Connecticut 2019 Regular Session

Connecticut Senate Bill SB00984 Compare Versions

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7	7		General Assembly Substitute Bill No. 984
8	8		January Session, 2019
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14	14		AN ACT CONCERNING MI NIMUM ESSENTIAL HEAL TH COVERAGE,
15	15		REPORTS REGARDING HE ALTH INSURANCE AND TAXATI ON, A
16	16		HEALTH INSURER SURCH ARGE AND THE CONNECT ICUT HEALTH
17	17		INSURANCE EXCHANGE.
18	18		Be it enacted by the Senate and House of Representatives in General
19	19		Assembly convened:
20	20
21	21		Section 1. (NEW) (Effective January 1, 2020) (a) For the purposes of 1
22	22		this section, unless the context otherwise requires: 2
23	23		(1) "Affordable Care Act" means the Patient Protection and 3
24	24		Affordable Care Act, P.L. 111-148, as amended from time to time. 4
25	25		(2) "Applicable individual" means, with respect to any month, an 5
26	26		individual who (A) is a citizen or national of the United States or an 6
27	27		alien lawfully present in the United States, (B) is not a member of an 7
28	28		Indian tribe as defined in Section 45A(c)(6) of the Internal Revenue 8
29	29		Code, (C) is not incarcerated, unless such individual is incarcerated 9
30	30		pending the disposition of charges, and (D) has not received an 10
31	31		exemption from the exchange pursuant to subdivision (15) of section 11
32	32		38a-1084 of the general statutes, as amended by this act, because such 12
33	33		individual has not certified that such individual is (i) a member of a 13
34	34		recognized religious sect or division thereof described in Section 14
35	35		1402(g)(1) of the Internal Revenue Code and an adherent of the 15
36	36		established tenets or teachings of such religious sect or division, or (ii) 16
37	37		a member of a religious sect or division thereof that is not described in 17 Substitute Bill No. 984
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44	44		said section, relies solely on a religious method of healing and for 18
45	45		whom the acceptance of medical health services would be inconsistent 19
46	46		with such individual's religious beliefs. 20
47	47		(3) "Dependent" has the same meaning as provided in Section 152 of 21
48	48		the Internal Revenue Code. 22
49	49		(4) (A) "Minimum essential coverage" means (i) coverage under the 23
50	50		Medicare program under Part A or C of Title XVIII of the Social 24
51	51		Security Act, (ii) coverage under the Medicaid program under Title 25
52	52		XIX of the Social Security Act, (iii) coverage under the Children's 26
53	53		Health Insurance Program under Title XXI of the Social Security Act, 27
54	54		(iv) medical coverage under 10 USC Chapter 55, including, but not 28
55	55		limited to, coverage under the TriCare program, (v) coverage under a 29
56	56		health care program under 38 USC Chapter 17 or 18, (vi) coverage for 30
57	57		United States Peace Corps volunteers under 22 USC 2504(e), (vii) 31
58	58		coverage under the Nonappropriated Fund Health Benefits Program of 32
59	59		the United States Department of Defense established under Section 349 33
60	60		of the National Defense Authorization Act for Fiscal Year 1995, P.L. 34
61	61		103-337, (viii) coverage under an eligible employer-sponsored plan, 35
62	62		(ix) coverage under a health plan offered in the individual market as 36
63	63		defined in Section 1304 of the Affordable Care Act, (x) coverage under 37
64	64		a grandfathered health plan, as that term is used in the Affordable 38
65	65		Care Act, or (xi) coverage under any other qualified health plan, as that 39
66	66		term is used in Section 1311(c) of the Affordable Care Act. 40
67	67		(B) "Minimum essential coverage" does not mean any health 41
68	68		insurance coverage that consists of coverage of excepted benefits 42
69	69		described in (i) Section 2791(c)(1) of the Public Health Service Act, 42 43
70	70		USC 300gg-91(c)(1), as amended by the Affordable Care Act, or (ii) 44
71	71		Section 2791(c)(2), (3) or (4) of the Public Health Service Act, 42 USC 45
72	72		300gg-91(c)(2), (3) or (4), as amended by the Affordable Care Act, if 46
73	73		such benefits are provided under a separate policy, certificate or 47
74	74		contract of insurance. 48
75	75		(5) "Resident of this state" has the same meaning as provided in 49 Substitute Bill No. 984
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82	82		section 12-701 of the general statutes. 50
83	83		(6) "Taxpayer" means a resident of this state who is a taxpayer 51
84	84		within the meaning of Section 5000A of the Internal Revenue Code. 52
85	85		(b) (1) Each taxpayer shall, for each month beginning on or after 53
