Connecticut 2019 Regular Session

Connecticut House Bill HB07260 Compare Versions

Version 1 (Old)

Version 2 (New)

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7	5		General Assembly Raised Bill No. 7260
8	6		January Session, 2019
9	7		LCO No. 4706
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11	9
12		-	Referred to Committee on INSURANCE AND REAL
13		-	ESTATE
	10	+	Referred to Committee on INSURANCE AND REAL ESTATE
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15	12
16	13		Introduced by:
17	14		(INS)
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21	19		AN ACT EXCLUDING BEE R MANUFACTURERS, THEIR EMPLOYEES
22	20		AND THE DEPENDENTS O F THEIR EMPLOYEES FR OM VARIOUS
23	21		PROVISIONS OF THE INSURANCE STATUTES CON CERNING SMALL
24	22		EMPLOYER HEALTH INSU RANCE COVERAGE.
25	23		Be it enacted by the Senate and House of Representatives in General
26	24		Assembly convened:
27	25
28	26		Section 1. Section 38a-564 of the general statutes is repealed and the 1
29	27		following is substituted in lieu thereof (Effective January 1, 2020): 2
30	28		As used in this section and sections 38a-566, 38a-567, 38a-569 and 3
31	29		38a-574: 4
32	30		(1) "Pool" means the Connecticut Small Employer Health 5
33	31		Reinsurance Pool, established under section 38a-569. 6
34	32		(2) "Board" means the board of directors of the pool. 7
35	33		(3) "Employee" means an individual employed by an employer. 8
36	34		"Employee" does not include (A) an individual and such individual's 9
37	35		spouse with respect to an incorporated or unincorporated trade or 10
38	36		business that is wholly owned by such individual, by such individual's 11 Raised Bill No. 7260
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45	42		spouse or by such individual and such individual's spouse, [or] (B) a 12
46	43		partner in a partnership and such partner's spouse with respect to such 13
47	44		partnership, or (C) an individual employed by an employer in this 14
48	45		state that holds a manufacturer permit for beer, as described in 15
49	46		subsection (b) of section 30-16, and obtains health insurance coverage 16
50	47		for its employees and their dependents through the Connecticut 17
51	48		Brewers Guild. 18
52	49		(4) (A) "Small employer" means (i) prior to January 1, 2016, an 19
53	50		employer that employed an average of at least one but not more than 20
54	51		fifty employees on business days during the preceding calendar year 21
55	52		and employs at least one employee on the first day of the group health 22
56	53		insurance plan year, and (ii) on and after January 1, 2016, an employer 23
57	54		that employed an average of at least one but not more than one 24
58	55		hundred employees on business days during the preceding calendar 25
59	56		year and employs at least one employee on the first day of the group 26
60	57		health insurance plan year, except the commissioner may postpone 27
61	58		said January 1, 2016, date to be consistent with any such postponement 28
62	59		made by the Secretary of the United States Department of Health and 29
63	60		Human Services under the Patient Protection and Affordable Care Act, 30
64	61		P.L. 111-148, as amended from time to time. "Small employer" does not 31
65	62		include a sole proprietorship that employs only the sole proprietor or 32
66	63		the spouse of such sole proprietor, or an employer in this state that 33
67	64		holds a manufacturer permit for beer, as described in subsection (b) of 34
68	65		section 30-16, and obtains health insurance coverage for its employees 35
69	66		and their dependents through the Connecticut Brewers Guild. 36
70	67		(B) (i) For purposes of subparagraph (A) of this subdivision, the 37
71	68		number of employees shall be determined by adding (I) the number of 38
72	69		full-time employees for each month who work a normal work week of 39
73	70		thirty hours or more, and (II) the number of full-time equivalent 40
74	71		employees, calculated for each month by dividing by one hundred 41
75	72		twenty the aggregate number of hours worked for such month by 42
76	73		employees who work a normal work week of less than thirty hours, 43
77	74		and averaging such total for the calendar year. 44 Raised Bill No. 7260
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84	80		(ii) If an employer was not in existence throughout the preceding 45
85	81		calendar year, the number of employees shall be based on the average 46
86	82		number of employees that such employer reasonably expects to 47
87	83		employ in the current calendar year. 48
88	84		(C) All persons treated as a single employer under Section 414 of the 49
89	85		Internal Revenue Code of 1986, or any subsequent corresponding 50
90	86		internal revenue code of the United States, as amended from time to 51
