Risk, No Longer A Part of Insurance?

SEC. 2701. FAIR INSURANCE COVERAGE.

`(a) In General- With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market--

`(1) such rate shall vary with respect to the particular plan or coverage involved only by--

`(A) family structure;

`(B) community rating area;

`(C) the actuarial value of the benefit;

`(D) age, except that such rate shall not vary by more than 2 to 1;

`(E) tobacco use, except that such rate shall not vary by more than 1.5 to 1; and

`(F) adherence to or participation in a reasonably designed program of health promotion and disease prevention, if such a program is offered by the employer that is the sponsor of the coverage involved; and

`(2) such rate shall not vary with respect to the particular plan or coverage involved by health status-related factors, gender, class of business, claims experience, industry, or any other factor not described in paragraph (1), except that group health plans and health insurance issuers offering group health insurance coverage may establish premium discounts or rebates for modifying otherwise applicable copayments or deductibles in return for adherence to or participation in reasonably designed programs of health promotion or disease prevention.

`(b) Community Rating Area- Taking into account the applicable recommendations of the National Association of Insurance Commissioners, the Secretary shall by regulation establish a minimum size for community rating areas for purposes of this section, which, for areas contained in a Metropolitan Statistical Area, shall not be smaller than such area.