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General Assembly Raised Bill No. 984
January Session, 2019
LCO No. 4910
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING MI NIMUM ESSENTIAL HEALTH COV ERAGE,
TAXATION OF HEALTH C ARRIERS AND RESIDENT S OF THIS STATE
AND THE CONNECTICUT HEALTH INSURANCE EXC HANGE.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective January 1, 2020) (a) For the purposes of 1
this section, unless the context otherwise requires: 2
(1) "Affordable Care Act" means the Patient Protection and 3
Affordable Care Act, P.L. 111-148, as amended from time to time. 4
(2) "Applicable individual" means, with respect to any month, an 5
individual who (A) is a citizen or national of the United States or an 6
alien lawfully present in the United States, (B) is not a member of an 7
Indian tribe as defined in Section 45A(c)(6) of the Internal Revenue 8
Code, (C) is not incarcerated, unless such individual is incarcerated 9
pending the disposition of charges, and (D) has not received an 10
exemption from the exchange pursuant to subdivision (15) of section 11
38a-1084 of the general statutes, as amended by this act, because such 12
individual has not certified that such individual is (i) a member of a 13 Raised Bill No. 984
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recognized religious sect or division thereof described in Section 14
1402(g)(1) of the Internal Revenue Code, and (ii) an adherent of the 15
established tenets or teachings of such religious sect or division. 16
(3) "Dependent" has the same meaning as provided in Section 152 of 17
the Internal Revenue Code. 18
(4) (A) "Minimum essential coverage" means (i) coverage under the 19
Medicare program under Part A or C of Title XVIII of the Social 20
Security Act, (ii) coverage under the Medicaid program under Title 21
XIX of the Social Security Act, (iii) coverage under the Children's 22
Health Insurance Program under Title XXI of the Social Security Act, 23
(iv) medical coverage under 10 USC Chapter 55, including, but not 24
limited to, coverage under the TriCare program, (v) coverage under a 25
health care program under 38 USC Chapter 17 or 18, (vi) coverage for 26
United States Peace Corps volunteers under 22 USC 2504(e), (vii) 27
coverage under the Nonappropriated Fund Health Benefits Program of 28
the United States Department of Defense established under Section 349 29
of the National Defense Authorization Act for Fiscal Year 1995, P.L. 30
103-337, (viii) coverage under an eligible employer-sponsored plan, 31
(ix) coverage under a health plan offered in the individual market as 32
defined in Section 1304 of the Affordable Care Act, (x) coverage under 33
a grandfathered health plan, as that term is used in the Affordable 34
Care Act, or (xi) coverage under any other qualified health plan, as that 35
term is used in Section 1311(c) of the Affordable Care Act. 36
(B) "Minimum essential coverage" does not mean any health 37
insurance coverage that consists of coverage of excepted benefits 38
described in (i) Section 2791(c)(1) of the Public Health Service Act, 42 39
USC 300gg-91(c)(1), as amended by the Affordable Care Act, or (ii) 40
Section 2791(c)(2), (3) or (4) of the Public Health Service Act, 42 USC 41
300gg-91(c)(2), (3) or (4), as amended by the Affordable Care Act, if 42
such benefits are provided under a separate policy, certificate or 43
contract of insurance. 44
(5) "Resident of this state" has the same meaning as provided in 45 Raised Bill No. 984
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section 12-701 of the general statutes. 46
(6) "Taxpayer" means a resident of this state who is a taxpayer 47
within the meaning of Section 5000A of the Internal Revenue Code. 48
(b) (1) Each taxpayer shall, for each month beginning on or after 49
January 1, 2020, ensure that such taxpayer, if such taxpayer is an 50
applicable individual, and each dependent of such taxpayer, if such 51
dependent is an applicable individual, maintains minimum essential 52
coverage. 53
(2) For the purposes of subdivision (1) of this subsection, an 54
applicable individual shall be deemed to have maintained minimum 55
essential coverage for any month during which the applicable 56
individual is not a resident of this state if: 57
(A) Such month occurs during any period described in Section 58
911(d)(1)(A) or (B) of the Internal Revenue Code that is applicable to 59
such applicable individual; 60
(B) Such applicable individual is a bona fide resident of any 61
possession of the United States, as determined under Section 937(a) of 62