91	87		time, shall be considered a single employer for purposes of this 52
92	88		subdivision. 53
93	89		(5) "Insurer" means any insurance company, hospital service 54
94	90		corporation, medical service corporation or health care center, 55
95	91		authorized to transact health insurance business in this state. 56
96	92		(6) "Insurance arrangement" means any multiple employer welfare 57
97	93		arrangement, as defined in Section 3 of the Employee Retirement 58
98	94		Income Security Act of 1974, as amended from time to time, except for 59
99	95		any such arrangement that is fully insured within the meaning of 60
100	96		Section 514(b)(6) of said act, as amended from time to time. 61
101	97		(7) "Health insurance plan" means any hospital and medical expense 62
102	98		incurred policy, hospital or medical service plan contract and health 63
103	99		care center subscriber contract. "Health insurance plan" does not 64
104	100		include (A) accident only, credit, dental, vision, Medicare supplement, 65
105	101		long-term care or disability insurance, hospital indemnity coverage, 66
106	102		coverage issued as a supplement to liability insurance, insurance 67
107	103		arising out of a workers' compensation or similar law, automobile 68
108	104		medical-payments insurance, or insurance under which beneficiaries 69
109	105		are payable without regard to fault and which is statutorily required to 70
110	106		be contained in any liability insurance policy or equivalent self-71
111	107		insurance, or (B) policies of specified disease or limited benefit health 72
112	108		insurance, provided the carrier offering such policies files on or before 73
113	109		March first of each year a certification with the commissioner that 74
114	110		contains the following: (i) A statement from the carrier certifying that 75
115	111		such policies are being offered and marketed as supplemental health 76 Raised Bill No. 7260
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122	117		insurance and not as a substitute for hospital or medical expense 77
123	118		insurance; (ii) a summary description of each such policy including the 78
124	119		average annual premium rates, or range of premium rates in cases 79
125	120		where premiums vary by age, gender or other factors, charged for such 80
126	121		policies in the state; and (iii) in the case of a policy that is described in 81
127	122		this subparagraph and that is offered for the first time in this state on 82
128	123		or after October 1, 1993, the carrier files with the commissioner the 83
129	124		information and statement required in this subparagraph at least thirty 84
130	125		days prior to the date such policy is issued or delivered in this state. 85
131	126		(8) "Plan of operation" means the plan of operation of the pool, 86
132	127		including articles, bylaws and operating rules, adopted by the board 87
133	128		pursuant to section 38a-569. 88
134	129		(9) "Dependent" means the spouse or child of an eligible employee, 89
135	130		subject to applicable terms of the health insurance plan covering such 90
136	131		employee. "Dependent" includes any dependent who is covered under 91
137	132		the small employer's health insurance plan pursuant to workers' 92
138	133		compensation, continuation of benefits pursuant to section 38a-512a or 93
139	134		other applicable laws. 94
140	135		(10) "Commissioner" means the Insurance Commissioner. 95
141	136		(11) "Member" means each insurer and insurance arrangement 96
142	137		participating in the pool. 97
143	138		(12) "Small employer carrier" means any insurer or insurance 98
144	139		arrangement that offers or maintains group health insurance plans 99
145	140		covering eligible employees of one or more small employers. 100
146	141		(13) "Health care center" has the same meaning as provided in 101
147	142		section 38a-175. 102
148	143		(14) "Case characteristics" means demographic or other objective 103
149	144		characteristics of a small employer, including age and geographic 104
150	145		location. "Case characteristics" does not include claims experience, 105
151	146		health status or duration of coverage since issue. 106 Raised Bill No. 7260
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158	152		This act shall take effect as follows and shall amend the following
159	153		sections:
160	154
161	155		Section 1 January 1, 2020 38a-564
162	156
163		-	INS Joint Favorable
	157	+	Statement of Purpose:
	158	+	To exclude beer manufacturers, their employees and the dependents of
	159	+	their employees from various provisions of the insurance statutes
	160	+	concerning small employer health insurance coverage.
	161	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
	162	+	except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
	163	+	not underlined.]
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