Connecticut 2019 Regular Session

Connecticut Senate Bill SB00042 Compare Versions

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Version 2 (New)

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7	7		General Assembly Committee Bill No. 42
8	8		January Session, 2019
9	9		LCO No. 5694
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12	12		Referred to Committee on INSURANCE AND REAL ESTATE
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14	14
15	15		Introduced by:
16	16		(INS)
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20	20		AN ACT CONCERNING CO INSURANCE, COPAYMENT S AND
21	21		DEDUCTIBLES AND CONT RACTING BY HEALTH CA RRIERS.
22	22		Be it enacted by the Senate and House of Representatives in General
23	23		Assembly convened:
24	24
25	25		Section 1. (NEW) (Effective January 1, 2020) (a) Notwithstanding any 1
26	26		provision of the general statutes and to the maximum extent permitted 2
27	27		by federal law, no individual or group health insurance policy 3
28	28		delivered, issued for delivery, renewed, amended or continued in this 4
29	29		state on or after January 1, 2020, providing coverage of the type 5
30	30		specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of 6
31	31		the general statutes shall impose: 7
32	32		(1) A coinsurance or deductible for a covered benefit in an amount 8
33	33		that exceeds the lesser of: 9
34	34		(A) An amount calculated on the basis of the amount due and 10
35	35		payable for the covered benefit by the insurer, health care center, 11
36	36		fraternal benefit society, hospital service corporation, medical service 12
37	37		corporation or other entity that delivered, issued for delivery, 13
38	38		renewed, amended or continued such policy; 14 Committee Bill No. 42
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45	45		(B) An amount calculated on the basis of the amount charged for the 15
46	46		covered benefit by the provider or vendor, less any discount for such 16
47	47		covered benefit and any amount due to, or charged by, an entity if 17
48	48		such entity is affiliated with, or owned or controlled by, the insurer, 18
49	49		health care center, fraternal benefit society, hospital service 19
50	50		corporation, medical service corporation or other entity that delivered, 20
51	51		issued for delivery, renewed, amended or continued such policy; or 21
52	52		(C) The amount that the insured would have paid for the covered 22
53	53		benefit without regard to such policy; or 23
54	54		(2) A copayment in an amount that the insured would have paid for 24
55	55		the covered benefit without regard to such policy. 25
56	56		(b) Any violation of this section shall constitute an unfair trade 26
57	57		practice in violation of chapter 735a of the general statutes. 27
58	58		Sec. 2. (NEW) (Effective January 1, 2020) Notwithstanding any 28
59	59		provision of the general statutes, and to the maximum extent 29
60	60		permitted by applicable law, no contract entered into or amended by a 30
61	61		health carrier, as defined in section 38a-591a of the general statutes, on 31
62	62		or after January 1, 2020, shall permit or require any party to such 32
63	63		contract to violate the fiduciary duties that the health carrier owes to 33
64	64		its insureds. 34
65	65		Sec. 3. Section 20-7f of the general statutes is repealed and the 35
66	66		following is substituted in lieu thereof (Effective January 1, 2020): 36
67	67		(a) For purposes of this section: 37
68	68		(1) "Request payment" includes, but is not limited to, submitting a 38
69	69		bill for services not actually owed or submitting for such services an 39
70	70		invoice or other communication detailing the cost of the services that is 40
71	71		not clearly marked with the phrase "This is not a bill". 41
72	72		(2) "Health care provider" means a person licensed to provide health 42
73	73		care services under chapters 370 to 373, inclusive, chapters 375 to 383b, 43 Committee Bill No. 42
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80	80		inclusive, chapters 384a to 384c, inclusive, or chapter 400j. 44
81	81		(3) "Enrollee" means a person who has contracted for or who 45
82	82		participates in a health care plan for such enrollee or such enrollee's 46
83	83		eligible dependents. 47
84	84		(4) ["Coinsurance, copayment, deductible or other out-of-pocket 48
85	85		expense"] "Coinsurance, copayment or deductible" means the portion 49
86	86		of a charge for services covered by a health care plan that, under the 50
87	87		plan's terms, it is the obligation of the enrollee to pay. 51
88	88		(5) "Health care plan" has the same meaning as provided in 52
89	89		subsection (a) of section 38a-477aa. 53
90	90		(6) "Health carrier" has the same meaning as provided in subsection 54
