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General Assembly Substitute Bill No. 984
January Session, 2019
AN ACT CONCERNING MI NIMUM ESSENTIAL HEAL TH COVERAGE,
REPORTS REGARDING HE ALTH INSURANCE AND TAXATI ON, A
HEALTH INSURER SURCH ARGE AND THE CONNECT ICUT HEALTH
INSURANCE EXCHANGE.
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
recognized religious sect or division thereof described in Section 14
1402(g)(1) of the Internal Revenue Code and an adherent of the 15
established tenets or teachings of such religious sect or division, or (ii) 16
a member of a religious sect or division thereof that is not described in 17 Substitute Bill No. 984
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said section, relies solely on a religious method of healing and for 18
whom the acceptance of medical health services would be inconsistent 19
with such individual's religious beliefs. 20
(3) "Dependent" has the same meaning as provided in Section 152 of 21
the Internal Revenue Code. 22
(4) (A) "Minimum essential coverage" means (i) coverage under the 23
Medicare program under Part A or C of Title XVIII of the Social 24
Security Act, (ii) coverage under the Medicaid program under Title 25
XIX of the Social Security Act, (iii) coverage under the Children's 26
Health Insurance Program under Title XXI of the Social Security Act, 27
(iv) medical coverage under 10 USC Chapter 55, including, but not 28
limited to, coverage under the TriCare program, (v) coverage under a 29
health care program under 38 USC Chapter 17 or 18, (vi) coverage for 30
United States Peace Corps volunteers under 22 USC 2504(e), (vii) 31
coverage under the Nonappropriated Fund Health Benefits Program of 32
the United States Department of Defense established under Section 349 33
of the National Defense Authorization Act for Fiscal Year 1995, P.L. 34
103-337, (viii) coverage under an eligible employer-sponsored plan, 35
(ix) coverage under a health plan offered in the individual market as 36
defined in Section 1304 of the Affordable Care Act, (x) coverage under 37
a grandfathered health plan, as that term is used in the Affordable 38
Care Act, or (xi) coverage under any other qualified health plan, as that 39
term is used in Section 1311(c) of the Affordable Care Act. 40
(B) "Minimum essential coverage" does not mean any health 41
insurance coverage that consists of coverage of excepted benefits 42
described in (i) Section 2791(c)(1) of the Public Health Service Act, 42 43
USC 300gg-91(c)(1), as amended by the Affordable Care Act, or (ii) 44
Section 2791(c)(2), (3) or (4) of the Public Health Service Act, 42 USC 45
300gg-91(c)(2), (3) or (4), as amended by the Affordable Care Act, if 46
such benefits are provided under a separate policy, certificate or 47
contract of insurance. 48
(5) "Resident of this state" has the same meaning as provided in 49 Substitute Bill No. 984
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section 12-701 of the general statutes. 50
(6) "Taxpayer" means a resident of this state who is a taxpayer 51
within the meaning of Section 5000A of the Internal Revenue Code. 52
(b) (1) Each taxpayer shall, for each month beginning on or after 53
January 1, 2020, ensure that such taxpayer, if such taxpayer is an 54
applicable individual, and each dependent of such taxpayer, if such 55
dependent is an applicable individual, maintains minimum essential 56
coverage. 57
(2) For the purposes of subdivision (1) of this subsection, an 58
applicable individual shall be deemed to have maintained minimum 59
essential coverage for any month during which the applicable 60
individual is not a resident of this state if: 61
(A) Such month occurs during any period described in Section 62
911(d)(1)(A) or (B) of the Internal Revenue Code that is applicable to 63
such applicable individual; 64
(B) Such applicable individual is a bona fide resident of any 65
possession of the United States, as determined under Section 937(a) of 66
the Internal Revenue Code, for such month; or 67
(C) Such applicable individual is a bona fide resident of any other 68
state of the United States for such month. 69
(c) The Insurance Commissioner may adopt regulations, in 70
accordance with chapter 54 of the general statutes, to implement the 71
provisions of this section. 72
Sec. 2. (Effective July 1, 2019) Not later than October 1, 2019, the 73
Commissioner of Revenue Services, in consultation with the Insurance 74
Commissioner, the executive director of the Office of Health Strategy 75
and the exchange established pursuant to section 38a-1081 of the 76
general statutes, shall submit a report, in accordance with section 11-4a 77
of the general statutes, to the joint standing committee of the General 78 Substitute Bill No. 984
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Assembly having cognizance of matters relating to insurance. Such 79
report shall include the commissioner's recommendations concerning: 80
(1) Measures to enforce the provisions of section 1 of this act, 81