the Internal Revenue Code, for such month; or 63
(C) Such applicable individual is a bona fide resident of any other 64
state of the United States for such month. 65
(c) The Insurance Commissioner may adopt regulations, in 66
accordance with chapter 54 of the general statutes, to implement the 67
provisions of this section. 68
Sec. 2. (NEW) (Effective July 1, 2019) Not later than October 1, 2019, 69
the Commissioner of Revenue Services, in consultation with the 70
Insurance Commissioner, the executive director of the Office of Health 71
Strategy and the exchange established pursuant to section 38a-1081 of 72
the general statutes, shall submit a report, in accordance with section 73
11-4a of the general statutes, to the joint standing committee of the 74
General Assembly having cognizance of matters relating to insurance. 75 Raised Bill No. 984
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Such report shall include the commissioner's recommendations 76
concerning: (1) Measures to enforce the provisions of section 1 of this 77
act, including, but not limited to, a state individual health care 78
responsibility fee that is designed to ensure that taxpayers and 79
dependents maintain minimum essential coverage, as those terms are 80
defined in said section; and (2) a refundable credit against the personal 81
income tax imposed under chapter 229 of the general statutes to help 82
residents of this state, as defined in section 12-701 of the general 83
statutes, offset the cost of health insurance. 84
Sec. 3. Section 12-201 of the general statutes is repealed and the 85
following is substituted in lieu thereof (Effective July 1, 2019): 86
When used in this chapter and section 4 of this act, unless the 87
context otherwise requires: 88
(1) "Commissioner of Revenue Services" or "commissioner" means 89
the Commissioner of Revenue Services; 90
(2) "Insurance Commissioner" means the state Insurance 91
Commissioner; 92
(3) "Taxpayer" means any insurance company subject to taxation 93
under this chapter; 94
(4) "Insurance company" means any corporation, limited liability 95
company, association, partnership or combination of persons doing 96
any kind or form of insurance business other than a fraternal benefit 97
society, including a receiver, trustee or other fiduciary of any insurance 98
company when the context reasonably permits; 99
(5) "Domestic insurance company" means any insurance company 100
chartered by or organized or constituted within or under the laws of 101
this state; 102
(6) "Local domestic insurance company" means any domestic 103
insurance company more than fifty per cent of the total gross direct 104
premiums of which are received during the calendar year next 105 Raised Bill No. 984
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preceding for insurance on property or risks located or resident in this 106
state; 107
(7) "Gross direct premiums" means all receipts of premiums from 108
policyholders and applicants for policies, whether received in the form 109
of money or other valuable consideration, but excluding annuity 110
premiums and considerations and premiums received for reinsurances 111
assumed from other insurance companies; 112
(8) "Net direct premiums" means gross direct premiums less the 113
following items: (A) Returned premiums, including cancellations, and 114
(B) dividends paid to policyholders on direct business, not including 115
any dividends paid on account of the ownership of stock; 116
(9) "Direct subscriber charges" means all charges made by a health 117
care center, as defined in section 38a-175, to subscribers, as defined in 118
section 38a-175, by whomever paid; 119
(10) "Net direct subscriber charges" means direct subscriber charges 120
less returned charges, including cancellations; 121
(11) "Received" means "received" or "accrued", construed according 122
to the method of accounting customarily employed by the taxpayers; 123
(12) "Domestic insurance holding company" means any company 124
engaged principally in the business of holding the stocks of domestic 125
insurance companies, whether or not such holding company is 126
chartered in this state; 127
(13) "Life insurance department" or "life insurance company" means 128
any department or company engaged in writing policies or annuities 129
the premiums on which are charged wholly or chiefly on the basis of 130
tables purporting to represent the mortality of insured lives or of 131
annuitants; 132
(14) "State" means any state, territory or district of the United States; 133
