HB 894-FN – AS INTRODUCED
2007 SESSION
01/05
HOUSE BILL 894-FN
AN ACT requiring insurance coverage for bariatric surgery for diabetics.
SPONSORS: Rep. Marshall Quandt, Rock 13; Rep. Matthew Quandt, Rock 13
This bill requires insurance coverage for bariatric surgery for diabetics.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
07-0152
01/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Seven
AN ACT requiring insurance coverage for bariatric surgery for diabetics.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Coverage for Bariatric Surgery for Diabetics; Individual. Amend RSA 415 by inserting after section 6-m the following new section:
415:6-n Coverage for Bariatric Surgery for Diabetics; Individual. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance, who are residents of this state, coverage for bariatric surgery for diabetics. The benefits included in this section shall not be subject to any greater deductible than any other benefits provided by the insurer. The coinsurance required by the certificate holder shall not exceed the amount allowed under the contract for the reasonable and customary charge for the services provided.
2 New Section; Coverage for Bariatric Surgery for Diabetics; Group. Amend RSA 415 by inserting after section 18-r the following new section:
415:18-s Coverage for Bariatric Surgery for Diabetics; Group. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses, shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for bariatric surgery for diabetics. The benefits included in this section shall not be subject to any greater deductible than any other benefits provided by the insurer. The coinsurance required by the certificate holder shall not exceed the amount allowed under the contract for the reasonable and customary charge for the services provided.
3 Coverage for Bariatric Surgery for Diabetics. Amend RSA 420-A:2 to read as follows:
420-A:2 Applicable Statutes. Every health service corporation shall be governed by this chapter and the relevant provisions of RSA 161-H, and shall be exempt from this title except for the provisions of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415-A, RSA 415-F, RSA 415:6, II(4), RSA 415:6-g, RSA 415:6-k, RSA 415:6-m, RSA 415:6-n, RSA 415:18, V, RSA 415:18, VII(g), RSA 415:18, VII-a, RSA 415:18-a, RSA 415:18-j, RSA 415:18-o, RSA 415:18-r, RSA 415:18-s, RSA 415:22, RSA 417, RSA 417-E, RSA 420-J, and all applicable provisions of title XXXVII wherein such corporations are specifically included. Every health service corporation and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.
4 Coverage for Bariatric Surgery for Diabetics. Amend RSA 420-B:20, III to read as follows:
III. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-n, RSA 415:18, VII(g), RSA 415:18, VII-a, RSA 415:18-j, RSA 415:18-r, RSA 415:18-s, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.
5 Effective Date. This act shall take effect 60 days after its passage.
LBAO
07-0152
Revised 03/01/07
HB 894 FISCAL NOTE
AN ACT requiring insurance coverage for bariatric surgery for diabetics.
FISCAL IMPACT:
The Insurance Department and Department of Administrative Services state this bill may increase state, county, and local expenditures, and state revenue by an indeterminable amount in FY 2008 and each year thereafter. This bill will have no fiscal impact on county and local revenue.
METHODOLOGY:
The Insurance Department states this bill requires that insurers cover bariatric surgery for diabetics. To the extent insurers do not provide this coverage, they may need to increase premiums to cover the additional cost. The Department does not know whether any insurers are providing this coverage, or the cost of such coverage. The Department states since the state is self-funded, this law would not require them to provide such coverage. The state collects insurance premium tax, so to the extent premiums increase, state revenues will also increase by an indeterminable amount.
The Department of Administrative Services states this bill requires health insurance providers to cover the cost for bariatric surgery. The Department assumes that the coverage required by this bill would result in an annual 1.1% increase in medical claims costs to the state health insurance program. Medical claims based on actuarial estimates are approximately $166 million in FY 2008 and $187 million in FY 2009. For FY 2010 and 2011 actuarial estimates for total claims were not available. For those two years the Department applied a factor of 12.43% to both FY 2009 and FY 2010 projected claims. The 12.43% factor is based on percent increase in claim activity from FY 2009 over FY 2008. The Department estimates costs at $1,834,940 in FY 2008, $2,062,989 in FY 2009, $2,319,419 in FY 2010, and $2,607,723 in FY 2011 if they were to provide the coverage contained in this bill.