HB3754 Summary

• Prohibits insurers from denying small group health insurance coverage based on applicants' health status and requires use of standard risk rates for premiums for the first 4 years of implementation.

• Requires all health insurers in the individual and small group markets to maintain a minimum medical loss ratio of 85% or above, meaning at least 85% of premium dollars must be spent on medical care rather than administrative costs, marketing, and profit.

• Mandates all insurers offer health insurance choice policies to employees of eligible employers (small employers with employees earning less than 250% of federal poverty level) and self-employed persons, with rating restrictions based only on age, geographic area, family size, and wellness participation.

• Requires health carriers to provide external independent reviews of claim denials and adverse determinations, with enrollees able to request review up to 180 days after an adverse determination.

• Establishes an Office of Patient Protection within the Division of Insurance to assist consumers, monitor health insurer compliance, and investigate claims practices.