and 134 Raised Bill No. 984
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(15) "Ocean marine insurance" means all insurance written within 135
this state upon hulls, freights or disbursements, or upon goods, wares, 136
merchandise and all other personal property and interests therein, in 137
course of exportation from or importation into any country or 138
transportation coastwise, including transportation by land or water 139
from point of origin to final destination, in respect to any and all risks 140
or perils of navigation, transit or transportation, and while being 141
prepared for and awaiting shipment, and during any delays, storage, 142
transshipment or reshipment incident thereto, including war risks and 143
marine builder's risks. 144
Sec. 4. (NEW) (Effective July 1, 2019) (a) For the purposes of this 145
section: 146
(1) "Affordable Care Act" means the Patient Protection and 147
Affordable Care Act, P.L. 111-148, as amended by Section 1406 of the 148
Health Care and Education Reconciliation Act of 2010, P.L. 111-152, as 149
both may be amended from time to time; 150
(2) "Health carrier" means a health carrier, as that term is defined in 151
section 38a-1080 of the general statutes, as amended by this act, that is 152
a covered entity within the meaning of Section 9010 of the Affordable 153
Care Act; 154
(3) "Health insurance" has the same meaning as provided in Section 155
9010 of the Affordable Care Act; and 156
(4) "Health risk" has the same meaning as provided in Section 9010 157
of the Affordable Care Act. 158
(b) Except as provided in subsection (c) of this section, each health 159
carrier shall, annually, pay a tax in an amount that is equal to two and 160
seventy-five hundredths per cent of the net direct premiums received 161
by such health carrier for the calendar year next preceding with respect 162
to health insurance for health risks resident in this state. The tax 163
imposed under this subsection shall apply to each calendar year 164
beginning on or after January 1, 2019, is in addition to any other tax 165 Raised Bill No. 984
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imposed under the general statutes and shall not be borne by 166
policyholders. 167
(c) No health carrier shall be liable to this state for the tax imposed 168
under subsection (b) of this section for any calendar year, or any 169
portion of any calendar year, during which such health carrier is 170
required to pay the fee imposed under Section 9010 of the Affordable 171
Care Act. 172
(d) The commissioner shall deposit any moneys collected pursuant 173
to this section into the Connecticut Health Insurance Exchange Fund 174
established pursuant to section 6 of this act. 175
(e) The commissioner may adopt regulations, in accordance with 176
chapter 54 of the general statutes, to implement the provisions of this 177
section. 178
Sec. 5. Section 38a-1080 of the general statutes is repealed and the 179
following is substituted in lieu thereof (Effective July 1, 2019): 180
For purposes of sections 38a-1080 to 38a-1093, inclusive, as amended 181
by this act, and section 6 of this act: 182
(1) "Board" means the board of directors of the Connecticut Health 183
Insurance Exchange; 184
(2) "Commissioner" means the Insurance Commissioner; 185
(3) "Exchange" means the Connecticut Health Insurance Exchange 186
established pursuant to section 38a-1081; 187
(4) "Affordable Care Act" means the Patient Protection and 188
Affordable Care Act, P.L. 111-148, as amended by the Health Care and 189
Education Reconciliation Act, P.L. 111-152, as both may be amended 190
from time to time, and regulations adopted thereunder; 191
(5) (A) "Health benefit plan" means an insurance policy or contract 192
offered, delivered, issued for delivery, renewed, amended or 193 Raised Bill No. 984
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continued in the state by a health carrier to provide, deliver, pay for or 194
reimburse any of the costs of health care services. 195
(B) "Health benefit plan" does not include: 196
(i) Coverage of the type specified in subdivisions (5), (6), (7), (8), (9), 197
(14), (15) and (16) of section 38a-469 or any combination thereof; 198
(ii) Coverage issued as a supplement to liability insurance; 199
(iii) Liability insurance, including general liability insurance and 200
automobile liability insurance; 201
(iv) Workers' compensation insurance; 202
(v) Automobile medical payment insurance; 203
(vi) Credit insurance; 204
(vii) Coverage for on-site medical clinics; or 205
