CSSB 70(FIN): "An Act establishing the Alaska Health Benefit Exchange; and providing for an effective date."
00 CS FOR SENATE BILL NO. 70(FIN) 01 "An Act establishing the Alaska Health Benefit Exchange; and providing for an effective 02 date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. The uncodified law of the State of Alaska is amended by adding a new section 05 to read: 06 INTENT. It is the intent of the legislature in this Act 07 (1) to facilitate the purchase and sale of qualified health plans in the individual 08 market in this state; 09 (2) to establish a small business health options program exchange to assist 10 qualified small employers in the state in enrolling employees in qualified health plans offered 11 in the small group market; 12 (3) to provide consumer education and assist individuals with access to 13 programs, credits, and cost-sharing reductions; 14 (4) to reduce the number of uninsured Alaskans by creating an organized,
01 transparent, and easy-to-navigate health insurance marketplace that offers a choice of high 02 value health plans with low administrative costs for individuals and employers; and 03 (5) that the Alaska Health Benefit Exchange Board recommend to the 04 legislature and the Office of the Governor methods to keep premium costs low and risk pools 05 strong in the health insurance market place. 06 * Sec. 2. AS 21.54 is amended by adding new sections to read: 07 Article 2A. Alaska Health Benefit Exchange. 08 Sec. 21.54.200. Alaska Health Benefit Exchange. The Alaska Health Benefit 09 Exchange is established as a public corporation of the state in the Department of 10 Commerce, Community, and Economic Development but with separate and 11 independent legal existence. 12 Sec. 21.54.210. Alaska Health Benefit Exchange Board. (a) The Alaska 13 Health Benefit Exchange Board is established to manage the exchange. 14 (b) The board consists of eight members, including six members appointed by 15 the governor, the commissioner of health and social services or the commissioner's 16 designee, serving ex officio, and the director, serving ex officio, without the power to 17 vote. The members of the board appointed by the governor are 18 (1) a representative of small business employers; 19 (2) a representative of the health care insurance business; 20 (3) a person with expertise in health plan finance; 21 (4) a person with expertise in health plan administration; 22 (5) an actuary or a person with a background in health care actuarial or 23 economic principles; and 24 (6) a health care consumer representative. 25 (c) Except for the commissioner or the commissioner's designee and the 26 director, who serve ex officio, each board member serves for a term of three years 27 beginning on January 1 and until a successor has been appointed. A member is eligible 28 for reappointment. 29 (d) The board shall select a member to serve as chair and a member to serve as 30 vice-chair for a term and with duties and powers necessary to perform their functions. 31 (e) A majority of the board constitutes a quorum for transacting business.
01 (f) If a vacancy occurs, the governor shall make an appointment, effective 02 immediately, for the balance of the unexpired term. 03 (g) Board members and the executive director hired under (j) of this section 04 shall comply with the requirements of AS 39.50 (public official financial disclosure) 05 and shall disclose an affiliation with an insurer, agent, broker, or other representative 06 of an insurer, a health care provider, or a health care facility. 07 (h) Members of the board are entitled to per diem and transportation costs 08 under AS 39.20.180. 09 (i) A member of the board of directors of the exchange may not be held civilly 10 or criminally liable for an act or omission if the act or omission was in good faith and 11 within the scope of the director's duties. 12 (j) The board shall employ an executive director to administer the exchange. 13 The executive director shall perform duties as prescribed by the board and may 14 employ a staff to assist in the performance of the duties of the executive director. The 15 executive director and staff employed under this subsection are in the partially exempt 16 service under AS 39.25.120. 17 Sec. 21.54.220. Duties and powers of the Alaska Health Benefit Exchange; 18 limitation. (a) The Alaska Health Benefit Exchange Board shall 19 (1) facilitate the purchase and sale of qualified health plans; 20 (2) establish a small business health options program exchange to 21 assist qualified small employers in the state in enrolling employees in a qualified 22 health plan; 23 (3) provide for the operation of a toll-free telephone hotline to respond 24 to requests for assistance; 25 (4) provide for enrollment periods under sec. 1311(c)(6), P.L. 111-148 26 (Patient Protection and Affordable Care Act), as amended, and regulations adopted 27 under that Act; 28 (5) maintain an Internet website through which enrollees and 29 prospective enrollees of qualified health plans may obtain standardized comparative 30 information on those plans; 31 (6) implement procedures for the certification, recertification, and