86	86		January 1, 2020, ensure that such taxpayer, if such taxpayer is an 54
87	87		applicable individual, and each dependent of such taxpayer, if such 55
88	88		dependent is an applicable individual, maintains minimum essential 56
89	89		coverage. 57
90	90		(2) For the purposes of subdivision (1) of this subsection, an 58
91	91		applicable individual shall be deemed to have maintained minimum 59
92	92		essential coverage for any month during which the applicable 60
93	93		individual is not a resident of this state if: 61
94	94		(A) Such month occurs during any period described in Section 62
95	95		911(d)(1)(A) or (B) of the Internal Revenue Code that is applicable to 63
96	96		such applicable individual; 64
97	97		(B) Such applicable individual is a bona fide resident of any 65
98	98		possession of the United States, as determined under Section 937(a) of 66
99	99		the Internal Revenue Code, for such month; or 67
100	100		(C) Such applicable individual is a bona fide resident of any other 68
101	101		state of the United States for such month. 69
102	102		(c) The Insurance Commissioner may adopt regulations, in 70
103	103		accordance with chapter 54 of the general statutes, to implement the 71
104	104		provisions of this section. 72
105	105		Sec. 2. (Effective July 1, 2019) Not later than October 1, 2019, the 73
106	106		Commissioner of Revenue Services, in consultation with the Insurance 74
107	107		Commissioner, the executive director of the Office of Health Strategy 75
108	108		and the exchange established pursuant to section 38a-1081 of the 76
109	109		general statutes, shall submit a report, in accordance with section 11-4a 77
110	110		of the general statutes, to the joint standing committee of the General 78 Substitute Bill No. 984
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117	117		Assembly having cognizance of matters relating to insurance. Such 79
118	118		report shall include the commissioner's recommendations concerning: 80
119	119		(1) Measures to enforce the provisions of section 1 of this act, 81
120	120		including, but not limited to, a state individual health care 82
121	121		responsibility fee that is designed to ensure that taxpayers and 83
122	122		dependents maintain minimum essential coverage, as those terms are 84
123	123		defined in said section; and (2) a refundable credit against the personal 85
124	124		income tax imposed under chapter 229 of the general statutes to help 86
125	125		residents of this state, as defined in section 12-701 of the general 87
126	126		statutes, offset the cost of health insurance. 88
127	127		Sec. 3. (NEW) (Effective July 1, 2019) (a) For each calendar month 89
128	128		beginning on or after January 1, 2020, each insurance company, 90
129	129		fraternal benefit society, hospital service corporation, medical service 91
130	130		corporation, health care center or other entity delivering, issuing for 92
131	131		delivery, renewing, amending or continuing in this state an individual 93
132	132		or group health insurance policy providing coverage of the type 94
133	133		specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of 95
134	134		the general statutes shall remit to the Insurance Commissioner, in a 96
135	135		form and manner prescribed by the commissioner, a surcharge for 97
136	136		each policy providing such coverage during such month or any 98
137	137		portion of such month. The amount of such surcharge shall be 99
138	138		calculated as follows: 100
139	139		(1) If such policy is an individual health insurance policy, ten dollars 101
140	140		multiplied by the number of insureds under such policy; or 102
141	141		(2) If such policy is a group health insurance policy, five dollars 103
142	142		multiplied by the number of insureds under such policy. 104
143	143		(b) The monthly surcharge imposed under subsection (a) of this 105
144	144		section shall not be considered premium for any purpose, and no 106
145	145		portion of such surcharge shall be refundable or borne by an insured. 107
146	146		(c) Each insurance company, fraternal benefit society, hospital 108
147	147		service corporation, medical service corporation, health care center or 109 Substitute Bill No. 984
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154	154		entity shall remit to the Insurance Commissioner, not later than the 110
155	155		thirtieth day of April annually, all monthly surcharges imposed on 111
156	156		such company, society, corporation, center or entity under subsection 112
157	157		(a) of this section for the calendar year immediately preceding. Each 113
158	158		remittance shall include documentation, in a form and manner 114
159	159		prescribed by the commissioner, to substantiate the amount of the 115
