Connecticut 2015 Regular Session

Connecticut Senate Bill SB00009 Compare Versions

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1-General Assembly Substitute Bill No. 9
2-January Session, 2015 *_____SB00009INS___031215____*
1+General Assembly Committee Bill No. 9
2+January Session, 2015 LCO No. 1064
3+ *01064SB00009INS*
4+Referred to Committee on INSURANCE AND REAL ESTATE
5+Introduced by:
6+(INS)
37
48 General Assembly
59
6-Substitute Bill No. 9
10+Committee Bill No. 9
711
812 January Session, 2015
913
10-*_____SB00009INS___031215____*
14+LCO No. 1064
15+
16+*01064SB00009INS*
17+
18+Referred to Committee on INSURANCE AND REAL ESTATE
19+
20+Introduced by:
21+
22+(INS)
1123
1224 AN ACT CONCERNING THE RATE APPROVAL PROCESS FOR CERTAIN HEALTH INSURANCE POLICIES.
1325
1426 Be it enacted by the Senate and House of Representatives in General Assembly convened:
1527
1628 Section 1. Subsections (a) to (c), inclusive, of section 38a-481 of the general statutes are repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
1729
1830 (a) No individual health insurance policy shall be delivered or issued for delivery to any person in this state, nor shall any application, rider or endorsement be used in connection with such policy, until a copy of the form thereof and of the classification of risks and the premium rates have been filed with the commissioner. Rate filings shall include an actuarial memorandum that includes, but is not limited to, pricing assumptions and claims experience, premium rates and loss ratios from the inception of the policy. The commissioner shall adopt regulations, in accordance with chapter 54, to establish a procedure for reviewing such policies. The commissioner shall disapprove the use of such form at any time if it does not comply with the requirements of law, or if it contains a provision or provisions [which] that are unfair or deceptive or [which] that encourage misrepresentation of the policy. The commissioner shall notify, in writing, the insurer [which] that has filed any such form of the commissioner's disapproval, specifying the reasons for disapproval, and ordering that no such insurer shall deliver or issue for delivery to any person in this state a policy on or containing such form. The provisions of section 38a-19 shall apply to such orders.
1931
2032 (b) (1) No rate filed under the provisions of subsection (a) of this section shall be effective until it has been [filed and] approved by the commissioner in accordance with regulations adopted pursuant to this subsection or as provided under subdivision (2) of this subsection. The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to prescribe standards to ensure that such rates shall not be excessive, inadequate or unfairly discriminatory, as described in section 6 of this act. [The commissioner may disapprove such rate within thirty days after it has been filed if it fails to comply with such standards, except that no rate filed under the provisions of subsection (a) of this section for any Medicare supplement policy shall be effective unless approved in accordance with section 38a-474.]
2133
2234 (2) Any rate filed under the provisions of subsection (a) of this section for health insurance that provides coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 shall be approved in accordance with section 6 of this act.
2335
2436 (c) (1) No rate filed under the provisions of subsection (a) of this section for any Medicare supplement policy shall be effective unless approved in accordance with section 38a-474.
2537
2638 [(c)] (2) No insurance company, fraternal benefit society, hospital service corporation, medical service corporation, health care center or other entity [which] that delivers or issues for delivery in this state any Medicare supplement policies or certificates shall incorporate in its rates or determinations to grant coverage for Medicare supplement insurance policies or certificates any factors or values based on the age, gender, previous claims history or the medical condition of any person covered by such policy or certificate.
2739
2840 Sec. 2. Section 38a-513 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
2941
3042 (a) No group health insurance policy, as defined by the commissioner, or certificate shall be [issued or] delivered or issued for delivery in this state unless a copy of the form for such policy or certificate has been submitted to and approved by the commissioner [under the regulations adopted pursuant to this section] and the classification of risks and the premium rates have been filed with the commissioner. The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, concerning the provisions, submission and approval, other than as provided under subdivision (2) of subsection (b) of this section, of such policies and certificates and establishing a procedure for reviewing such policies and certificates. If the commissioner issues an order disapproving the use of such form, the provisions of section 38a-19 shall apply to such order.