01 decertification of qualified health plans according to the determination of the division 02 consistent with guidelines developed by the United States Secretary of Health and 03 Human Services under sec. 1311(c), P.L. 111-148 (Patient Protection and Affordable 04 Care Act), as amended, and regulations adopted under that Act; 05 (7) assign a rating to each qualified health plan offered through the 06 exchange according to the determination of the division in accordance with the criteria 07 developed by the United States Secretary of Health and Human Services under sec. 08 1311(c)(3), P.L. 111-148 (Patient Protection and Affordable Care Act), as amended, 09 and regulations adopted under that Act; 10 (8) determine the level of coverage of each qualified health plan 11 according to the determination of the division under regulations issued by the United 12 States Secretary of Health and Human Services under sec. 1302(d)(2)(A), P.L. 111- 13 148 (Patient Protection and Affordable Care Act), as amended, and regulations 14 adopted under that Act; 15 (9) use a standardized format for presenting health benefit options in 16 the exchange, including the use of the uniform outline of coverage established under 17 42 U.S.C. 300gg et seq. (sec. 2715, Part A, subpart II, title XXVII, Public Health 18 Service Act); 19 (10) in accordance with sec. 1413, P.L. 111-148 (Patient Protection 20 and Affordable Care Act), as amended, and regulations adopted under that Act, inform 21 individuals of title XIX, Social Security Act eligibility requirements for the Medicaid 22 program under 42 U.S.C. 1396 - 1396w-2, the Children's Health Insurance Program 23 under 42 U.S.C. 1397aa - 1397mm (title XXI of the Social Security Act), or any 24 applicable state or local public program; and, if the exchange determines that any 25 individual is eligible for a program, enroll that individual in that program; 26 (11) establish and make available by electronic means a calculator to 27 determine the actual cost of coverage after application of any premium tax credit 28 under 26 U.S.C. 36B (Internal Revenue Code of 1986), and any cost-sharing reduction 29 under sec. 1402, P.L. 111-148 (Patient Protection and Affordable Care Act), as 30 amended, and regulations adopted under that Act; 31 (12) establish a small business health options program exchange
01 through which qualified employers may access coverage for their employees and 02 which shall enable a qualified employer to specify a level of coverage so that any of 03 its employees may enroll in any qualified health plan offered through the small 04 business health options program exchange at the specified level of coverage; 05 (13) subject to sec. 1411, P.L. 111-148 (Patient Protection and 06 Affordable Care Act), as amended, and regulations adopted under that Act, grant a 07 certification attesting that, for purposes of the individual responsibility penalty under 08 26 U.S.C. 5000A (Internal Revenue Code of 1986), an individual is exempt from the 09 individual responsibility requirement or from the penalty imposed by that section 10 because 11 (A) an affordable qualified health plan covering the individual 12 is not available through the exchange or through the individual's employer; or 13 (B) the individual meets the requirements for another 14 exemption from the individual responsibility requirement or penalty; 15 (14) provide the following information to the United States Secretary 16 of the Treasury: 17 (A) the name and taxpayer identification number of each 18 individual issued a certification under (13) of this subsection; 19 (B) the name and taxpayer identification number of each 20 individual who was an employee but who was determined to be eligible for the 21 premium tax credit under 26 U.S.C. 36B (Internal Revenue Code of 1986) 22 because 23 (i) the employer did not provide minimum essential 24 coverage; or 25 (ii) the employer provided the minimum essential 26 coverage, but it was determined under 26 U.S.C. 36B(c)(2)(C) (Internal 27 Revenue Code of 1986), to be unaffordable to the employee or not to 28 provide the required minimum actuarial value; and 29 (C) the name and taxpayer identification number of each 30 individual who 31 (i) notifies the exchange under sec. 1411(b)(4), P.L.