160	160		monthly surcharges being remitted by such company, society, 116
161	161		corporation, center or entity. 117
162	162		(d) Not later than the first day of June annually, the Insurance 118
163	163		Commissioner shall deposit all remittances for the calendar year 119
164	164		immediately preceding in the Connecticut Health Insurance Exchange 120
165	165		Fund established pursuant to section 5 of this act. 121
166	166		(e) The surcharge imposed under subsection (a) of this section shall 122
167	167		constitute a special purpose assessment for the purposes of section 12-123
168	168		211 of the general statutes. 124
169	169		(f) The Insurance Commissioner may adopt regulations, in 125
170	170		accordance with chapter 54 of the general statutes, to implement the 126
171	171		provisions of this section. 127
172	172		Sec. 4. Section 38a-1080 of the general statutes is repealed and the 128
173	173		following is substituted in lieu thereof (Effective July 1, 2019): 129
174	174		For purposes of sections 38a-1080 to 38a-1093, inclusive, as amended 130
175	175		by this act, and section 5 of this act: 131
176	176		(1) "Board" means the board of directors of the Connecticut Health 132
177	177		Insurance Exchange; 133
178	178		(2) "Commissioner" means the Insurance Commissioner; 134
179	179		(3) "Exchange" means the Connecticut Health Insurance Exchange 135
180	180		established pursuant to section 38a-1081; 136
181	181		(4) "Affordable Care Act" means the Patient Protection and 137 Substitute Bill No. 984
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188	188		Affordable Care Act, P.L. 111-148, as amended by the Health Care and 138
189	189		Education Reconciliation Act, P.L. 111-152, as both may be amended 139
190	190		from time to time, and regulations adopted thereunder; 140
191	191		(5) (A) "Health benefit plan" means an insurance policy or contract 141
192	192		offered, delivered, issued for delivery, renewed, amended or 142
193	193		continued in the state by a health carrier to provide, deliver, pay for or 143
194	194		reimburse any of the costs of health care services. 144
195	195		(B) "Health benefit plan" does not include: 145
196	196		(i) Coverage of the type specified in subdivisions (5), (6), (7), (8), (9), 146
197	197		(14), (15) and (16) of section 38a-469 or any combination thereof; 147
198	198		(ii) Coverage issued as a supplement to liability insurance; 148
199	199		(iii) Liability insurance, including general liability insurance and 149
200	200		automobile liability insurance; 150
201	201		(iv) Workers' compensation insurance; 151
202	202		(v) Automobile medical payment insurance; 152
203	203		(vi) Credit insurance; 153
204	204		(vii) Coverage for on-site medical clinics; or 154
205	205		(viii) Other similar insurance coverage specified in regulations 155
206	206		issued pursuant to the Health Insurance Portability and Accountability 156
207	207		Act of 1996, P.L. 104-191, as amended from time to time, under which 157
208	208		benefits for health care services are secondary or incidental to other 158
209	209		insurance benefits. 159
210	210		(C) "Health benefit plan" does not include the following benefits if 160
211	211		they are provided under a separate insurance policy, certificate or 161
212	212		contract or are otherwise not an integral part of the plan: 162
213	213		(i) Limited scope dental or vision benefits; 163 Substitute Bill No. 984
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220	220		(ii) Benefits for long-term care, nursing home care, home health 164
221	221		care, community-based care or any combination thereof; or 165
222	222		(iii) Other similar, limited benefits specified in regulations issued 166
223	223		pursuant to the Health Insurance Portability and Accountability Act of 167
224	224		1996, P.L. 104-191, as amended from time to time; 168
225	225		(iv) Other supplemental coverage, similar to coverage of the type 169
226	226		specified in subdivisions (9) and (14) of section 38a-469, provided 170
227	227		under a group health plan. 171
228	228		(D) "Health benefit plan" does not include coverage of the type 172
229	229		specified in subdivisions (3) and (13) of section 38a-469 or other fixed 173
230	230		indemnity insurance if (i) such coverage is provided under a separate 174
231	231		insurance policy, certificate or contract, (ii) there is no coordination 175
232	232		between the provision of the benefits and any exclusion of benefits 176
233	233		under any group health plan maintained by the same plan sponsor, 177
234	234		and (iii) the benefits are paid with respect to an event without regard 178
235	235		to whether benefits were also provided under any group health plan 179
236	236		maintained by the same plan sponsor; 180