3143
3244 (b) (1) No rate filed under the provisions of subsection (a) of this section shall be effective until it has been approved by the commissioner in accordance with regulations adopted pursuant to this subsection or as provided under subdivision (2) of this subsection. The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to prescribe standards to ensure that such rates shall not be excessive, inadequate or unfairly discriminatory, as described in section 6 of this act.
3345
3446 (2) Any rate filed under the provisions of subsection (a) of this section for a small employer group health insurance policy that provides coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 shall be approved in accordance with section 6 of this act.
3547
3648 [(b)] (c) No insurance company, fraternal benefit society, hospital service corporation, medical service corporation, health care center or other entity [which] that delivers or issues for delivery in this state any Medicare supplement policies or certificates shall incorporate in its rates or determinations to grant coverage for Medicare supplement insurance policies or certificates any factors or values based on the age, gender, previous claims history or the medical condition of any person covered by such policy or certificate.
3749
3850 [(c)] (d) Nothing in this chapter shall preclude the issuance of a group health insurance policy that includes an optional life insurance rider, provided the optional life insurance rider shall be filed with and approved by the Insurance Commissioner pursuant to section 38a-430. Any company offering such policies for sale in this state shall be licensed to sell life insurance in this state pursuant to the provisions of section 38a-41.
3951
4052 [(d)] (e) Not later than January 1, 2009, the commissioner shall adopt regulations, in accordance with chapter 54, to establish minimum standards for benefits in group specified disease policies, certificates, riders, endorsements and benefits.
4153
4254 Sec. 3. Subsection (a) of section 38a-183 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
4355
4456 (a) A health care center governed by sections 38a-175 to 38a-192, inclusive, shall not enter into any agreement with subscribers unless and until it has filed with the commissioner a full schedule of the amounts to be paid by the subscribers and has obtained the commissioner's approval [thereof] in accordance with section 6 of this act. The commissioner [may refuse such approval if he finds such amounts to] shall adopt regulations, in accordance with the provisions of chapter 54, to prescribe standards to ensure that such amounts shall not be excessive, inadequate or discriminatory, as described in section 6 of this act. Each such health care center shall not enter into any agreement with subscribers unless and until it has filed with the commissioner a copy of such agreement or agreements, including all riders and endorsements thereon, and until the commissioner's approval thereof has been obtained. The commissioner shall, within a reasonable time after the filing of any request for an approval of [the amounts to be paid,] any agreement or any form, notify the health care center of [either his] the commissioner's approval or disapproval thereof.
4557
4658 Sec. 4. Section 38a-208 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
4759
4860 No such corporation shall enter into any contract with subscribers unless and until it has filed with the Insurance Commissioner a full schedule of the rates to be paid by the subscribers and has obtained said commissioner's approval [thereof] in accordance with section 6 of this act. The commissioner [may refuse such approval if he finds such rates to] shall adopt regulations, in accordance with the provisions of chapter 54, to prescribe standards to ensure that such amounts shall not be excessive, inadequate or discriminatory, as described in section 6 of this act. No hospital service corporation shall enter into any contract with subscribers unless and until it has filed with the Insurance Commissioner a copy of such contract, including all riders and endorsements thereof, and until said commissioner's approval thereof has been obtained. The Insurance Commissioner shall, within a reasonable time after the filing of any such form, notify such corporation [either of his] of the commissioner's approval or disapproval thereof.