01 111-148 (Patient Protection and Affordable Care Act), as amended, and 02 regulations adopted under that Act, that the individual has changed 03 employers; and 04 (ii) ceases coverage under a qualified health plan during 05 a plan year and the effective date of that cessation; 06 (15) provide to each employer the name of each employee of the 07 employer described in (14)(B) of this subsection who ceases coverage under a 08 qualified health plan during a plan year and the effective date of the cessation; 09 (16) perform duties required of the exchange by the United States 10 Secretary of Health and Human Services or the United States Secretary of the 11 Treasury related to determining eligibility for premium tax credits, reduced cost- 12 sharing, or individual responsibility requirement exemptions; 13 (17) select entities qualified to serve as navigators as determined by 14 the division in accordance with sec. 1311(i), P.L. 111-148 (Patient Protection and 15 Affordable Care Act), as amended, and regulations adopted under that Act, and 16 standards developed by the United States Secretary of Health and Human Services and 17 award grants to enable navigators to 18 (A) conduct public education activities to raise awareness of 19 the availability of qualified health plans; 20 (B) distribute fair and impartial information concerning 21 enrollment in qualified health plans, the availability of premium tax credits 22 under 26 U.S.C. 36B (Internal Revenue Code of 1986), and the availability of 23 cost-sharing reductions under sec. 1402, P.L. 111-148 (Patient Protection and 24 Affordable Care Act), as amended, and regulations adopted under that Act; 25 (C) facilitate enrollment in qualified health plans; 26 (D) provide referrals to the division for consumer assistance for 27 a person with a grievance, complaint, or question regarding the person's health 28 benefit plan or coverage, or a determination under that plan or coverage; and 29 (E) provide information in a manner that is culturally and 30 linguistically appropriate to the needs of the population being served by the 31 exchange;
01 (18) review the rate of premium growth within the exchange and 02 outside the exchange as determined by the division and rely on the information 03 developed by the division on whether to continue limiting qualified employer status to 04 small employers; 05 (19) rely on policies and procedures developed by the division to 06 minimize adverse selection among plans sold within the exchange and review policies 07 within the exchange and outside the exchange to monitor the effect of adverse 08 selection between the two marketplaces; 09 (20) credit the amount of any free choice voucher to the monthly 10 premium of the plan in which a qualified employee is enrolled, in accordance with sec. 11 10108, P.L. 111-148 (Patient Protection and Affordable Care Act), as amended, and 12 regulations adopted under that Act, and collect the amount credited from the offering 13 employer; 14 (21) consult with persons having an interest in the activities of the 15 exchange, including 16 (A) health care insurers; 17 (B) health care consumers who are enrollees in qualified health 18 plans; 19 (C) individuals and entities with experience in facilitating 20 enrollment in qualified health plans; 21 (D) representatives of small businesses and self-employed 22 individuals; 23 (E) the division in the Department of Health and Social 24 Services responsible for administering Medicaid; and 25 (F) advocates for enrolling hard-to-reach populations; 26 (22) establish one or more advisory groups to consult with the board to 27 provide expertise on and input into operations of the exchange; the membership of an 28 advisory group may include health care providers, hospitals, and persons identified in 29 (21) of this subsection; 30 (23) maintain an accurate accounting of all activities, receipts, and 31 expenditures;
01 (24) submit an annual accounting report to the United States Secretary 02 of Health and Human Services, the governor, the director and the legislature; the 03 report must include the following information described by insurer by benefit plan: 04 (A) the number of covered persons; 05 (B) the number of covered persons receiving free choice 06 vouchers and the amount of free choice vouchers credited; 07 (C) the number of individuals exempted from individual 08 responsibility requirements by reason; 09 (D) the number of individuals eligible for premium tax credit; 10 (E) the number of employees who terminated coverage and the 11 number of individuals obtaining coverage through the exchange who were 12 covered under an employer health plan in the preceding