237	237		(6) "Health care services" has the same meaning as provided in 181
238	238		section 38a-478; 182
239	239		(7) "Health carrier" means an insurance company, fraternal benefit 183
240	240		society, hospital service corporation, medical service corporation, 184
241	241		health care center or other entity subject to the insurance laws and 185
242	242		regulations of the state or the jurisdiction of the commissioner that 186
243	243		contracts or offers to contract to provide, deliver, pay for or reimburse 187
244	244		any of the costs of health care services; 188
245	245		(8) "Internal Revenue Code" means the Internal Revenue Code of 189
246	246		1986, or any subsequent corresponding internal revenue code of the 190
247	247		United States, as amended from time to time; 191
248	248		(9) "Person" has the same meaning as provided in section 38a-1; 192 Substitute Bill No. 984
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255	255		(10) "Qualified dental plan" means a limited scope dental plan that 193
256	256		has been certified in accordance with subsection (e) of section 38a-1086; 194
257	257		(11) "Qualified employer" has the same meaning as provided in 195
258	258		Section 1312 of the Affordable Care Act; 196
259	259		(12) "Qualified health plan" means a health benefit plan that has in 197
260	260		effect a certification that the plan meets the criteria for certification 198
261	261		described in Section 1311(c) of the Affordable Care Act and section 199
262	262		38a-1086; 200
263	263		(13) "Qualified individual" has the same meaning as provided in 201
264	264		Section 1312 of the Affordable Care Act; 202
265	265		(14) "Secretary" means the Secretary of the United States 203
266	266		Department of Health and Human Services; and 204
267	267		(15) "Small employer" has the same meaning as provided in section 205
268	268		38a-564. 206
269	269		Sec. 5. (NEW) (Effective July 1, 2019) The exchange shall establish 207
270	270		and administer a fund, to be known as the "Connecticut Health 208
271	271		Insurance Exchange Fund", to provide funding for (1) state-financed 209
272	272		health insurance premium and cost-sharing subsidies to individuals in 210
273	273		this state, and (2) a reinsurance program for the purpose of decreasing 211
274	274		the cost of health insurance in this state. The fund shall contain any 212
275	275		moneys required by law to be deposited in the fund and shall be 213
276	276		accounted for separately from all other moneys, funds and accounts. 214
277	277		Sec. 6. Section 38a-1084 of the general statutes is repealed and the 215
278	278		following is substituted in lieu thereof (Effective July 1, 2019): 216
279	279		The exchange shall: 217
280	280		(1) Administer the exchange for both qualified individuals and 218
281	281		qualified employers; 219
282	282		(2) Commission surveys of individuals, small employers and health 220 Substitute Bill No. 984
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289	289		care providers on issues related to health care and health care 221
290	290		coverage; 222
291	291		(3) Implement procedures for the certification, recertification and 223
292	292		decertification, consistent with guidelines developed by the Secretary 224
293	293		under Section 1311(c) of the Affordable Care Act, and section 38a-1086, 225
294	294		of health benefit plans as qualified health plans; 226
295	295		(4) Provide for the operation of a toll-free telephone hotline to 227
296	296		respond to requests for assistance; 228
297	297		(5) Provide for enrollment periods, as provided under Section 229
298	298		1311(c)(6) of the Affordable Care Act; 230
299	299		(6) Maintain an Internet web site through which enrollees and 231
300	300		prospective enrollees of qualified health plans may obtai n 232
301	301		standardized comparative information on such plans including, but 233
302	302		not limited to, the enrollee satisfaction survey information under 234
303	303		Section 1311(c)(4) of the Affordable Care Act and any other 235
304	304		information or tools to assist enrollees and prospective enrollees 236
305	305		evaluate qualified health plans offered through the exchange; 237
306	306		(7) Publish the average costs of licensing, regulatory fees and any 238
307	307		other payments required by the exchange and the administrative costs 239
308	308		of the exchange, including information on moneys lost to waste, fraud 240
309	309		and abuse, on an Internet web site to educate individuals on such 241
310	310		costs; 242
311	311		(8) On or before the open enrollment period for plan year 2017, 243
312	312		assign a rating to each qualified health plan offered through the 244