(viii) Other similar insurance coverage specified in regulations 206
issued pursuant to the Health Insurance Portability and Accountability 207
Act of 1996, P.L. 104-191, as amended from time to time, under which 208
benefits for health care services are secondary or incidental to other 209
insurance benefits. 210
(C) "Health benefit plan" does not include the following benefits if 211
they are provided under a separate insurance policy, certificate or 212
contract or are otherwise not an integral part of the plan: 213
(i) Limited scope dental or vision benefits; 214
(ii) Benefits for long-term care, nursing home care, home health 215
care, community-based care or any combination thereof; or 216
(iii) Other similar, limited benefits specified in regulations issued 217
pursuant to the Health Insurance Portability and Accountability Act of 218
1996, P.L. 104-191, as amended from time to time; 219 Raised Bill No. 984
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(iv) Other supplemental coverage, similar to coverage of the type 220
specified in subdivisions (9) and (14) of section 38a-469, provided 221
under a group health plan. 222
(D) "Health benefit plan" does not include coverage of the type 223
specified in subdivisions (3) and (13) of section 38a-469 or other fixed 224
indemnity insurance if (i) such coverage is provided under a separate 225
insurance policy, certificate or contract, (ii) there is no coordination 226
between the provision of the benefits and any exclusion of benefits 227
under any group health plan maintained by the same plan sponsor, 228
and (iii) the benefits are paid with respect to an event without regard 229
to whether benefits were also provided under any group health plan 230
maintained by the same plan sponsor; 231
(6) "Health care services" has the same meaning as provided in 232
section 38a-478; 233
(7) "Health carrier" means an insurance company, fraternal benefit 234
society, hospital service corporation, medical service corporation, 235
health care center or other entity subject to the insurance laws and 236
regulations of the state or the jurisdiction of the commissioner that 237
contracts or offers to contract to provide, deliver, pay for or reimburse 238
any of the costs of health care services; 239
(8) "Internal Revenue Code" means the Internal Revenue Code of 240
1986, or any subsequent corresponding internal revenue code of the 241
United States, as amended from time to time; 242
(9) "Person" has the same meaning as provided in section 38a-1; 243
(10) "Qualified dental plan" means a limited scope dental plan that 244
has been certified in accordance with subsection (e) of section 38a-1086; 245
(11) "Qualified employer" has the same meaning as provided in 246
Section 1312 of the Affordable Care Act; 247
(12) "Qualified health plan" means a health benefit plan that has in 248
effect a certification that the plan meets the criteria for certification 249 Raised Bill No. 984
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described in Section 1311(c) of the Affordable Care Act and section 250
38a-1086; 251
(13) "Qualified individual" has the same meaning as provided in 252
Section 1312 of the Affordable Care Act; 253
(14) "Secretary" means the Secretary of the United States 254
Department of Health and Human Services; 255
(15) "Small employer" has the same meaning as provided in section 256
38a-564. 257
Sec. 6. (NEW) (Effective July 1, 2019) The exchange shall establish 258
and administer a fund, to be known as the "Connecticut Health 259
Insurance Exchange Fund", to provide funding for (1) state-financed 260
health insurance premium and cost-sharing subsidies to individuals in 261
this state, and (2) a reinsurance program for the purpose of decreasing 262
the cost of health insurance in this state. The fund shall contain any 263
moneys required by law to be deposited in the fund and shall be 264
accounted for separately from all other moneys, funds and accounts. 265
Sec. 7. Section 38a-1084 of the general statutes is repealed and the 266
following is substituted in lieu thereof (Effective July 1, 2019): 267
The exchange shall: 268
(1) Administer the exchange for both qualified individuals and 269
qualified employers; 270
(2) Commission surveys of individuals, small employers and health 271
care providers on issues related to health care and health care 272
coverage; 273
(3) Implement procedures for the certification, recertification and 274
decertification, consistent with guidelines developed by the Secretary 275
under Section 1311(c) of the Affordable Care Act, and section 38a-1086, 276