six months; and 13 (F) other data specified by the director; 14 (25) cooperate with an investigation conducted by the division or the 15 United States Secretary of Health and Human Services under the Secretary's authority 16 under P.L. 111-148 (Patient Protection and Affordable Care Act), as amended, and 17 regulations adopted under that Act, and allow the division or the Secretary, in 18 coordination with the Inspector General of the United States Department of Health and 19 Human Services, to 20 (A) investigate the affairs of the exchange; 21 (B) examine the properties and records of the exchange; 22 (C) require periodic reports in relation to the activities 23 undertaken by the exchange; 24 (26) allow a health care insurer to offer a plan that provides limited 25 scope dental benefits under 26 U.S.C. 9832(c)(2)(A) (Internal Revenue Code of 1986), 26 through the exchange, either separately or in conjunction with a qualified health plan, 27 if the plan provides pediatric dental benefits under sec. 1302(b)(1)(J), P.L. 111-148 28 (Patient Protection and Affordable Care Act), as amended, and regulations adopted 29 under that Act; 30 (27) apply for planning and establishment grants made available to the 31 exchange under sec. 1311, P.L. 111-148 (Patient Protection and Affordable Care Act),
01 as amended, and regulations adopted under that Act; 02 (28) rely on the division's determination relating to the potential for 03 interstate compacts that would permit the sale and purchase of health care insurance 04 across state borders and recommend particular compact arrangements for legislative 05 approval; and 06 (29) submit to the director a plan of operation to ensure the fair, 07 reasonable, and equitable administration of the exchange; the plan of operation 08 becomes effective on approval in writing by the director, subject to the following: 09 (A) if the exchange fails to submit a suitable plan under this 10 paragraph, the director may adopt reasonable regulations necessary or 11 advisable to carry out the provisions of AS 21.54.200 - AS 21.54.270; the 12 regulations adopted by the director under this subparagraph must continue in 13 force until modified by the director or superseded by a plan submitted by the 14 exchange and approved by the director; 15 (B) the plan of operation must 16 (i) establish procedures for the performance of the 17 duties and powers of the exchange; 18 (ii) establish procedures for handling assets of the 19 exchange; 20 (iii) establish the amount and method of reimbursing 21 members of the board of directors; 22 (iv) establish regular places and times for meetings of 23 the board of directors; 24 (v) establish procedures for records to be kept of all 25 financial transactions of the exchange, its agents, and the board of 26 directors; 27 (vi) contain any additional provisions necessary or 28 proper for the execution of the powers and duties of the exchange. 29 (b) The exchange may 30 (1) enter into a contract for the performance of the exchange's duties 31 with the Department of Health and Social Services or another entity that has
01 experience in individual and small group health insurance or benefit administration, or 02 other experience relevant to the responsibilities to be assumed by the entity, except 03 that the exchange may not contract for the performance of its duties with a health care 04 insurer or an affiliate of a health care insurer; 05 (2) enter into information-sharing agreements with federal and state 06 agencies and other state exchanges to carry out its duties if the agreements include 07 adequate protections with respect to the confidentiality of the information to be shared 08 and comply with all state and federal laws and regulations; and 09 (3) apply for and receive grants or donations from federal, state, local 10 government, foundation, or private entities; the exchange shall make records of 11 application for or receipt of grants or donations under this paragraph available to the 12 public on the exchange's Internet website within 30 days after application or receipt. 13 (c) The exchange may not use money intended for the administrative and 14 operational expenses of the exchange for staff retreats, promotional giveaways, or 15 excessive executive compensation. 16 (d) Neither the exchange nor a health care insurer offering a health benefit 17 plan through the exchange may charge an individual a fee or penalty for termination of 18 coverage if the individual enrolls in another type of minimum essential coverage 19 because 20 (1) the individual has become newly eligible for that coverage; or 21 (2) the individual's employer-sponsored coverage has become 22 affordable under the standards of 26 U.S.C. 36B(c)(2)(C) (Internal Revenue Code of 23 1986). 24 Sec. 21.54.230. Health benefit plan certification. (a) The exchange may 25 certify a health benefit plan as a qualified health plan if 26 (1) the plan provides the essential health benefits described in sec. 27 1302(a), P.L. 111-148 (Patient Protection and Affordable Care Act), as amended, and 28 regulations adopted under that Act, except that the plan is not required to provide 29 essential benefits that duplicate the minimum benefits of qualified dental plans if 30 (A) the exchange has determined that at least one qualified 31 dental plan is available to supplement the plan's coverage; and