4961
5062 Sec. 5. Section 38a-218 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
5163
5264 No such medical service corporation shall enter into any contract with subscribers unless and until it has filed with the Insurance Commissioner a full schedule of the rates to be paid by the subscriber and has obtained said commissioner's approval [thereof] in accordance with section 6 of this act. The commissioner [may refuse such approval if he finds such rates are] shall adopt regulations, in accordance with the provisions of chapter 54, to prescribe standards to ensure that such amounts shall not be excessive, inadequate or discriminatory, as described in section 6 of this act. No such medical service corporation shall enter into any contract with subscribers unless and until it has filed with the Insurance Commissioner a copy of such contract, including all riders and endorsements thereof, and until said commissioner's approval thereof has been obtained. The Insurance Commissioner shall, within a reasonable time after the filing of any such form, notify such corporation [either of his] of the commissioner's approval or disapproval thereof.
5365
5466 Sec. 6. (NEW) (Effective January 1, 2016) (a) (1) With respect to a health insurance policy, agreement or contract that provides coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes, any (A) rate filed for such policy pursuant to section 38a-481 of the general statutes, as amended by this act, (B) rate filed for such policy pursuant to section 38a-513 of the general statutes, as amended by this act, (C) schedule of amounts filed for such agreement pursuant to section 38a-183 of the general statutes, as amended by this act, (D) schedule of rates filed for such contract pursuant to section 38a-208 of the general statutes, as amended by this act, or (E) schedule of rates filed for such contract pursuant to section 38a-218 of the general statutes, as amended by this act, on or after January 1, 2016, shall be filed not later than one hundred twenty calendar days prior to the proposed effective date of such rates or amounts.
5567
5668 (2) Each filer making a rate or amount filing pursuant to this subsection shall:
5769
5870 (A) On the date the filer submits such rate or amount filing to the Insurance Commissioner, clearly and conspicuously disclose to its insureds or subscribers, in writing and in such form as the commissioner may prescribe: (i) The proposed general rate or amount increase and the dollar amount by which an insured's or subscriber's policy or agreement will increase, including any increase because of the insured's or subscriber's age or change in age rating classification and the percentage increase or decrease of the proposed rate or amount from the current rate or amount; (ii) a statement that the proposed rate or amount is subject to Insurance Department review and approval; and (iii) detailed information on the insured's right to submit public comment to the Insurance Department, including the Internet web site, mailing address and phone number of said department and instructions on how to submit comments to the department; and
5971
60-(B) Include with its rate or amount filing an actuarial memorandum, certified by a qualified actuary, that to the best of such actuary's knowledge, (i) such rate or amount filing is in compliance with law, and (ii) the rate or amount filing is not excessive, as described in this section. For the purposes of this subparagraph, "qualified actuary" means a member in good standing of the American Academy of Actuaries who is qualified in accordance with the standards of the American Academy of Actuaries.
72+(B) Include with its rate or amount filing an actuarial memorandum, certified by a qualified actuary, as defined in section 38a-78 of the general statutes, that to the best of such actuary's knowledge, (i) such rate or amount filing is in compliance with law, and (ii) the rate or amount filing is not excessive, as described in this section.
6173
6274 (3) (A) Notwithstanding the provisions of section 38a-69a of the general statutes, the Insurance Department shall post on its Internet web site all documents, materials and other information provided to or requested by the department in relation to a rate or amount filing made pursuant to this subsection, including, but not limited to, financial reports, financial statements, actuarial reports and actuarial memoranda. The rate or amount filing and the documents, materials and other information shall be posted not later than three business days after the department receives such filing, and such posting shall be updated to include any correspondence between the department and the filer.
6375
6476 (B) The department shall provide for a written public comment period of thirty calendar days following the posting of such filing. The department shall include in such posting the date the public comment period closes and instructions on how to submit comments to the department.
6577
66-(b) Except where a hearing is required under subsection (d) of this section, the commissioner shall issue a written decision approving, disapproving or modifying a rate or amount filing not later than forty-five days after such filing was made. Such decision shall specify all factors used to reach such decision and shall be posted on the Internet web site of the Insurance Department not later than two business days after the commissioner issues such decision.