91	91		(a) of section 38a-477aa. 55
92	92		(7) "Emergency services" has the same meaning as provided in 56
93	93		subsection (a) of section 38a-477aa. 57
94	94		(b) It shall be an unfair trade practice in violation of chapter 735a for 58
95	95		any health care provider to request payment from an enrollee: [, other] 59
96	96		(1) Other than a coinsurance, copayment [,] or deductible, [or other 60
97	97		out-of-pocket expense,] for [(1)] (A) health care services or a facility 61
98	98		fee, as defined in section 19a-508c, covered under a health care plan, 62
99	99		[(2)] (B) emergency services covered under a health care plan and 63
100	100		rendered by an out-of-network health care provider, or [(3)] (C) a 64
101	101		surprise bill, as defined in section 38a-477aa; [.] or 65
102	102		(2) For a coinsurance, copayment or deductible in an amount that 66
103	103		exceeds the amount calculated pursuant to section 1 of this act. 67
104	104		(c) It shall be an unfair trade practice in violation of chapter 735a for 68
105	105		any health care provider to report to a credit reporting agency an 69
106	106		enrollee's failure to pay a bill for the services, facility fee or surprise bill 70
107	107		as set forth in subdivision (1) of subsection (b) of this section, when a 71 Committee Bill No. 42
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114	114		health carrier has primary responsibility for payment of such services, 72
115	115		fees or bills. 73
116	116		Sec. 4. Subdivision (3) of subsection (c) of section 38a-193 of the 74
117	117		general statutes is repealed and the following is substituted in lieu 75
118	118		thereof (Effective January 1, 2020): 76
119	119		(3) No participating provider, or agent, trustee or assignee thereof, 77
120	120		may: (A) Maintain any action at law against a subscriber or enrollee to 78
121	121		collect sums owed by the health care center; (B) request payment from 79
122	122		a subscriber or enrollee for such sums; (C) request payment from a 80
123	123		subscriber or enrollee for covered emergency services that are 81
124	124		provided by an out-of-network provider; or (D) request payment from 82
125	125		a subscriber or enrollee for a surprise bill, as defined in section 38a-83
126	126		477aa, as amended by this act. For purposes of this subdivision 84
127	127		"request payment" includes, but is not limited to, submitting a bill for 85
128	128		services not actually owed or submitting for such services an invoice 86
129	129		or other communication detailing the cost of the services that is not 87
130	130		clearly marked with the phrase "THIS IS NOT A BILL". The contract 88
131	131		between a health care center and a participating provider shall inform 89
132	132		the participating provider that pursuant to section 20-7f, as amended 90
133	133		by this act, it is an unfair trade practice in violation of chapter 735a for 91
134	134		any health care provider to request payment from a subscriber or an 92
135	135		enrollee, other than a coinsurance, copayment [,] or deductible, [or 93
136	136		other out-of-pocket expense,] for covered medical or emergency 94
137	137		services or facility fees, as defined in section 19a-508c, or surprise bills, 95
138	138		or to report to a credit reporting agency an enrollee's failure to pay a 96
139	139		bill for such services when a health care center has primary 97
140	140		responsibility for payment of such services, fees or bills. 98
141	141		Sec. 5. Section 38a-478j of the general statutes is repealed and the 99
142	142		following is substituted in lieu thereof (Effective January 1, 2020): 100
143	143		Each managed care plan that requires a deductible or percentage 101
144	144		coinsurance payment by the insured shall calculate the insured's 102
145	145		deductible or coinsurance payment on the lesser of the provider's or 103 Committee Bill No. 42
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152	152		vendor's charges for the goods or services or the amount payable by 104
153	153		the managed care organization or a subcontractor of such managed 105
154	154		care organization for such goods or services, except as otherwise 106
155	155		required by the laws of a foreign state when applicable to providers, 107
156	156		vendors or patients in such foreign state. 108
157	157		This act shall take effect as follows and shall amend the following
158	158		sections:
159	159
160	160		Section 1 January 1, 2020 New section
161	161		Sec. 2 January 1, 2020 New section
162	162		Sec. 3 January 1, 2020 20-7f
163	163		Sec. 4 January 1, 2020 38a-193(c)(3)
164	164		Sec. 5 January 1, 2020 38a-478j
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166	166		INS Joint Favorable
167		-	JUD Joint Favorable
168	167