including, but not limited to, a state individual health care 82
responsibility fee that is designed to ensure that taxpayers and 83
dependents maintain minimum essential coverage, as those terms are 84
defined in said section; and (2) a refundable credit against the personal 85
income tax imposed under chapter 229 of the general statutes to help 86
residents of this state, as defined in section 12-701 of the general 87
statutes, offset the cost of health insurance. 88
Sec. 3. (NEW) (Effective July 1, 2019) (a) For each calendar month 89
beginning on or after January 1, 2020, each insurance company, 90
fraternal benefit society, hospital service corporation, medical service 91
corporation, health care center or other entity delivering, issuing for 92
delivery, renewing, amending or continuing in this state an individual 93
or group health insurance policy providing coverage of the type 94
specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of 95
the general statutes shall remit to the Insurance Commissioner, in a 96
form and manner prescribed by the commissioner, a surcharge for 97
each policy providing such coverage during such month or any 98
portion of such month. The amount of such surcharge shall be 99
calculated as follows: 100
(1) If such policy is an individual health insurance policy, ten dollars 101
multiplied by the number of insureds under such policy; or 102
(2) If such policy is a group health insurance policy, five dollars 103
multiplied by the number of insureds under such policy. 104
(b) The monthly surcharge imposed under subsection (a) of this 105
section shall not be considered premium for any purpose, and no 106
portion of such surcharge shall be refundable or borne by an insured. 107
(c) Each insurance company, fraternal benefit society, hospital 108
service corporation, medical service corporation, health care center or 109 Substitute Bill No. 984
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entity shall remit to the Insurance Commissioner, not later than the 110
thirtieth day of April annually, all monthly surcharges imposed on 111
such company, society, corporation, center or entity under subsection 112
(a) of this section for the calendar year immediately preceding. Each 113
remittance shall include documentation, in a form and manner 114
prescribed by the commissioner, to substantiate the amount of the 115
monthly surcharges being remitted by such company, society, 116
corporation, center or entity. 117
(d) Not later than the first day of June annually, the Insurance 118
Commissioner shall deposit all remittances for the calendar year 119
immediately preceding in the Connecticut Health Insurance Exchange 120
Fund established pursuant to section 5 of this act. 121
(e) The surcharge imposed under subsection (a) of this section shall 122
constitute a special purpose assessment for the purposes of section 12-123
211 of the general statutes. 124
(f) The Insurance Commissioner may adopt regulations, in 125
accordance with chapter 54 of the general statutes, to implement the 126
provisions of this section. 127
Sec. 4. Section 38a-1080 of the general statutes is repealed and the 128
following is substituted in lieu thereof (Effective July 1, 2019): 129
For purposes of sections 38a-1080 to 38a-1093, inclusive, as amended 130
by this act, and section 5 of this act: 131
(1) "Board" means the board of directors of the Connecticut Health 132
Insurance Exchange; 133
(2) "Commissioner" means the Insurance Commissioner; 134
(3) "Exchange" means the Connecticut Health Insurance Exchange 135
established pursuant to section 38a-1081; 136
(4) "Affordable Care Act" means the Patient Protection and 137 Substitute Bill No. 984
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Affordable Care Act, P.L. 111-148, as amended by the Health Care and 138
Education Reconciliation Act, P.L. 111-152, as both may be amended 139
from time to time, and regulations adopted thereunder; 140
(5) (A) "Health benefit plan" means an insurance policy or contract 141
offered, delivered, issued for delivery, renewed, amended or 142
continued in the state by a health carrier to provide, deliver, pay for or 143
reimburse any of the costs of health care services. 144
(B) "Health benefit plan" does not include: 145
(i) Coverage of the type specified in subdivisions (5), (6), (7), (8), (9), 146
(14), (15) and (16) of section 38a-469 or any combination thereof; 147
(ii) Coverage issued as a supplement to liability insurance; 148
(iii) Liability insurance, including general liability insurance and 149
automobile liability insurance; 150
(iv) Workers' compensation insurance; 151
(v) Automobile medical payment insurance; 152
(vi) Credit insurance; 153
(vii) Coverage for on-site medical clinics; or 154
(viii) Other similar insurance coverage specified in regulations 155
issued pursuant to the Health Insurance Portability and Accountability 156
Act of 1996, P.L. 104-191, as amended from time to time, under which 157
benefits for health care services are secondary or incidental to other 158