78+(b) Except where a symposium is required under subsection (d) of this section, the commissioner shall issue a written decision approving, disapproving or modifying a rate or amount filing not later than forty-five days after such filing was made. Such decision shall specify all factors used to reach such decision and shall be posted on the Internet web site of the Insurance Department not later than two business days after the commissioner issues such decision.
6779
6880 (c) The commissioner shall not approve a rate or amount filing made under this section if it is excessive, inadequate or unfairly discriminatory. The commissioner shall conduct an actuarial review to determine if the methodology and assumptions used to develop the rate or amount filing are actuarially sound and in compliance with the Actuarial Standards of Practice issued by the Actuarial Standards Board.
6981
7082 (1) A rate or amount is excessive if it is unreasonably high for the insurance provided in relation to the underlying risks and costs after due consideration to (A) the experience of the filer; (B) the past and projected costs of the filer including amounts paid and to be paid for commissions; (C) any transfers of funds to the holding or parent company, subsidiary or affiliate of the filer; (D) the filer's rate of return on assets or profitability, as compared to similar filers; (E) a reasonable margin for profit and contingencies; (F) any public comments received on such filing; and (G) other factors the commissioner deems relevant.
7183
7284 (2) A rate or amount is inadequate if it is unreasonably low for the insurance provided in relation to the underlying risks and costs and continued use of such rate or amount would endanger solvency of the filer.
7385
7486 (3) A rate or amount is unfairly discriminatory if the premium charged for any classification is not reasonably related to the underlying risks and costs, such that different premiums result for insureds with similar risks and costs.
7587
76-(d) (1) With respect to a health insurance policy, agreement or contract that provides coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes, if (A) a rate, schedule of amounts or schedule of rates filed pursuant to subdivision (1) of subsection (a) of this section is for more than a ten per cent increase in such rate or amount, or (B) the Healthcare Advocate requests, not later than five business days after such rate or amount filing has been posted on the Internet web site of the Insurance Department, a hearing on such rate or amount filing, the commissioner shall, not later than five business days after the receipt of such request, set a hearing date. The commissioner shall not be required to hold more than four hearings pursuant to this subdivision in a calendar year.
88+(d) (1) With respect to a health insurance policy, agreement or contract that provides coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes, if (A) a rate, schedule of amounts or schedule of rates filed pursuant to subdivision (1) of subsection (a) of this section is for more than a ten per cent increase in such rate or amount, and (B) the Healthcare Advocate or the Attorney General requests, not later than five business days after such rate or amount filing has been posted on the Internet web site of the Insurance Department, a symposium on such rate or amount filing, the commissioner shall, not later than five business days after the receipt of such request, set a symposium date and post the date, place and time of the symposium in a conspicuous place on the Internet web site of said department. The commissioner shall not be required to hold more than ten symposiums pursuant to this subdivision in a calendar year.
7789
78-(2) Such hearing shall be held not later than ninety calendar days prior to the proposed effective date of such rate or amount, at a place and time that is convenient to the public.
90+(2) (A) Such symposium shall be held not later than ninety calendar days prior to the proposed effective date of such rate or amount, at a place and time that is convenient to the public.
7991
80-(3) Upon setting the date, place and time of the hearing on the proposed rate or amount, the commissioner shall immediately notify the filer of the date, place and time of the hearing.
92+(B) Such symposium shall be conducted in accordance with section 7 of this act and shall not be deemed to be a contested case for purposes of chapter 54 of the general statutes.
8193
82-(4) Notwithstanding section 4-177a of the general statutes:
94+(3) Upon setting the date, place and time of the symposium on the proposed rate or amount, the commissioner shall immediately notify the filer of the date, place and time of the symposium.
8395
84-(A) The Healthcare Advocate shall be deemed an intervenor in any hearing held pursuant to this subsection, shall be allowed to present evidence and information at such hearing and shall be allowed to present a closing argument in support of his or her position; and
85-
86-(B) The Insurance Commissioner shall assist the Healthcare Advocate to obtain from the Insurance Department or the filer documents or materials related to the subject matter of the filing that are not readily available from the Insurance Department's Internet web site, provided such documents or materials are not confidential or prohibited to be disclosed by law.
