Connecticut 2017 Regular Session

Connecticut Senate Bill SB00879 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	General Assembly Raised Bill No. 879
2	2	January Session, 2017 LCO No. 4250
3	3	04250_______INS
4	4	Referred to Committee on INSURANCE AND REAL ESTATE
5	5	Introduced by:
6	6	(INS)
7	7
8	8	General Assembly
9	9
10	10	Raised Bill No. 879
11	11
12	12	January Session, 2017
13	13
14	14	LCO No. 4250
15	15
16	16	04250_______INS
17	17
18	18	Referred to Committee on INSURANCE AND REAL ESTATE
19	19
20	20	Introduced by:
21	21
22	22	(INS)
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24	24	AN ACT ESTABLISHING STATE MEDICAL LOSS RATIOS FOR INDIVIDUAL HEALTH INSURANCE POLICIES AND GROUP HEALTH INSURANCE POLICIES FOR SMALL EMPLOYERS.
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26	26	Be it enacted by the Senate and House of Representatives in General Assembly convened:
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28	28	Section 1. Section 38a-477c of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2018):
29	29
30	30	(a) For the purposes of this section:
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32	32	(1) "Federal medical loss ratio" has the same meaning as provided in, and shall be calculated in accordance with, the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, and regulations adopted thereunder.
33	33
34	34	(2) "Group health insurance policy" means each group health insurance policy for a small employer, as defined in section 38a-564, delivered, issued for delivery, renewed, amended or continued in this state providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469.
35	35
36	36	(3) "Individual health insurance policy" means each individual health insurance policy delivered, issued for delivery, renewed, amended or continued in this state providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469.
37	37
38	38	(4) "State medical loss ratio" means the ratio of incurred claims to earned premiums for the prior calendar year for individual health insurance policies and group health insurance policies. Claims shall be limited to medical expenses for services and supplies provided to enrollees or insureds and shall not include expenses for stop loss coverage, reinsurance, insured or enrollee educational programs or other cost containment programs or features.
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40	40	(b) (1) Each individual health insurance policy shall have a state medical loss ratio of not less than eighty per cent.
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42	42	(2) Each group health insurance policy shall have a state medical loss ratio of not less than eighty-five per cent.
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44	44	(3) If an individual or group health insurance policy does not meet the applicable state medical loss ratio in subdivision (1) or (2) of this subsection during any period for which premium payment has been made, the insurer or health care center delivering, issuing, renewing, amending or continuing such policy shall pay a rebate to each insured, subscriber or enrollee under such policy in an amount equal to any overpayment by such insured, subscriber or enrollee that is attributable to the failure to meet the applicable state medical loss ratio.
45	45
46	46	(c) An insurer or health care center shall include a written notice with each application for individual or group health insurance coverage that discloses such insurer's or health care center's state medical loss ratio and federal medical loss ratio, [as both terms are defined in section 38a-478l,] as reported in the last Consumer Report Card on Health Insurance Carriers in Connecticut, to an applicant at the time of application for coverage.
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48	48	(d) The commissioner shall adopt regulations, in accordance with chapter 54, to implement the provisions of this section.
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50	50	Sec. 2. Subsection (b) of section 38a-478l of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2018):
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52	52	(b) (1) The consumer report card shall be known as the "Consumer Report Card on Health Insurance Carriers in Connecticut" and shall include (A) all health care centers licensed pursuant to chapter 698a, (B) the fifteen largest licensed health insurers that use provider networks and that are not included in subparagraph (A) of this subdivision, (C) the state medical loss ratio of each such health care center or licensed health insurer, (D) the federal medical loss ratio of each such health care center or licensed health insurer, (E) the information required under subdivision (6) of subsection (a) of section 38a-478c, and (F) information concerning mental health services, as specified in subsection (c) of this section. The insurers selected pursuant to subparagraph (B) of this subdivision shall be selected on the basis of Connecticut direct written health premiums from such network plans.
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54	54	(2) For the purposes of this section and sections [38a-477c,] 38a-478c and 38a-478g:
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56	56	(A) "State medical loss ratio" means the ratio of incurred claims to earned premiums for the prior calendar year for managed care plans issued in the state. Claims shall be limited to medical expenses for services and supplies provided to enrollees and shall not include expenses for stop loss coverage, reinsurance, enrollee educational programs or other cost containment programs or features;
57	57
58	58	(B) "Federal medical loss ratio" has the same meaning as provided in, and shall be calculated in accordance with, the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, and regulations adopted thereunder.
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63	63	This act shall take effect as follows and shall amend the following sections:
64	64	Section 1 January 1, 2018 38a-477c
65	65	Sec. 2 January 1, 2018 38a-478l(b)
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67	67	This act shall take effect as follows and shall amend the following sections:
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69	69	Section 1
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71	71	January 1, 2018
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73	73	38a-477c
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75	75	Sec. 2
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77	77	January 1, 2018
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79	79	38a-478l(b)
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81	81	Statement of Purpose:
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83	83	To establish state medical loss ratios for individual health insurance policies and group health insurance policies for small employers.
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85	85	[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.]