SB391 Alabama 2021 Session

Summary

Primary Sponsor

Shay ShelnuttSenator

Republican

Session

Regular Session 2021

Title

Insurance, state health insurance exchange, Commissioner of Insurance to estab. for individual coverage under fed. Affordable Care Act, Comm. to apply to fed. gov't for waivers for reinsurance program relating to this act, Secs. 10A-20-6.16, 27-21A-23 am'd.

Summary

SB391 would let Alabama create a state-run health insurance exchange and a reinsurance program to stabilize premiums in the individual market.

What This Bill Does

Authorizes the Alabama Commissioner of Insurance to establish the Alabama Health Insurance Exchange Fund to facilitate the purchase and sale of qualified health plans in the state’s individual market, potentially replacing the federal ACA exchange. Authorizes the Commissioner to seek federal waivers under the ACA (Section 1332) to implement a state reinsurance program that stabilizes rates and may increase federal funding for health insurance in Alabama. Creates a reinsurance program and fund, sets parameters (attachment point, cap, coinsurance rate), requires reporting and audits, and amends existing state health insurance laws to align with the new exchange and reinsurance framework.

Who It Affects

• Individuals and families buying health insurance in Alabama’s individual market, who could access a state-based exchange and potential reinsurance support that aims to stabilize premiums.
• Health insurance carriers operating in Alabama’s individual market, particularly those offering silver plans, who would participate in the reinsurance program and be subject to new reporting and funding rules.
• State agencies and the Department of Insurance, which would administer the exchange and reinsurance funds, pursue waivers, and oversee compliance and audits.
• Rural, urban, and suburban consumers, as the act emphasizes maintaining consumer choice and considering area-specific needs when implementing the exchange and reinsurance program.

Key Provisions

• Authorizes the Commissioner of Insurance to establish the Alabama Health Insurance Exchange and the Alabama Health Insurance Exchange Fund to facilitate on-exchange purchase of qualified plans in the individual market.
• Authorizes the Commissioner to apply for federal waivers (including a Section 1332 innovation waiver) to establish a state reinsurance program and to maximize federal support for the program.
• Creates a Reinsurance Program and Reinsurance Fund with defined terms (attachment point, reinsurance cap, coinsurance rate) and provisions to determine and pay reinsurance payments to eligible health carriers.
• Defines roles and responsibilities for health carriers, exchange assisters, and state agencies, including data reporting, confidentiality protections, and enforcement aligned with federal and state law.
• Imposes annual audits and reports for transparency, with required posting on the department’s website and sharing with legislative leadership and committees.
• States that reinsurance funds are not an entitlement, establishes sunset conditions tied to ACA changes or state determination of best interest, and requires steps to cease operations if sunset occurs.
• Amends Sections 10A-20-6.16 and 27-21A-23 of Alabama law to reflect the new exchange and reinsurance framework and regulatory adjustments.

AI-generated summary using openai/gpt-5-nano on Feb 23, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Insurance Department