Connecticut 2017 Regular Session

Connecticut Senate Bill SB00877 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	General Assembly Substitute Bill No. 877
2		-	January Session, 2017 _____SB00877INS___031017____
	1	+	General Assembly Raised Bill No. 877
	2	+	January Session, 2017 LCO No. 4007
	3	+	04007_______INS
	4	+	Referred to Committee on INSURANCE AND REAL ESTATE
	5	+	Introduced by:
	6	+	(INS)
3	7
4	8		General Assembly
5	9
6		-	~~Substitute~~ Bill No. 877
	10	+	Raised Bill No. 877
7	11
8	12		January Session, 2017
9	13
10		-	_____SB00877INS___031017____
	14	+	LCO No. 4007
	15	+
	16	+	04007_______INS
	17	+
	18	+	Referred to Committee on INSURANCE AND REAL ESTATE
	19	+
	20	+	Introduced by:
	21	+
	22	+	(INS)
11	23
12	24		AN ACT AUTHORIZING PREGNANCY AS A QUALIFYING EVENT FOR SPECIAL ENROLLMENT PERIODS.
13	25
14	26		Be it enacted by the Senate and House of Representatives in General Assembly convened:
15	27
16	28		Section 1. Subdivision (1) of section 38a-567 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2018):
17	29
18	30		(1) (A) Any such plan or arrangement shall be offered on a guaranteed issue basis with respect to all eligible employees or dependents of such employees, at the option of the small employer, policyholder or contractholder, as the case may be.
19	31
20	32		(B) Any such plan or arrangement shall be renewable with respect to all eligible employees or dependents at the option of the small employer, policyholder or contractholder, as the case may be, except: (i) For nonpayment of the required premiums by the small employer, policyholder or contractholder; (ii) for fraud or misrepresentation of the small employer, policyholder or contractholder or, with respect to coverage of individual insured, the insureds or their representatives; (iii) for noncompliance with plan or arrangement provisions; (iv) when the number of insureds covered under the plan or arrangement is less than the number of insureds or percentage of insureds required by participation requirements under the plan or arrangement; or (v) when the small employer, policyholder or contractholder is no longer actively engaged in the business in which it was engaged on the effective date of the plan or arrangement.
21	33
22	34		(C) Renewability of coverage may be effected by either continuing in effect a plan or arrangement covering a small employer or by substituting upon renewal for the prior plan or arrangement the plan or arrangement then offered by the carrier that most closely corresponds to the prior plan or arrangement and is available to other small employers. Such substitution shall only be made under conditions approved by the commissioner. A carrier may substitute a plan or arrangement as set forth in this subparagraph only if the carrier effects the same substitution upon renewal for all small employers previously covered under the particular plan or arrangement, unless otherwise approved by the commissioner. The substitute plan or arrangement shall be subject to the rating restrictions specified in this section on the same basis as if no substitution had occurred, except for an adjustment based on coverage differences.
23	35
24		-	(D) Any such plan or arrangement shall provide special enrollment periods (i) to all eligible employees or dependents as set forth in 45 CFR 147.104, as amended from time to time, [and] (ii) for coverage under such plan or arrangement ordered by a court for a spouse or minor child of an eligible employee where request for enrollment is made not later than thirty days after the issuance of such court order, and (iii) to all eligible pregnant employees at any time after the commencement of the pregnancy, as certified by ~~any~~ licensed ~~health care provider~~ acting within the scope of such ~~health care provider~~'s practice. Coverage under subparagraph (D)(iii) of this subdivision shall be effective as of the first of the month in which the employee receives such certification.
	36	+	(D) Any such plan or arrangement shall provide special enrollment periods (i) to all eligible employees or dependents as set forth in 45 CFR 147.104, as amended from time to time, [and] (ii) for coverage under such plan or arrangement ordered by a court for a spouse or minor child of an eligible employee where request for enrollment is made not later than thirty days after the issuance of such court order, and (iii) to all eligible pregnant employees at any time after the commencement of the pregnancy, as certified by a physician licensed under chapter 370 or an advanced practice registered nurse licensed under chapter 378, acting within the scope of such physician's or advanced practice registered nurse's scope of practice. Coverage under subparagraph (D)(iii) of this subdivision shall be effective as of the first of the month in which the employee receives such certification.
25	37
26	38		Sec. 2. Subdivision (2) of subsection (g) of section 38a-481 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2018):
27	39
28		-	(2) Each individual health insurance policy subject to the Affordable Care Act shall (A) be offered on a guaranteed issue basis with respect to all eligible individuals or dependents, and (B) provide special enrollment periods (i) to all eligible individuals or dependents as set forth in 45 CFR 147.104, as amended from time to time, and (ii) to all eligible pregnant individuals at any time after the commencement of the pregnancy, as certified by ~~any~~ licensed ~~health care provider~~ acting within the scope of such ~~health care provider~~'s practice. Coverage under subparagraph (B)(ii) of this subdivision shall be effective as of the first of the month in which the employee receives such certification.