of health benefit plans as qualified health plans; 277 Raised Bill No. 984
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(4) Provide for the operation of a toll-free telephone hotline to 278
respond to requests for assistance; 279
(5) Provide for enrollment periods, as provided under Section 280
1311(c)(6) of the Affordable Care Act; 281
(6) Maintain an Internet web site through which enrollees and 282
prospective enrollees of qualified health plans may obtain 283
standardized comparative information on such plans including, but 284
not limited to, the enrollee satisfaction survey information under 285
Section 1311(c)(4) of the Affordable Care Act and any other 286
information or tools to assist enrollees and prospective enrollees 287
evaluate qualified health plans offered through the exchange; 288
(7) Publish the average costs of licensing, regulatory fees and any 289
other payments required by the exchange and the administrative costs 290
of the exchange, including information on moneys lost to waste, fraud 291
and abuse, on an Internet web site to educate individuals on such 292
costs; 293
(8) On or before the open enrollment period for plan year 2017, 294
assign a rating to each qualified health plan offered through the 295
exchange in accordance with the criteria developed by the Secretary 296
under Section 1311(c)(3) of the Affordable Care Act, and determine 297
each qualified health plan's level of coverage in accordance with 298
regulations issued by the Secretary under Section 1302(d)(2)(A) of the 299
Affordable Care Act; 300
(9) Use a standardized format for presenting health benefit options 301
in the exchange, including the use of the uniform outline of coverage 302
established under Section 2715 of the Public Health Service Act, 42 303
USC 300gg-15, as amended from time to time; 304
(10) Inform individuals, in accordance with Section 1413 of the 305
Affordable Care Act, of eligibility requirements for the Medicaid 306
program under Title XIX of the Social Security Act, as amended from 307
time to time, the Children's Health Insurance Program (CHIP) under 308 Raised Bill No. 984
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Title XXI of the Social Security Act, as amended from time to time, or 309
any applicable state or local public program, and enroll an individual 310
in such program if the exchange determines, through screening of the 311
application by the exchange, that such individual is eligible for any 312
such program; 313
(11) Collaborate with the Department of Social Services, to the 314
extent possible, to allow an enrollee who loses premium tax credit 315
eligibility under Section 36B of the Internal Revenue Code and is 316
eligible for HUSKY A or any other state or local public program, to 317
remain enrolled in a qualified health plan; 318
(12) Establish and make available by electronic means a calculator to 319
determine the actual cost of coverage after application of any premium 320
tax credit under Section 36B of the Internal Revenue Code and any 321
cost-sharing reduction under Section 1402 of the Affordable Care Act; 322
(13) Establish a program for small employers through which 323
qualified employers may access coverage for their employees and that 324
shall enable any qualified employer to specify a level of coverage so 325
that any of its employees may enroll in any qualified health plan 326
offered through the exchange at the specified level of coverage; 327
(14) Offer enrollees and small employers the option of having the 328
exchange collect and administer premiums, including through 329
allocation of premiums among the various insurers and qualified 330
health plans chosen by individual employers; 331
(15) (A) Grant a certification, subject to Section 1411 of the 332
Affordable Care Act, attesting that, for purposes of the individual 333
responsibility penalty under Section 5000A of the Internal Revenue 334
Code, an individual is exempt from the individual responsibility 335
requirement or from the penalty imposed by said Section 5000A 336
because: 337
[(A)] (i) There is no affordable qualified health plan available 338
through the exchange, or the individual's employer, covering the 339 Raised Bill No. 984
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individual; or 340
[(B)] (ii) The individual meets the requirements for any other such 341
exemption from the individual responsibility requirement or penalty; 342
(B) Grant a certification, subject to section 1 of this act, attesting that, 343
