HB 1203 Summary

• Creates Chapter 26.1-36.8 of North Dakota Century Code establishing minimum health insurance policy coverage standards including ambulatory services, emergency care, hospitalization, maternity care, mental health services, drugs, rehabilitation services, laboratory services, preventive care, and pediatric services including dental and vision.

• Prohibits health insurance issuers from imposing pre-existing condition exclusions or denying coverage based on pre-existing conditions and eliminates lifetime and annual limits on essential health benefits.

• Limits cost-sharing (copayments, coinsurance, deductibles) to $8,550 for self-only coverage and $17,100 for other coverage, with commissioner authority to adjust by rule, and restricts premium rate variations to family versus individual coverage, geographic rating area, age (maximum 3:1 ratio for adults), and tobacco use (maximum 1.5:1 ratio).

• Continues Medicaid Expansion coverage under federal Affordable Care Act for individuals under 65 with income below 138% of federal poverty line and requires provider reimbursement rate reporting to legislative management before August 1 of even-numbered years.

• Becomes effective only upon certification by the insurance commissioner that a court has ruled all or a significant portion of the federal Affordable Care Act unconstitutional with final judgment.