313	313		exchange in accordance with the criteria developed by the Secretary 245
314	314		under Section 1311(c)(3) of the Affordable Care Act, and determine 246
315	315		each qualified health plan's level of coverage in accordance with 247
316	316		regulations issued by the Secretary under Section 1302(d)(2)(A) of the 248
317	317		Affordable Care Act; 249
318	318		(9) Use a standardized format for presenting health benefit options 250 Substitute Bill No. 984
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325	325		in the exchange, including the use of the uniform outline of coverage 251
326	326		established under Section 2715 of the Public Health Service Act, 42 252
327	327		USC 300gg-15, as amended from time to time; 253
328	328		(10) Inform individuals, in accordance with Section 1413 of the 254
329	329		Affordable Care Act, of eligibility requirements for the Medicaid 255
330	330		program under Title XIX of the Social Security Act, as amended from 256
331	331		time to time, the Children's Health Insurance Program (CHIP) under 257
332	332		Title XXI of the Social Security Act, as amended from time to time, or 258
333	333		any applicable state or local public program, and enroll an individual 259
334	334		in such program if the exchange determines, through screening of the 260
335	335		application by the exchange, that such individual is eligible for any 261
336	336		such program; 262
337	337		(11) Collaborate with the Department of Social Services, to the 263
338	338		extent possible, to allow an enrollee who loses premium tax credit 264
339	339		eligibility under Section 36B of the Internal Revenue Code and is 265
340	340		eligible for HUSKY A or any other state or local public program, to 266
341	341		remain enrolled in a qualified health plan; 267
342	342		(12) Establish and make available by electronic means a calculator to 268
343	343		determine the actual cost of coverage after application of any premium 269
344	344		tax credit under Section 36B of the Internal Revenue Code and any 270
345	345		cost-sharing reduction under Section 1402 of the Affordable Care Act; 271
346	346		(13) Establish a program for small employers through which 272
347	347		qualified employers may access coverage for their employees and that 273
348	348		shall enable any qualified employer to specify a level of coverage so 274
349	349		that any of its employees may enroll in any qualified health plan 275
350	350		offered through the exchange at the specified level of coverage; 276
351	351		(14) Offer enrollees and small employers the option of having the 277
352	352		exchange collect and administer premiums, including through 278
353	353		allocation of premiums among the various insurers and qualified 279
354	354		health plans chosen by individual employers; 280
355	355		(15) (A) Grant a certification, subject to Section 1411 of the 281 Substitute Bill No. 984
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362	362		Affordable Care Act, attesting that, for purposes of the individual 282
363	363		responsibility penalty under Section 5000A of the Internal Revenue 283
364	364		Code, an individual is exempt from the individual responsibility 284
365	365		requirement or from the penalty imposed by said Section 5000A 285
366	366		because: 286
367	367		[(A)] (i) There is no affordable qualified health plan available 287
368	368		through the exchange, or the individual's employer, covering the 288
369	369		individual; or 289
370	370		[(B)] (ii) The individual meets the requirements for any other such 290
371	371		exemption from the individual responsibility requirement or penalty; 291
372	372		(B) Grant a certification, subject to section 1 of this act, attesting that, 292
373	373		for purposes of said section, an individual is exempt from the 293
374	374		requirement that the individual maintain minimum essential coverage 294
375	375		pursuant to said section because such individual meets the 295
376	376		requirements for an exemption from such requirement; 296
377	377		(16) (A) Provide to the Secretary of the Treasury of the United States 297
378	378		the following: 298
379	379		[(A)] (i) A list of the individuals granted a certification under 299
380	380		subparagraph (A) of subdivision (15) of this section, including the 300
381	381		name and taxpayer identification number of each individual; 301
382	382		[(B)] (ii) The name and taxpayer identification number of each 302
383	383		individual who was an employee of an employer but who was 303
384	384		determined to be eligible for the premium tax credit under Section 36B 304
385	385		of the Internal Revenue Code because: 305
386	386		[(i)] (I) The employer did not provide minimum essential health 306
387	387		benefits coverage; or 307
