical screenings.

5.1 - Insurers are prohibited from charging co-payments, co-insurance, or deductibles for all services provided.

6.1 - Insurers' abilities to enforce annual spending caps are to be restricted.

7.1 - Prohibit insurers from dropping policyholders when they get sick.

8.1 - Insurers are mandated to reveal details about administrative and executive expenditures.

9.1 - Mandate insurers permit dependants to remain on their parents' insurance plan until their 26th birthday.

10.1 - Mandate all new insurance plans cover childhood immunizations and adult vaccinations without charging co-payments, co-insurance, or deductibles when provided by an in-network provider.

11.1 - Mandate insurers spend 80% (for individual or small group insurers) or 85% (for large group insurers) of premium dollars on health costs and claims, leaving only 20% or 15% respectively for administrative costs and profits, subject to various waivers and exemptions.

11.2 - Insurers that fail to meet this requirement are mandated to issue a rebate to the policy holder.

12.1 - Prohibit insurers from denying coverage or charging higher rates to any individual based on pre-existing medical conditions or discrimination of any sort.

13.1 - Prohibits patient eligibility waiting periods in excess of 90 days for group health plan coverage. The 90-day rule applies to all insurers.

* 13.1.1 - Plans will still be allowed to impose eligibility requirements based on factors other than the lapse of time; for example, a health plan can restrict eligibility to employees who work at a particular location or who are in an eligible job classification. The waiting period limitation means that coverage must be effective no later than the 91st day after the employee satisfies the substantive eligibility requirements.

### **Article 3 - Goverment Funding of Employer Healthcare Association Plans**

1.1 - Companies that provide early retiree benefits are eligible to participate in a temporary program that reduces premium costs.

2.1 - Two years of tax credits will be offered to qualified small businesses. To receive the full benefit of a 50% premium subsidy, said business must have at least five full-time employees.

* 2.1.1 - Seasonal employees, owners and their relations are not considered as an employee under this amendment.

### **Article 4 - Transparency of Insurers**

1.1 - Mandate the Ministry of Health and Education provide consumer insurance information for individuals and small businesses in all states.

2.1 Mandate Insurance companies use simpler, more standardized paperwork with the intention of helping consumers make apples-to-apples comparisons between the prices and benefits of different health plans.