for purposes of said section, an individual is exempt from the 344
requirement that the individual maintain minimum essential coverage 345
pursuant to said section because such individual meets the 346
requirements for an exemption from such requirement; 347
(16) (A) Provide to the Secretary of the Treasury of the United States 348
the following: 349
[(A)] (i) A list of the individuals granted a certification under 350
subparagraph (A) of subdivision (15) of this section, including the 351
name and taxpayer identification number of each individual; 352
[(B)] (ii) The name and taxpayer identification number of each 353
individual who was an employee of an employer but who was 354
determined to be eligible for the premium tax credit under Section 36B 355
of the Internal Revenue Code because: 356
[(i)] (I) The employer did not provide minimum essential health 357
benefits coverage; or 358
[(ii)] (II) The employer provided the minimum essential coverage 359
but it was determined under Section 36B(c)(2)(C) of the Internal 360
Revenue Code to be unaffordable to the employee or not provide the 361
required minimum actuarial value; and 362
[(C)] (iii) The name and taxpayer identification number of: 363
[(i)] (I) Each individual who notifies the exchange under Section 364
1411(b)(4) of the Affordable Care Act that such individual has changed 365
employers; and 366
[(ii)] (II) Each individual who ceases coverage under a qualified 367 Raised Bill No. 984
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health plan during a plan year and the effective date of that cessation; 368
(B) Provide to the Commissioner of Revenue Services the following: 369
(i) The information described in subparagraph (A) of this 370
subdivision; and 371
(ii) A list of the individuals granted a certification under 372
subparagraph (B) of subdivision (15) of this section, including the 373
name and taxpayer identification number of each individual; 374
(17) Provide to each employer the name of each employee, as 375
described in subparagraph [(B)] (A)(ii) of subdivision (16) of this 376
section, of the employer who ceases coverage under a qualified health 377
plan during a plan year and the effective date of the cessation; 378
(18) Perform duties required of, or delegated to, the exchange by the 379
Secretary or the Secretary of the Treasury of the United States related 380
to determining eligibility for premium tax credits, reduced cost-381
sharing or individual responsibility requirement exemptions; 382
(19) Select entities qualified to serve as Navigators in accordance 383
with Section 1311(i) of the Affordable Care Act and award grants to 384
enable Navigators to: 385
(A) Conduct public education activities to raise awareness of the 386
availability of qualified health plans; 387
(B) Distribute fair and impartial information concerning enrollment 388
in qualified health plans and the availability of premium tax credits 389
under Section 36B of the Internal Revenue Code and cost-sharing 390
reductions under Section 1402 of the Affordable Care Act; 391
(C) Facilitate enrollment in qualified health plans; 392
(D) Provide referrals to the Office of the Healthcare Advocate or 393
health insurance ombudsman established under Section 2793 of the 394
Public Health Service Act, 42 USC 300gg-93, as amended from time to 395 Raised Bill No. 984
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time, or any other appropriate state agency or agencies, for any 396
enrollee with a grievance, complaint or question regarding the 397
enrollee's health benefit plan, coverage or a determination under that 398
plan or coverage; and 399
(E) Provide information in a manner that is culturally and 400
linguistically appropriate to the needs of the population being served 401
by the exchange; 402
(20) Review the rate of premium growth within and outside the 403
exchange and consider such information in developing 404
recommendations on whether to continue limiting qualified employer 405
status to small employers; 406
(21) Credit the amount, in accordance with Section 10108 of the 407
Affordable Care Act, of any free choice voucher to the monthly 408
premium of the plan in which a qualified employee is enrolled and 409
collect the amount credited from the offering employer; 410
(22) Consult with stakeholders relevant to carrying out the activities 411
required under sections 38a-1080 to 38a-1090, inclusive, as amended by 412
this act, including, but not limited to: 413
(A) Individuals who are knowledgeable about the health care 414