388	388		[(ii)] (II) The employer provided the minimum essential coverage 308
389	389		but it was determined under Section 36B(c)(2)(C) of the Internal 309
390	390		Revenue Code to be unaffordable to the employee or not provide the 310 Substitute Bill No. 984
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397	397		required minimum actuarial value; and 311
398	398		[(C)] (iii) The name and taxpayer identification number of: 312
399	399		[(i)] (I) Each individual who notifies the exchange under Section 313
400	400		1411(b)(4) of the Affordable Care Act that such individual has changed 314
401	401		employers; and 315
402	402		[(ii)] (II) Each individual who ceases coverage under a qualified 316
403	403		health plan during a plan year and the effective date of that cessation; 317
404	404		(B) Provide to the Commissioner of Revenue Services the following: 318
405	405		(i) The information described in subparagraph (A) of this 319
406	406		subdivision; and 320
407	407		(ii) A list of the individuals granted a certification under 321
408	408		subparagraph (B) of subdivision (15) of this section, including the 322
409	409		name and taxpayer identification number of each individual; 323
410	410		(17) Provide to each employer the name of each employee, as 324
411	411		described in subparagraph [(B)] (A)(ii) of subdivision (16) of this 325
412	412		section, of the employer who ceases coverage under a qualified health 326
413	413		plan during a plan year and the effective date of the cessation; 327
414	414		(18) Perform duties required of, or delegated to, the exchange by the 328
415	415		Secretary or the Secretary of the Treasury of the United States related 329
416	416		to determining eligibility for premium tax credits, reduced cost-330
417	417		sharing or individual responsibility requirement exemptions; 331
418	418		(19) Select entities qualified to serve as Navigators in accordance 332
419	419		with Section 1311(i) of the Affordable Care Act and award grants to 333
420	420		enable Navigators to: 334
421	421		(A) Conduct public education activities to raise awareness of the 335
422	422		availability of qualified health plans; 336
423	423		(B) Distribute fair and impartial information concerning enrollment 337 Substitute Bill No. 984
424	424
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429	429
430	430		in qualified health plans and the availability of premium tax credits 338
431	431		under Section 36B of the Internal Revenue Code and cost-sharing 339
432	432		reductions under Section 1402 of the Affordable Care Act; 340
433	433		(C) Facilitate enrollment in qualified health plans; 341
434	434		(D) Provide referrals to the Office of the Healthcare Advocate or 342
435	435		health insurance ombudsman established under Section 2793 of the 343
436	436		Public Health Service Act, 42 USC 300gg-93, as amended from time to 344
437	437		time, or any other appropriate state agency or agencies, for any 345
438	438		enrollee with a grievance, complaint or question regarding the 346
439	439		enrollee's health benefit plan, coverage or a determination under that 347
440	440		plan or coverage; and 348
441	441		(E) Provide information in a manner that is culturally and 349
442	442		linguistically appropriate to the needs of the population being served 350
443	443		by the exchange; 351
444	444		(20) Review the rate of premium growth within and outside the 352
445	445		exchange and consider such information in developing 353
446	446		recommendations on whether to continue limiting qualified employer 354
447	447		status to small employers; 355
448	448		(21) Credit the amount, in accordance with Section 10108 of the 356
449	449		Affordable Care Act, of any free choice voucher to the monthly 357
450	450		premium of the plan in which a qualified employee is enrolled and 358
451	451		collect the amount credited from the offering employer; 359
452	452		(22) Consult with stakeholders relevant to carrying out the activities 360
453	453		required under sections 38a-1080 to 38a-1090, inclusive, as amended by 361
454	454		this act, including, but not limited to: 362
455	455		(A) Individuals who are knowledgeable about the health care 363
456	456		system, have background or experience in making informed decisions 364
457	457		regarding health, medical and scientific matters and are enrollees in 365
458	458		qualified health plans; 366 Substitute Bill No. 984
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464	464
465	465		(B) Individuals and entities with experience in facilitating 367
466	466		enrollment in qualified health plans; 368
467	467		(C) Representatives of small employers and self-employed 369
468	468		individuals; 370
469	469		(D) The Department of Social Services; and 371