01 (B) the health care insurer makes prominent disclosure at the 02 time it offers the plan, in a form approved by the exchange, that the plan does 03 not provide the full range of essential pediatric benefits, and that qualified 04 dental plans providing those benefits and other dental benefits not covered by 05 the plan are offered through the exchange; 06 (2) the premium rates and contract language have been approved by 07 the director; 08 (3) the plan provides at least a bronze level of coverage under 09 AS 21.54.220(a)(7) unless the plan is certified as a qualified catastrophic plan, meets 10 the requirements of P.L. 111-148 (Patient Protection and Affordable Care Act), as 11 amended, and regulations adopted under that Act, for catastrophic plans, and will only 12 be offered to individuals eligible for catastrophic coverage; 13 (4) the cost-sharing requirements of the plan do not exceed the limits 14 established under sec. 1302(c)(1), P.L. 111-148 (Patient Protection and Affordable 15 Care Act), as amended, and regulations adopted under that Act, and, if the plan is 16 offered through the small business health options program exchange, the deductible 17 for the plan does not exceed the limits established under sec. 1302(c)(2), P.L. 111-148 18 (Patient Protection and Affordable Care Act), as amended, and regulations adopted 19 under that Act; 20 (5) the health care insurer offering the plan 21 (A) is licensed and in good standing to offer health insurance 22 coverage in the state; 23 (B) offers at least one qualified health plan that provides a 24 silver level of coverage under AS 21.54.220(a)(7) and at least one plan that 25 provides a gold level of coverage through each small business health options 26 program exchange and exchange for individual coverage in which the health 27 care insurer participates; 28 (C) charges the same premium rate for each qualified health 29 plan without regard to whether the plan is offered through the exchange and 30 without regard to whether the plan is offered directly from the health care 31 insurer or through an insurance producer;
01 (D) does not charge cancellation fees or penalties in violation 02 of AS 21.54.220(d); and 03 (E) complies with the regulations developed by the United 04 States Secretary of Health and Human Services under sec. 1311(d), P.L. 111- 05 148 (Patient Protection and Affordable Care Act), as amended, and regulations 06 adopted under that Act, and other requirements the exchange establishes; 07 (6) the plan meets the requirements of certification as adopted by 08 regulation under AS 21.54.250 and by the United States Secretary of Health and 09 Human Services under sec. 1311(c), P.L. 111-148 (Patient Protection and Affordable 10 Care Act), as amended, and regulations adopted under that Act, which include 11 minimum standards in the areas of marketing practices, network adequacy, essential 12 community providers in underserved areas, accreditation, quality improvement, 13 uniform enrollment forms, and descriptions of coverage and information on quality 14 measures for health benefit plan performance; and 15 (7) the exchange determines that making the plan available through the 16 exchange is in the interest of qualified individuals and qualified employers in this 17 state. 18 (b) The exchange may not exclude a health benefit plan 19 (1) because the plan is a fee-for-service plan; 20 (2) by imposing premium price controls; or 21 (3) because the plan provides treatments necessary to prevent patients' 22 deaths that the exchange determines are inappropriate or too costly. 23 (c) The exchange shall require each health care insurer seeking certification of 24 a plan as a qualified health plan to 25 (1) submit to the exchange a justification for any premium increase 26 before implementation of that increase; the health care insurer shall prominently post 27 the justification information on the health care insurer's Internet website; the exchange 28 shall consider the information submitted, along with the information and the 29 recommendations provided to the exchange by the director under 42 U.S.C. 300gg-94 30 (sec. 2794(b), Part C, title XXVII, Public Health Service Act) when determining 31 whether to allow the health care insurer to make plans available through the exchange;