	40	+	(2) Each individual health insurance policy subject to the Affordable Care Act shall (A) be offered on a guaranteed issue basis with respect to all eligible individuals or dependents, and (B) provide special enrollment periods (i) to all eligible individuals or dependents as set forth in 45 CFR 147.104, as amended from time to time, and (ii) to all eligible pregnant individuals at any time after the commencement of the pregnancy, as certified by a physician licensed under chapter 370 or an advanced practice registered nurse licensed under chapter 378, acting within the scope of such physician's or advanced practice registered nurse's scope of practice. Coverage under subparagraph (B)(ii) of this subdivision shall be effective as of the first of the month in which the employee receives such certification.
29	41
30	42		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, 2018):
31	43
32	44		(a) (1) 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. Such filing shall include an actuarial memorandum that includes, but is not limited to, pricing assumptions and claims experience, and premium rates and loss ratios from the inception of the contract or policy. The commissioner may refuse such approval if the commissioner finds such amounts to be excessive, inadequate or discriminatory. As used in this subsection, "loss ratio" means the ratio of incurred claims to earned premiums by the number of years of policy duration for all combined durations.
33	45
34	46		(2) Premium rates and special enrollment periods offered to individuals shall be consistent with the requirements set forth in section 38a-481, as amended by this act.
35	47
36	48		(3) Premium rates and special enrollment periods offered to small employers, as defined in section 38a-564, shall be consistent with the requirements set forth in section 38a-567, as amended by this act.
37	49
38	50		(4) No such health care center shall 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 the commissioner's approval or disapproval thereof.
39	51
40	52		Sec. 4. Section 38a-208 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2018):
41	53
42	54		(a) 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. Such filing shall include an actuarial memorandum that includes, but is not limited to, pricing assumptions and claims experience, and premium rates and loss ratios from the inception of the contract. The commissioner may refuse such approval if the commissioner finds such rates to be excessive, inadequate or discriminatory. As used in this subsection, "loss ratio" means the ratio of incurred claims to earned premiums by the number of years of policy duration for all combined durations.
43	55
44	56		(b) Premium rates and special enrollment periods offered to individuals shall be consistent with the requirements set forth in section 38a-481, as amended by this act.
45	57
46	58		(c) Premium rates and special enrollment periods offered to small employers, as defined in section 38a-564, shall be consistent with the requirements set forth in section 38a-567, as amended by this act.
47	59
48	60		(d) 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 of the commissioner's approval or disapproval thereof.
49	61
50	62		Sec. 5. Section 38a-218 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2018):
51	63
52	64		(a) 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. Such filing shall include an actuarial memorandum that includes, but is not limited to, pricing assumptions and claims experience, and premium rates and loss ratios from the inception of the contract. The commissioner may refuse such approval if the commissioner finds such rates are excessive, inadequate or discriminatory. As used in this subsection, "loss ratio" means the ratio of incurred claims to earned premiums by the number of years of policy duration for all combined durations.
53	65
54	66		(b) Premium rates and special enrollment periods offered to individuals shall be consistent with the requirements set forth in section 38a-481, as amended by this act.
55	67
56	68		(c) Premium rates and special enrollment periods offered to small employers, as defined in section 38a-564, shall be consistent with the requirements set forth in section 38a-567, as amended by this act.
57	69
58	70		(d) 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 of the commissioner's approval or disapproval thereof.
59	71
60	72
61	73
62	74
63	75		This act shall take effect as follows and shall amend the following sections:
64	76		Section 1 January 1, 2018 38a-567(1)
65	77		Sec. 2 January 1, 2018 38a-481(g)(2)
66	78		Sec. 3 January 1, 2018 38a-183(a)
67	79		Sec. 4 January 1, 2018 38a-208
68	80		Sec. 5 January 1, 2018 38a-218
69	81
70	82		This act shall take effect as follows and shall amend the following sections:
71	83
72	84		Section 1
73	85
74	86		January 1, 2018
75	87
76	88		38a-567(1)
77	89
78	90		Sec. 2
79	91
80	92		January 1, 2018
81	93
82	94		38a-481(g)(2)
83	95
84	96		Sec. 3
85	97
86	98		January 1, 2018
87	99
88	100		38a-183(a)
89	101
90	102		Sec. 4
91	103
92	104		January 1, 2018
93	105
94	106		38a-208
95	107
96	108		Sec. 5
97	109
98	110		January 1, 2018
99	111
100	112		38a-218
101	113
	114	+	Statement of Purpose:
102	115
	116	+	To permit a pregnant individual to enroll in a health insurance policy or plan at any time after the individual's pregnancy has been certified by a physician or an advanced practice registered nurse.
103	117
104		-	INS Joint Favorable Subst.
105		-
106		-	INS
107		-
108		-	Joint Favorable Subst.
	118	+	[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.]