470	470		(E) Advocates for enrolling hard-to-reach populations; 372
471	471		(23) Meet the following financial integrity requirements: 373
472	472		(A) Keep an accurate accounting of all activities, receipts and 374
473	473		expenditures and annually submit to the Secretary, the Governor, the 375
474	474		Insurance Commissioner and the General Assembly a report 376
475	475		concerning such accountings; 377
476	476		(B) Fully cooperate with any investigation conducted by the 378
477	477		Secretary pursuant to the Secretary's authority under the Affordable 379
478	478		Care Act and allow the Secretary, in coordination with the Inspector 380
479	479		General of the United States Department of Health and Human 381
480	480		Services, to: 382
481	481		(i) Investigate the affairs of the exchange; 383
482	482		(ii) Examine the properties and records of the exchange; and 384
483	483		(iii) Require periodic reports in relation to the activities undertaken 385
484	484		by the exchange; and 386
485	485		(C) Not use any funds in carrying out its activities under sections 387
486	486		38a-1080 to 38a-1089, inclusive, as amended by this act, that are 388
487	487		intended for the administrative and operational expenses of the 389
488	488		exchange, for staff retreats, promotional giveaways, excessive 390
489	489		executive compensation or promotion of federal or state legislative and 391
490	490		regulatory modifications; 392
491	491		(24) (A) Seek to include the most comprehensive health benefit 393 Substitute Bill No. 984
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497	497
498	498		plans that offer high quality benefits at the most affordable price in the 394
499	499		exchange, (B) encourage health carriers to offer tiered health care 395
500	500		provider network plans that have different cost-sharing rates for 396
501	501		different health care provider tiers and reward enrollees for choosing 397
502	502		low-cost, high-quality health care providers by offering lower 398
503	503		copayments, deductibles or other out-of-pocket expenses, and (C) offer 399
504	504		any such tiered health care provider network plans through the 400
505	505		exchange; [and] 401
506	506		(25) Report at least annually to the General Assembly on the effect 402
507	507		of adverse selection on the operations of the exchange and make 403
508	508		legislative recommendations, if necessary, to reduce the negative 404
509	509		impact from any such adverse selection on the sustainability of the 405
510	510		exchange, including recommendations to ensure that regulation of 406
511	511		insurers and health benefit plans are similar for qualified health plans 407
512	512		offered through the exchange and health benefit plans offered outside 408
513	513		the exchange. The exchange shall evaluate whether adverse selection is 409
514	514		occurring with respect to health benefit plans that are grandfathered 410
515	515		under the Affordable Care Act, self-insured plans, plans sold through 411
516	516		the exchange and plans sold outside the exchange; [.] and 412
517	517		(26) Establish and administer the "Connecticut Health Insurance 413
518	518		Exchange Fund" pursuant to section 5 of this act. 414
519	519		Sec. 7. (NEW) (Effective October 1, 2019) (a) For the purposes of this 415
520	520		section: 416
521	521		(1) "Exchange" means the Connecticut Health Insurance Exchange 417
522	522		established pursuant to section 38a-1081 of the general statutes; 418
523	523		(2) "Plan year" has the same meaning as that term is used in section 419
524	524		38a-1084 of the general statutes, as amended by this act; and 420
525	525		(3) "Qualified health plan" has the same meaning as provided in 421
526	526		section 38a-1080 of the general statutes, as amended by this act. 422
527	527		(b) Each insurer, health care center, fraternal benefit society, hospital 423 Substitute Bill No. 984
528	528
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533	533
534	534		service corporation, medical service corporation or other entity that 424
535	535		delivers, issues for delivery, renews, amends or continues not fewer 425
536	536		than five thousand individual or group health insurance policies in 426
537	537		this state that provide coverage of the type specified in subdivision (1), 427
538	538		(2), (4), (11) or (12) of section 38a-469 of the general statutes during a 428
539	539		calendar year beginning on or after January 1, 2020, shall, for the 429
540	540		immediately following plan year, offer not fewer than one qualified 430
541	541		health plan through the exchange. 431
542	542		(c) The Insurance Commissioner may adopt regulations, in 432