01 (2) make available to the public in plain language, as defined in sec. 02 1311(e)(3)(B), P.L. 111-148 (Patient Protection and Affordable Care Act), as 03 amended, and regulations adopted under that Act, and submit to the exchange, the 04 United States Secretary of Health and Human Services, and the director accurate and 05 timely disclosure of the following: 06 (A) claims payment policies and practices; 07 (B) periodic financial disclosures; 08 (C) data on enrollment; 09 (D) data on disenrollment; 10 (E) data on the number of claims that are denied; 11 (F) data on rating practices; 12 (G) information on cost-sharing and payments with respect to 13 any out-of-network coverage; 14 (H) information on enrollee and participant rights under Title I 15 of P.L. 111-148 (Patient Protection and Affordable Care Act), as amended, and 16 regulations adopted under that Act; and 17 (I) other appropriate information as determined by the United 18 States Secretary of Health and Human Services. 19 (3) permit individuals to learn, in a timely manner on the request of the 20 individual, the amount of cost-sharing, including deductibles, copayments, and 21 coinsurance, under the individual's plan or coverage that the individual would be 22 responsible for paying with respect to the furnishing of a specific item or service by a 23 participating provider; a minimum, that information must be made available to the 24 individual through an Internet website and through other means for individuals 25 without access to the Internet. 26 (d) The exchange may not exempt a health care insurer seeking certification of 27 a qualified health plan from state licensure or solvency requirements, regardless of the 28 type or size of the health care insurer, and shall apply the criteria of this section in a 29 manner that ensures equality between or among health care insurers participating in 30 the exchange. 31 (e) The provisions of AS 21.54.200 - 21.54.270 that are applicable to qualified
01 health plans also apply, to the extent relevant, to qualified dental plans, except as 02 modified under (1) - (3) of this subsection or by regulations adopted by the exchange. 03 Under this subsection, 04 (1) the health care insurer shall be licensed to offer dental coverage, 05 but need not be licensed to offer other health benefits; 06 (2) the plan must be limited to dental and oral health benefits, without 07 substantially duplicating the benefits typically offered by a health benefit plan without 08 dental coverage and must include, at a minimum, the essential pediatric dental benefits 09 prescribed by the United States Secretary of Health and Human Services under sec. 10 1302(b)(1)(J), P.L. 111-148 (Patient Protection and Affordable Care Act), as amended, 11 and regulations adopted under that Act, and other dental benefits as the exchange or 12 the Secretary may specify by regulation; and 13 (3) the health care insurer may jointly offer a comprehensive plan 14 through the exchange in which the dental benefits are provided by a health care insurer 15 through a qualified dental plan and the other benefits are provided by a health care 16 insurer through a qualified health plan if the plans are priced separately and are also 17 made available for purchase separately at the same price. 18 Sec. 21.54.240. Exchange funding; publication of costs of the exchange. (a) 19 The exchange may charge assessments or user fees to a health care insurer offering a 20 health benefit plan or otherwise generate funding necessary to support its operations 21 provided under AS 21.54.200 - 21.54.270. 22 (b) The exchange shall publish the average costs of licensing, regulatory fees, 23 and any other payments required by the exchange, and the administrative costs of the 24 exchange, on its Internet website. That information must include information on 25 money lost to waste, fraud, and abuse. 26 Sec. 21.54.250. Regulations. The division or the exchange may adopt 27 regulations to implement their respective authority under the provisions of 28 AS 21.54.200 - 21.54.270. Regulations adopted under this section may not conflict 29 with or prevent the application of regulations adopted by the United States Secretary 30 of Health and Human Services under P.L. 111-148 (Patient Protection and Affordable 31 Care Act), as amended, and regulations adopted under that Act.