system, have background or experience in making informed decisions 415
regarding health, medical and scientific matters and are enrollees in 416
qualified health plans; 417
(B) Individuals and entities with experience in facilitating 418
enrollment in qualified health plans; 419
(C) Representatives of small employers and self-employed 420
individuals; 421
(D) The Department of Social Services; and 422
(E) Advocates for enrolling hard-to-reach populations; 423 Raised Bill No. 984
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(23) Meet the following financial integrity requirements: 424
(A) Keep an accurate accounting of all activities, receipts and 425
expenditures and annually submit to the Secretary, the Governor, the 426
Insurance Commissioner and the General Assembly a report 427
concerning such accountings; 428
(B) Fully cooperate with any investigation conducted by the 429
Secretary pursuant to the Secretary's authority under the Affordable 430
Care Act and allow the Secretary, in coordination with the Inspector 431
General of the United States Department of Health and Human 432
Services, to: 433
(i) Investigate the affairs of the exchange; 434
(ii) Examine the properties and records of the exchange; and 435
(iii) Require periodic reports in relation to the activities undertaken 436
by the exchange; and 437
(C) Not use any funds in carrying out its activities under sections 438
38a-1080 to 38a-1089, inclusive, as amended by this act, that are 439
intended for the administrative and operational expenses of the 440
exchange, for staff retreats, promotional giveaways, excessive 441
executive compensation or promotion of federal or state legislative and 442
regulatory modifications; 443
(24) (A) Seek to include the most comprehensive health benefit 444
plans that offer high quality benefits at the most affordable price in the 445
exchange, (B) encourage health carriers to offer tiered health care 446
provider network plans that have different cost-sharing rates for 447
different health care provider tiers and reward enrollees for choosing 448
low-cost, high-quality health care providers by offering lower 449
copayments, deductibles or other out-of-pocket expenses, and (C) offer 450
any such tiered health care provider network plans through the 451
exchange; [and] 452
(25) Report at least annually to the General Assembly on the effect 453 Raised Bill No. 984
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of adverse selection on the operations of the exchange and make 454
legislative recommendations, if necessary, to reduce the negative 455
impact from any such adverse selection on the sustainability of the 456
exchange, including recommendations to ensure that regulation of 457
insurers and health benefit plans are similar for qualified health plans 458
offered through the exchange and health benefit plans offered outside 459
the exchange. The exchange shall evaluate whether adverse selection is 460
occurring with respect to health benefit plans that are grandfathered 461
under the Affordable Care Act, self-insured plans, plans sold through 462
the exchange and plans sold outside the exchange; and 463
(26) Establish and administer the "Connecticut Health Insurance 464
Exchange Fund" pursuant to section 6 of this act. 465
Sec. 8. (NEW) (Effective October 1, 2019) (a) For the purposes of this 466
section: 467
(1) "Exchange" means the Connecticut Health Insurance Exchange 468
established pursuant to section 38a-1081 of the general statutes; 469
(2) "Plan year" has the same meaning as that term is used in section 470
38a-1084 of the general statutes, as amended by this act; and 471
(3) "Qualified health plan" has the same meaning as provided in 472
section 38a-1080 of the general statutes, as amended by this act. 473
(b) Each insurer, health care center, fraternal benefit society, hospital 474
service corporation, medical service corporation or other entity that 475
delivers, issues for delivery, renews, amends or continues not fewer 476
than five thousand individual or group health insurance policies in 477
this state that provide coverage of the type specified in subdivisions 478
(1), (2), (4), (11) and (12) of section 38a-469 of the general statutes 479
during a calendar year beginning on or after January 1, 2020, shall, for 480
the immediately following plan year, offer not fewer than one 481
qualified health plan through the exchange. 482
(c) The Insurance Commissioner may adopt regulations, in 483 Raised Bill No. 984
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accordance with chapter 54 of the general statutes, to implement the 484