87-
88-(5) If the presiding officer has allowed, pursuant to section 4-177c of the general statutes, persons not named as parties or intervenors to present oral or written statements, the commissioner shall consider, in making a decision to approve, disapprove or modify a rate or amount filing for which a hearing was held, such oral or written statements and any written public comments submitted pursuant to subparagraph (B) of subdivision (3) of subsection (a) of this section.
89-
90-(6) Not later than thirty calendar days after the hearing, the commissioner shall issue a final decision, in writing, approving, disapproving or modifying the rate or amount filing. Such decision shall specify all factors used to reach such decision and shall be posted on the Internet web site of the Insurance Department not later than two business days after the commissioner issues such decision.
96+(4) Not later than thirty calendar days after the symposium, the commissioner shall issue a written decision approving, disapproving or modifying the rate or amount filing. Such decision shall specify all factors used to reach such decision and shall be posted on the Internet web site of the Insurance Department not later than two business days after the commissioner issues such decision.
9197
9298 (e) (1) If the Insurance Commissioner issues a decision to approve or modify a rate or amount filing made pursuant to subsection (a) of this section, the filer shall provide written notice to each insured or subscriber by first class mail that states (A) the approved rate or amount for the insured's or subscriber's policy or agreement, (B) any increase in the rate or amount due to the insured's or subscriber's age or change in age rating classification, and (C) the percentage increase or decrease of the approved rate from the current rate of the insured or subscriber.
9399
94100 (2) No such rate or amount shall be effective until thirty calendar days after the notice has been sent by the filer as set forth in subdivision (1) of this subsection or the effective date proposed under subdivision (1) of subsection (a) of this section, whichever is later.
95101
96102 (f) Each insurance company, health care center, hospital service corporation or medical service corporation subject to the provisions of this section shall disclose in writing to a prospective customer of a policy or agreement that may be affected by a rate or amount filing made pursuant to this section, (1) that the rate or amount of such policy or agreement is under review by the Insurance Department, and (2) the proposed increase or decrease in the rate or amount of such policy or agreement.
97103
98104 (g) Each insurance company, health care center, hospital service corporation or medical service corporation subject to the provisions of this section shall retain records of all earned premiums and incurred benefits per calendar year for each policy or agreement for which a rate or amount filing is made pursuant to this section. Such records shall be retained for not less than seven years after the date each such filing is made and shall include records for any rider or endorsement used in connection with such policy or agreement.
99105
100106 (h) The Insurance Department shall retain all records of any rate or amount filing made pursuant to this section for not less than seven years after such filing was approved, disapproved or modified.
101107
102-Sec. 7. (NEW) (Effective January 1, 2016) Not later than January thirty-first, annually, the Insurance Department shall submit a report to the joint standing committee of the General Assembly having cognizance of matters relating to insurance that lists all rates filed pursuant to section 38a-481 or 38a-513 of the general statutes, as amended by this act, schedule of amounts filed pursuant to section 38a-183 of the general statutes, as amended by this act, and schedule of rates filed pursuant to section 38a-208 or 38a-218 of the general statutes, as amended by this act, for health insurance policies, agreements or contracts that provide coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes, in the calendar year immediately preceding. Such report shall include the name of the filer, the per cent increase or decrease of such rate of amount filing, the per cent increase or decrease approved by the Insurance Department, the market segment and the product type.
108+Sec. 7. (NEW) (Effective January 1, 2016) (a) Each symposium held pursuant to section 6 of this act shall include an opportunity for public participation. The Healthcare Advocate or the Attorney General, or both, shall be allowed to present evidence and information at such symposium and each shall be allowed to present a closing argument in support of his or her position.
