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General Assembly Raised Bill No. 7260
January Session, 2019
LCO No. 4706
Referred to Committee on INSURANCE AND REAL
ESTATE
Introduced by:
(INS)
AN ACT EXCLUDING BEE R MANUFACTURERS, THE IR EMPLOYEES
AND THE DEPENDENTS O F THEIR EMPLOYEES FR OM VARIOUS
PROVISIONS OF THE INSURANCE STATUTES CON CERNING SMALL
EMPLOYER HEALTH INSU RANCE COVERAGE.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 38a-564 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective January 1, 2020): 2
As used in this section and sections 38a-566, 38a-567, 38a-569 and 3
38a-574: 4
(1) "Pool" means the Connecticut Small Employer Health 5
Reinsurance Pool, established under section 38a-569. 6
(2) "Board" means the board of directors of the pool. 7
(3) "Employee" means an individual employed by an employer. 8
"Employee" does not include (A) an individual and such individual's 9
spouse with respect to an incorporated or unincorporated trade or 10
business that is wholly owned by such individual, by such individual's 11 Raised Bill No. 7260
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spouse or by such individual and such individual's spouse, [or] (B) a 12
partner in a partnership and such partner's spouse with respect to such 13
partnership, or (C) an individual employed by an employer in this 14
state that holds a manufacturer permit for beer, as described in 15
subsection (b) of section 30-16, and obtains health insurance coverage 16
for its employees and their dependents through the Connecticut 17
Brewers Guild. 18
(4) (A) "Small employer" means (i) prior to January 1, 2016, an 19
employer that employed an average of at least one but not more than 20
fifty employees on business days during the preceding calendar year 21
and employs at least one employee on the first day of the group health 22
insurance plan year, and (ii) on and after January 1, 2016, an employer 23
that employed an average of at least one but not more than one 24
hundred employees on business days during the preceding calendar 25
year and employs at least one employee on the first day of the group 26
health insurance plan year, except the commissioner may postpone 27
said January 1, 2016, date to be consistent with any such postponement 28
made by the Secretary of the United States Department of Health and 29
Human Services under the Patient Protection and Affordable Care Act, 30
P.L. 111-148, as amended from time to time. "Small employer" does not 31
include a sole proprietorship that employs only the sole proprietor or 32
the spouse of such sole proprietor, or an employer in this state that 33
holds a manufacturer permit for beer, as described in subsection (b) of 34
section 30-16, and obtains health insurance coverage for its employees 35
and their dependents through the Connecticut Brewers Guild. 36
(B) (i) For purposes of subparagraph (A) of this subdivision, the 37
number of employees shall be determined by adding (I) the number of 38
full-time employees for each month who work a normal work week of 39
thirty hours or more, and (II) the number of full-time equivalent 40
employees, calculated for each month by dividing by one hundred 41
twenty the aggregate number of hours worked for such month by 42
employees who work a normal work week of less than thirty hours, 43
and averaging such total for the calendar year. 44 Raised Bill No. 7260
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(ii) If an employer was not in existence throughout the preceding 45
calendar year, the number of employees shall be based on the average 46
number of employees that such employer reasonably expects to 47
employ in the current calendar year. 48
(C) All persons treated as a single employer under Section 414 of the 49
Internal Revenue Code of 1986, or any subsequent corresponding 50
internal revenue code of the United States, as amended from time to 51
time, shall be considered a single employer for purposes of this 52
subdivision. 53
(5) "Insurer" means any insurance company, hospital service 54
corporation, medical service corporation or health care center, 55
authorized to transact health insurance business in this state. 56
(6) "Insurance arrangement" means any multiple employer welfare 57
arrangement, as defined in Section 3 of the Employee Retirement 58
Income Security Act of 1974, as amended from time to time, except for 59
any such arrangement that is fully insured within the meaning of 60
Section 514(b)(6) of said act, as amended from time to time. 61
(7) "Health insurance plan" means any hospital and medical expense 62
incurred policy, hospital or medical service plan contract and health 63
care center subscriber contract. "Health insurance plan" does not 64
include (A) accident only, credit, dental, vision, Medicare supplement, 65
long-term care or disability insurance, hospital indemnity coverage, 66
coverage issued as a supplement to liability insurance, insurance 67
arising out of a workers' compensation or similar law, automobile 68
medical-payments insurance, or insurance under which beneficiaries 69
are payable without regard to fault and which is statutorily required to 70
be contained in any liability insurance policy or equivalent self-71
insurance, or (B) policies of specified disease or limited benefit health 72
insurance, provided the carrier offering such policies files on or before 73
March first of each year a certification with the commissioner that 74
contains the following: (i) A statement from the carrier certifying that 75
such policies are being offered and marketed as supplemental health 76 Raised Bill No. 7260
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insurance and not as a substitute for hospital or medical expense 77
insurance; (ii) a summary description of each such policy including the 78
average annual premium rates, or range of premium rates in cases 79
where premiums vary by age, gender or other factors, charged for such 80
policies in the state; and (iii) in the case of a policy that is described in 81
this subparagraph and that is offered for the first time in this state on 82
or after October 1, 1993, the carrier files with the commissioner the 83
information and statement required in this subparagraph at least thirty 84
days prior to the date such policy is issued or delivered in this state. 85
(8) "Plan of operation" means the plan of operation of the pool, 86
including articles, bylaws and operating rules, adopted by the board 87
pursuant to section 38a-569. 88
(9) "Dependent" means the spouse or child of an eligible employee, 89
subject to applicable terms of the health insurance plan covering such 90
employee. "Dependent" includes any dependent who is covered under 91
the small employer's health insurance plan pursuant to workers' 92
compensation, continuation of benefits pursuant to section 38a-512a or 93
other applicable laws. 94
(10) "Commissioner" means the Insurance Commissioner. 95
(11) "Member" means each insurer and insurance arrangement 96
participating in the pool. 97
(12) "Small employer carrier" means any insurer or insurance 98
arrangement that offers or maintains group health insurance plans 99
covering eligible employees of one or more small employers. 100
(13) "Health care center" has the same meaning as provided in 101
section 38a-175. 102
(14) "Case characteristics" means demographic or other objective 103
characteristics of a small employer, including age and geographic 104
location. "Case characteristics" does not include claims experience, 105
health status or duration of coverage since issue. 106 Raised Bill No. 7260
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This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2020 38a-564
INS Joint Favorable