543	543		accordance with chapter 54 of the general statutes, to implement the 433
544	544		provisions of this section. 434
545	545		Sec. 8. Subdivisions (1) and (2) of subsection (m) of section 5-259 of 435
546	546		the general statutes are repealed and the following is substituted in 436
547	547		lieu thereof (Effective October 1, 2019): 437
548	548		(m) (1) Notwithstanding any provision of the general statutes, the 438
549	549		Comptroller shall begin procedures to convert the group 439
550	550		hospitalization and medical and surgical insurance plans set forth in 440
551	551		subsection (a) of this section, including any prescription drug plan 441
552	552		offered in connection with or in addition to such insurance plans, to 442
553	553		self-insured plans, except that any dental plan offered in connection 443
554	554		with or in addition to such self-insured plans may be fully insured. 444
555	555		(2) The Comptroller may enter into contracts with third-party 445
556	556		administrators to provide administrative services only for the self-446
557	557		insured plans set forth in subdivision (1) of this subsection. Any such 447
558	558		third-party administrator shall be required under such contract to: 448
559	559		[charge] 449
560	560		(A) Charge such third-party administrator's lowest available rate for 450
561	561		such services; [.] and 451
562	562		(B) Offer not fewer than one qualified health plan, as defined in 452
563	563		section 38a-1080, as amended by this act, through the exchange 453
564	564		established pursuant to section 38a-1081 for each plan year, as that 454 Substitute Bill No. 984
565	565
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570	570
571	571		term is used in section 38a-1084, as amended by this act, during the 455
572	572		term of such contract if: 456
573	573		(i) Such contract is entered into, renewed or amended on or after 457
574	574		October 1, 2019; 458
575	575		(ii) Such plan year begins on or after January 1, 2020, and on or after 459
576	576		the date that such contract is entered into, renewed or amended; and 460
577	577		(iii) Such third-party administrator is an insurer, health care center, 461
578	578		fraternal benefit society, hospital service corporation, medical service 462
579	579		corporation or other entity that (I) is authorized to transact health 463
580	580		insurance business in this state, and (II) delivered, issued for delivery, 464
581	581		renewed, amended or continued not fewer than five thousand 465
582	582		individual or group health insurance policies in this state that 466
583	583		provided coverage of the type specified in subdivision (1), (2), (4), (11) 467
584	584		or (12) of section 38a-469 during the calendar year immediately 468
585	585		preceding such plan year. 469
586	586		Sec. 9. (Effective July 1, 2019) Not later than October 1, 2019, the 470
587	587		Office of Health Strategy, in consultation with the Insurance 471
588	588		Commissioner, the Healthcare Advocate, the Connecticut Health 472
589	589		Insurance Exchange established pursuant to section 38a-1081 of the 473
590	590		general statutes and the insurance industry, shall submit a report, in 474
591	591		accordance with section 11-4a of the general statutes, to the joint 475
592	592		standing committee of the General Assembly having cognizance of 476
593	593		matters relating to insurance. Such report shall include the Office of 477
594	594		Health Strategy's recommendations concerning the implementation of 478
595	595		state-financed health insurance premium and cost-sharing subsidies 479
596	596		and a reinsurance program for the purpose of decreasing the cost of 480
597	597		health insurance in this state. 481
598	598		This act shall take effect as follows and shall amend the following
599	599		sections:
600	600
601	601		Section 1 January 1, 2020 New section
602	602		Sec. 2 July 1, 2019 New section Substitute Bill No. 984
603	603
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608	608
609	609		Sec. 3 July 1, 2019 New section
610	610		Sec. 4 July 1, 2019 38a-1080
611	611		Sec. 5 July 1, 2019 New section
612	612		Sec. 6 July 1, 2019 38a-1084
613	613		Sec. 7 October 1, 2019 New section
614	614		Sec. 8 October 1, 2019 5-259(m)(1) and (2)
615	615		Sec. 9 July 1, 2019 New section
616	616
617	617		Statement of Legislative Commissioners:
618	618		In Section 7(b), "subdivision" was substituted for "subdivisions" and
619	619		"or" was substituted for "and" for clarity; in Section 8(m)(2)(B), "that
620	620		term is" was deleted for conciseness; and in Section 8(m)(2)(B)(iii),
621	621		"subdivision" was substituted for "subdivisions" and "or" was
622	622		substituted for "and" for clarity.
623	623
624	624
625	625		INS Joint Favorable Subst.
626	626