01 Sec. 21.54.260. Relation to other laws. Provisions of AS 21.54.200 - 02 21.54.270, and actions taken by the exchange under AS 21.54.200 - 21.54.270 may 03 not be construed to preempt or supersede the authority of the director to regulate the 04 business of insurance in the state. Except as expressly provided to the contrary in 05 AS 21.54.200 - 21.54.270, all health care insurers offering qualified health plans in the 06 state shall comply fully with all applicable health insurance laws of the state and 07 regulations adopted and orders issued by the director. 08 Sec. 21.54.270. Definitions. In AS 21.54.200 - 21.54.270, 09 (1) "board" means the Alaska Health Benefit Exchange Board 10 established AS 21.54.210; 11 (2) "exchange" means the Alaska Health Benefit Exchange established 12 under AS 21.54.200; 13 (3) "health benefit plan" has the meaning given in AS 21.54.500, 14 except that, notwithstanding AS 21.54.500, it does not include 15 (A) coverage only for accident or disability income insurance, 16 or any combination of accident or disability income insurance; 17 (B) coverage issued as a supplement to liability insurance; 18 (C) liability insurance, including general liability insurance and 19 automobile liability insurance; 20 (D) workers' compensation insurance or similar insurance; 21 (E) automobile medical payment insurance; 22 (F) credit-only insurance; 23 (G) coverage for on-site medical clinics; 24 (H) insurance coverage specified in federal regulations issued 25 under the P.L. 104-191 (Health Insurance Portability and Accountability Act of 26 1996), under which benefits for health care services are secondary or incidental 27 to other insurance benefits; 28 (I) the following benefits if they are provided under a separate 29 policy, certificate, or contract of insurance or are otherwise not an integral part 30 of the plan: 31 (i) limited scope dental or vision benefits;
01 (ii) benefits for long-term care, nursing home care, 02 home health care, community-based care, or any combination of long- 03 term care, nursing home care, home health care, or community based 04 care; 05 (J) limited benefits specified in federal regulations issued under 06 P. L. 104-191 (Health Insurance Portability and Accountability Act of 1996); 07 (K) the following benefits if the benefits are provided under a 08 separate policy, certificate, or contract of insurance; there is no coordination 09 between the provision of the benefits and any exclusion of benefits under any 10 group health plan maintained by the same plan sponsor; and the benefits are 11 paid with respect to an event without regard to whether benefits are provided 12 with respect to an event under any group health plan maintained by the same 13 plan sponsor: 14 (i) coverage for only a specified disease or illness; or 15 (ii) hospital indemnity or other fixed indemnity 16 insurance; 17 (L) the following benefits if offered as a separate policy, 18 certificate, or contract of insurance: 19 (i) Medicare supplemental health insurance as defined 20 in 42 U.S.C. 1395ss(g)(1) (sec. 1882(g)(1) ch. 7, Subchapter XVIII, 21 Part E, Social Security Act); 22 (ii) coverage supplemental to the coverage provided 10 23 U.S.C. 1071 - 1110a (Civilian Health and Medical Program of the 24 Uniformed Services (CHAMPUS)); or 25 (iii) similar supplemental coverage provided to 26 coverage under a group health plan; 27 (4) "qualified dental plan" means a limited scope dental plan that has 28 been certified under AS 21.54.230(e); 29 (5) "qualified employer" means a small employer that elects to make 30 its full-time employees and, at the option of the employer, some or all of its part-time 31 employees, eligible for one or more qualified health plans offered through the small
01 business health options program exchange if the employer 02 (A) has its principal place of business in this state and elects to 03 provide coverage through the small business health options program exchange 04 to all of its eligible employees, wherever employed; or 05 (B) elects to provide coverage through the small business 06 health options program exchange to all of its eligible employees who are 07 principally employed in this state; 08 (6) "qualified health plan" means a health benefit plan that has in effect 09 a certification that the plan meets the criteria for certification described in sec. 10 1311(c), P.L. 111-148 (Patient Protection and Affordable Care Act), as amended, and 11 regulations adopted under that Act, and AS 21.54.230; 12 (7) "qualified individual" means an individual, including a minor, who 13 (A) is seeking to enroll in a qualified health plan offered to 14 individuals through the exchange; 15 (B) resides in this