103109
104-Sec. 8. Subsection (b) of section 4-186 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
110+(b) The Insurance Commissioner shall assist the Healthcare Advocate or the Attorney General, or both, to obtain from the Insurance Department or the filer documents or materials related to the subject matter of the filing that are not readily available from the Insurance Department's Internet web site, provided such documents or materials are not confidential or prohibited to be disclosed by law.
105111
106-(b) (1) In the case of conflict between the provisions of this chapter and the provisions of chapter 567 and provisions of the general statutes relating to limitations of periods of time, procedures for filing appeals, or jurisdiction or venue of any court or tribunal governing unemployment compensation, employment security or manpower appeals, the provisions of the law governing unemployment compensation, employment security and manpower appeals shall prevail.
112+(c) In making a decision to approve, disapprove or modify a rate or amount filing made pursuant to subsection (a) of this section, the commissioner shall consider any oral and written comments made or submitted at such symposium and any written public comments submitted pursuant to subparagraph (B) of subdivision (3) of subsection (a) of section 6 of this act.
107113
108-(2) In the case of conflict between the provisions of this chapter and the provisions of section 6 of this act relating to the conducting of a hearing under said section, including, but not limited to, the period of time for rendering a final decision on a rate or amount filing for which a hearing was held under said section, the provisions of section 6 of this act shall prevail.
114+Sec. 8. (NEW) (Effective January 1, 2016) Not later than January thirty-first, annually, the Insurance Department shall submit a report to the joint standing committee of the General Assembly having cognizance of matters relating to insurance that lists all rates filed pursuant to section 38a-481 or 38a-513 of the general statutes, as amended by this act, schedule of amounts filed pursuant to section 38a-183 of the general statutes, as amended by this act, and schedule of rates filed pursuant to section 38a-208 or 38a-218 of the general statutes, as amended by this act, for health insurance policies, agreements or contracts that provide coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes, in the calendar year immediately preceding. Such report shall include the name of the filer, the per cent increase or decrease of such rate of amount filing, the per cent increase or decrease approved by the Insurance Department, the market segment and the product type.
109115
110116
111117
112118
113119 This act shall take effect as follows and shall amend the following sections:
114120 Section 1 January 1, 2016 38a-481(a) to (c)
115121 Sec. 2 January 1, 2016 38a-513
116122 Sec. 3 January 1, 2016 38a-183(a)
117123 Sec. 4 January 1, 2016 38a-208
118124 Sec. 5 January 1, 2016 38a-218
119125 Sec. 6 January 1, 2016 New section
120126 Sec. 7 January 1, 2016 New section
121-Sec. 8 January 1, 2016 4-186(b)
127+Sec. 8 January 1, 2016 New section
122128
123129 This act shall take effect as follows and shall amend the following sections:
124130
125131 Section 1
126132
127133 January 1, 2016
128134
129135 38a-481(a) to (c)
130136
131137 Sec. 2
132138
133139 January 1, 2016
134140
135141 38a-513
136142
137143 Sec. 3
138144
139145 January 1, 2016
140146
141147 38a-183(a)
142148
143149 Sec. 4
144150
145151 January 1, 2016
146152
147153 38a-208
148154
149155 Sec. 5
150156
151157 January 1, 2016
152158
153159 38a-218
154160
155161 Sec. 6
156162
157163 January 1, 2016
158164
159165 New section
160166
161167 Sec. 7
162168
163169 January 1, 2016
164170
165171 New section
166172
167173 Sec. 8
168174
169175 January 1, 2016
170176
171-4-186(b)
177+New section
178+
179+Statement of Purpose:
180+
181+To establish procedures for the approval of rate or amount filings for certain health insurance policies.
182+
183+[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]
172184
173185
174186
175-INS Joint Favorable Subst.
187+Co-Sponsors: SEN. CRISCO, 17th Dist.
176188
177-INS
189+Co-Sponsors:
178190
179-Joint Favorable Subst.
191+SEN. CRISCO, 17th Dist.
192+
193+S.B. 9