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FACTBOX: Provisions of Senate health panel legislation

Wed Jul 15, 2009 6:37pm EDT

(Reuters) - The Senate health committee approved its version of healthcare reform on Wednesday. The following are some of the provisions in the legislation:

* INSURANCE CHANGES

Sets up a government-run health program to compete with private health insurers.

Sets up a gateway, or exchange, were businesses and individuals would shop for insurance policies among private and public plans.

Private insurance premiums could vary only by family size, region, actuarial value of the benefits, tobacco use and age.

Increases in private insurance premiums would be limited.

Insurers can provide incentives for health promotion and disease prevention practices.

Insurers could not exclude consumers based on pre-existing health conditions, genetic information, disability or sex.

Dependents would be covered in family policies through age 26, rather than age 21 as in most current policies.

Health policies would not have annual or lifetime limits on benefit payments.

The government would subsidize insurance premiums for individuals and families with incomes up to 400 percent of the poverty level.

The secretary of Health and Human Services will set out what are essential healthcare benefits that must be included in the plans participating in the exchanges.

* INSURANCE COVERAGE

Individuals could keep their current insurance coverage.

Small businesses with 50 or fewer full-time workers could receive tax credits for subsidizing insurance coverage.

All individuals will be required to have health insurance or face a $750 penalty, exemptions will be made for those who cannot afford it.

All companies with more than 25 workers would be required to pay at least 60 percent of their workers' health insurance or face a $750 per full-time employee fee, with a reduced rate of $375 per part-time employee. The first 25 workers would be exempt.

Employers would be reimbursed temporarily through a Retiree Reserve Trust Fund for providing insurance for retirees over age 55 and their dependents, who are not yet eligible for Medicare, which usually starts at age 65. This would continue until the gateway, or exchange, is set up.

(Reporting by Jackie Frank; editing by Todd Eastham)



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