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119-s-3434119th CongressWALLET

Health Coverage Across State Lines Act

Sponsored By: Senator Blackburn, Marsha [R-TN]

Introduced

Summary

Primary-state governance for interstate individual health plans. This bill would let insurers sell individual-market coverage across state lines while applying the laws of a single designated "primary" State, subject to specific consumer protections and State exceptions.

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  • Families and enrollees would get a required, clear disclosure in 12-point bold type explaining which State's laws govern their plan and how costs or coverage may differ. Renewals could not be reclassified or raised for health-status reasons except for narrow exceptions like plan discontinuation or documented fraud.
  • State regulators would keep key powers. Secondary States retain authority over taxes, fraud and abuse enforcement, unfair claims settlement rules, court-ordered remedies for hazardous financial conditions, and can require agent licensing without discriminating against nonresident licensees.
  • Insurers must designate one primary State for all their policies and may only sell in a secondary State if the same product exists in the primary State. They must file operational and quarterly certified financial reports and meet risk-based capital rules before selling across State lines.

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 1 benefits, 0 costs, 4 mixed.

Patient notices, appeals, and fraud rules

If enacted, insurers selling into another State would have to give a bold notice at sale and renewal naming the insurer and the primary State and warning that some local rules may not apply. Insurers would also have to provide independent external review for denials (or use State review laws). Insurers must follow the secondary State's fraud and unfair-claims laws when selling there.

Interstate rules start in one year

If enacted, the new interstate insurance rules would begin one year after the bill is enacted. They would apply to individual policies sold or renewed after that date. This delay would postpone any changes to out-of-state sale rules, protections, and market options for households.

One State's rules govern your policy

If enacted, an insurer would choose one "primary State" for each individual policy and must be licensed there. That primary State's covered laws would control many policy features in any State where the plan is sold. Some local care and provider rules would still apply, but many secondary-State insurance rules would not.

State solvency checks and taxes

If enacted, a State where you live could require out-of-state insurers to pay the same premium taxes and high-risk assessments as local insurers. States could also examine an insurer's finances if the primary State delays an exam, and insurers must participate in State guaranty associations. These rules aim to protect your claims if an insurer fails but could raise insurer costs that affect premiums.

No local countersignature required

If enacted, your State could not require that an out-of-state individual health policy be countersigned by a local agent. States also could not otherwise discriminate against insurers issuing in both their primary State and your State. Insurers may still need to register to receive legal papers.

Sponsors & CoSponsors

Sponsor

Blackburn, Marsha [R-TN]

TN • R

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

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