state; 16 (C) at the time of enrollment, is not incarcerated, other than 17 incarceration pending the disposition of charges; and 18 (D) for the entire period for which enrollment is sought, is and 19 is reasonably expected to be a citizen or national of the United States or an 20 alien lawfully present in the United States; 21 (8) "small business health options program exchange" means the small 22 business health options exchange under AS 21.54.220(a)(12) and sec. 1321, P.L. 111- 23 148, (Patient Protection and Affordable Care Act), as amended, and regulations 24 adopted under that Act; 25 (9) "small employer," notwithstanding AS 21.54.500, means an 26 employer that employed an average of not more than 50 employees during the 27 preceding calendar year; for purposes of this paragraph, 28 (A) a person treated as a single employer under 26 U.S.C. 414 29 (b), (c), (m), or (o) (Internal Revenue Code of 1986), shall be treated as a 30 single employer; 31 (B) an employer and any predecessor employer shall be treated
01 as a single employer; 02 (C) all employees shall be counted, including a part-time 03 employee and an employee who is not eligible for coverage through the 04 employer; 05 (D) if an employer was not in existence throughout the 06 preceding calendar year, the determination of whether that employer is a small 07 employer shall be based on the average number of employees the employer is 08 reasonably expected to employ on business days in the current calendar year; 09 and 10 (E) an employer that makes enrollment in qualified health plans 11 available to its employees through the small business health options program 12 exchange and that would cease to be a small employer because of an increase 13 in the number of its employees, shall continue to be treated as a small 14 employer for purposes of AS 21.54.200 - 21.54.270 as long as the employer 15 continuously makes enrollment through the small business health options 16 program exchange available to its employees. 17 * Sec. 3. AS 39.25.120(c) is amended by adding a new paragraph to read: 18 (22) the executive director and employees of the Alaska Health Benefit 19 Exchange Board employed under AS 21.54.210(j). 20 * Sec. 4. AS 39.50.200(a)(9) is amended to read: 21 (9) "public official" means 22 (A) a judicial officer; 23 (B) the governor or the lieutenant governor; 24 (C) a person hired or appointed in a department in the 25 executive branch as 26 (i) the head or deputy head of the department; 27 (ii) the director or deputy director of a division; 28 (iii) a special assistant to the head of the department; 29 (iv) a person serving as the legislative liaison for the 30 department; 31 (D) an assistant to the governor or the lieutenant governor;
01 (E) the chair or a member of a state commission or board; 02 (F) state investment officers and the state comptroller in the 03 Department of Revenue; 04 (G) the chief procurement officer appointed under 05 AS 36.30.010; 06 (H) the executive director of the Alaska Workforce Investment 07 Board; 08 (I) each appointed or elected municipal officer; [AND] 09 (J) the members of the board of trustees, the executive director, 10 and the investment officers of the Alaska Permanent Fund Corporation; and 11 (K) the executive director of the Alaska Health Benefit 12 Exchange employed under AS 21.54.210; 13 * Sec. 5. AS 39.50.200(b) is amended by adding a new paragraph to read: 14 (64) the Alaska Health Benefit Exchange Board (AS 21.54.210). 15 * Sec. 6. The uncodified law of the State of Alaska is amended by adding a new section to 16 read: 17 TRANSITIONAL PROVISIONS. Notwithstanding AS 21.54.210(c), enacted by sec. 18 2 of this Act, the initial terms for members of the Alaska Health Benefit Exchange Board 19 appointed by the governor are as follows: 20 (1) three members shall be appointed to serve for terms ending December 31, 21 2012; 22 (2) three members shall be appointed to serve for terms ending December 31, 23 2013. 24 * Sec. 7. The uncodified law of the State of Alaska is amended by adding a new section to 25 read: 26 TRANSITION: REGULATIONS. The Alaska Health Benefit Exchange Board 27 established under AS 21.54.200, enacted by sec. 2 of this Act, and the director of insurance 28 may adopt regulations necessary to implement their respective powers and duties created by 29 this Act under AS 21.54.250, enacted by sec. 2 of this Act. The regulations take effect under 30 AS 44.62 (Administrative Procedure Act), but not before the effective date of the statutory 31 changes.
01 * Sec. 8. Section 7 of this Act takes effect immediately under AS 01.10.070(c). 02 * Sec. 9. Except as provided in sec. 8 of this Act, this Act takes effect July 1, 2012.