This report responds to several study directives approved by the 1999 Session of the General Assembly. These study directives, all of which relate to health insurance issues, include:

• Senate Joint Resolution (SJR) 489 regarding pooled purchasing of health insurance coverage for small employers;

• Senate Bill 1235/House Bill 871 regarding the issue of whether insurance carriers should be required to provide direct reimbursement to providers who do not participate in their provider networks;

• House Joint Resolution (HJR) 555 regarding certain issues related to Medicare managed care plans and Medigap insurance coverage for disabled persons;

• HJR 601 regarding the feasibility of offering group insurance to self-employed individuals; and

• House Bill 2708 regarding the feasibility of licensing self-insurance associations to offer health insurance coverage to holders of medical savings accounts.

In addition to the above study directives approved by the 1999 Session of the General Assembly, this report also represents the third and final component of a three-year study required by HB 2304 (1995) regarding the impact of managed care on the availability and quality of ancillary medical services.