provisions of this section. 485
Sec. 9. Subdivisions (1) and (2) of subsection (m) of section 5-259 of 486
the general statutes are repealed and the following is substituted in 487
lieu thereof (Effective October 1, 2019): 488
(m) (1) Notwithstanding any provision of the general statutes, the 489
Comptroller shall begin procedures to convert the group 490
hospitalization and medical and surgical insurance plans set forth in 491
subsection (a) of this section, including any prescription drug plan 492
offered in connection with or in addition to such insurance plans, to 493
self-insured plans, except that any dental plan offered in connection 494
with or in addition to such self-insured plans may be fully insured. 495
(2) The Comptroller may enter into contracts with third-party 496
administrators to provide administrative services only for the self-497
insured plans set forth in subdivision (1) of this subsection. Any such 498
third-party administrator shall be required under such contract to: 499
[charge] 500
(A) Charge such third-party administrator's lowest available rate for 501
such services; and 502
(B) Offer not fewer than one qualified health plan, as that term is 503
defined in section 38a-1080, as amended by this act, through the 504
exchange established pursuant to section 38a-1081 for each plan year, 505
as that term is used in section 38a-1084, as amended by this act, during 506
the term of such contract if: 507
(i) Such contract is entered into, renewed or amended on or after 508
October 1, 2019; 509
(ii) Such plan year begins on or after January 1, 2020, and after the 510
date that such contract was entered into, renewed or amended; and 511
(iii) Such third-party administrator is an insurer, health care center, 512
fraternal benefit society, hospital service corporation, medical service 513 Raised Bill No. 984
LCO No. 4910 19 of 20
corporation or other entity that (I) is authorized to transact health 514
insurance business in this state, and (II) delivered, issued for delivery, 515
renewed, amended or continued not fewer than five thousand 516
individual or group health insurance policies in this state that 517
provided coverage of the type specified in subdivisions (1), (2), (4), (11) 518
and (12) of section 38a-469 during the calendar year immediately 519
preceding such plan year. 520
Sec. 10. (NEW) (Effective July 1, 2019) Not later than October 1, 2019, 521
the Office of Health Strategy, in consultation with the Insurance 522
Commissioner, the Healthcare Advocate, the Connecticut Health 523
Insurance Exchange established pursuant to section 38a-1081 of the 524
general statutes and the insurance industry, shall submit a report, in 525
accordance with section 11-4a of the general statutes, to the joint 526
standing committee of the General Assembly having cognizance of 527
matters relating to insurance. Such report shall include the Office of 528
Health Strategy's recommendations concerning the implementation of 529
state-financed health insurance premium and cost-sharing subsidies 530
and a reinsurance program for the purpose of decreasing the cost of 531
health insurance in this state. 532
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2020 New section
Sec. 2 July 1, 2019 New section
Sec. 3 July 1, 2019 12-201
Sec. 4 July 1, 2019 New section
Sec. 5 July 1, 2019 38a-1080
Sec. 6 July 1, 2019 New section
Sec. 7 July 1, 2019 38a-1084
Sec. 8 October 1, 2019 New section
Sec. 9 October 1, 2019 5-259(m)(1) and (2)
Sec. 10 July 1, 2019 New section
Statement of Purpose:
To: (1) Establish a minimum essential health coverage requirement; (2)
require the Commissioner of Revenue Services to develop methods to Raised Bill No. 984
LCO No. 4910 20 of 20
enforce such requirement and design a tax credit to offset the cost of
health insurance; (3) impose a tax on certain health carriers for net
direct premiums; (4) establish the "Connecticut Health Insurance
Exchange Fund"; (5) require certain insurers, health care centers,
fraternal benefit societies, hospital service corporations, medical
service corporations and other entities that transact health insurance
business in this state or administer state health plans to offer not fewer
than one qualified health plan through the Connecticut Health
Insurance Exchange; and (6) require the Office of Health Strategy to
study the possible implementation of state-financed health insurance
premium and cost-sharing subsidies and a reinsurance program.
[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.]