insurance benefits. 159
(C) "Health benefit plan" does not include the following benefits if 160
they are provided under a separate insurance policy, certificate or 161
contract or are otherwise not an integral part of the plan: 162
(i) Limited scope dental or vision benefits; 163 Substitute Bill No. 984
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(ii) Benefits for long-term care, nursing home care, home health 164
care, community-based care or any combination thereof; or 165
(iii) Other similar, limited benefits specified in regulations issued 166
pursuant to the Health Insurance Portability and Accountability Act of 167
1996, P.L. 104-191, as amended from time to time; 168
(iv) Other supplemental coverage, similar to coverage of the type 169
specified in subdivisions (9) and (14) of section 38a-469, provided 170
under a group health plan. 171
(D) "Health benefit plan" does not include coverage of the type 172
specified in subdivisions (3) and (13) of section 38a-469 or other fixed 173
indemnity insurance if (i) such coverage is provided under a separate 174
insurance policy, certificate or contract, (ii) there is no coordination 175
between the provision of the benefits and any exclusion of benefits 176
under any group health plan maintained by the same plan sponsor, 177
and (iii) the benefits are paid with respect to an event without regard 178
to whether benefits were also provided under any group health plan 179
maintained by the same plan sponsor; 180
(6) "Health care services" has the same meaning as provided in 181
section 38a-478; 182
(7) "Health carrier" means an insurance company, fraternal benefit 183
society, hospital service corporation, medical service corporation, 184
health care center or other entity subject to the insurance laws and 185
regulations of the state or the jurisdiction of the commissioner that 186
contracts or offers to contract to provide, deliver, pay for or reimburse 187
any of the costs of health care services; 188
(8) "Internal Revenue Code" means the Internal Revenue Code of 189
1986, or any subsequent corresponding internal revenue code of the 190
United States, as amended from time to time; 191
(9) "Person" has the same meaning as provided in section 38a-1; 192 Substitute Bill No. 984
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(10) "Qualified dental plan" means a limited scope dental plan that 193
has been certified in accordance with subsection (e) of section 38a-1086; 194
(11) "Qualified employer" has the same meaning as provided in 195
Section 1312 of the Affordable Care Act; 196
(12) "Qualified health plan" means a health benefit plan that has in 197
effect a certification that the plan meets the criteria for certification 198
described in Section 1311(c) of the Affordable Care Act and section 199
38a-1086; 200
(13) "Qualified individual" has the same meaning as provided in 201
Section 1312 of the Affordable Care Act; 202
(14) "Secretary" means the Secretary of the United States 203
Department of Health and Human Services; and 204
(15) "Small employer" has the same meaning as provided in section 205
38a-564. 206
Sec. 5. (NEW) (Effective July 1, 2019) The exchange shall establish 207
and administer a fund, to be known as the "Connecticut Health 208
Insurance Exchange Fund", to provide funding for (1) state-financed 209
health insurance premium and cost-sharing subsidies to individuals in 210
this state, and (2) a reinsurance program for the purpose of decreasing 211
the cost of health insurance in this state. The fund shall contain any 212
moneys required by law to be deposited in the fund and shall be 213
accounted for separately from all other moneys, funds and accounts. 214
Sec. 6. Section 38a-1084 of the general statutes is repealed and the 215
following is substituted in lieu thereof (Effective July 1, 2019): 216
The exchange shall: 217
(1) Administer the exchange for both qualified individuals and 218
qualified employers; 219
(2) Commission surveys of individuals, small employers and health 220 Substitute Bill No. 984
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care providers on issues related to health care and health care 221
coverage; 222
(3) Implement procedures for the certification, recertification and 223
decertification, consistent with guidelines developed by the Secretary 224
under Section 1311(c) of the Affordable Care Act, and section 38a-1086, 225
of health benefit plans as qualified health plans; 226
(4) Provide for the operation of a toll-free telephone hotline to 227
respond to requests for assistance; 228
(5) Provide for enrollment periods, as provided under Section 229
1311(c)(6) of the Affordable Care Act; 230
(6) Maintain an Internet web site through which enrollees and 231
prospective enrollees of qualified health plans may obtai n 232
standardized comparative information on such plans including, but 233
not limited to, the enrollee satisfaction survey information under 234
Section 1311(c)(4) of the Affordable Care Act and any other 235
information or tools to assist enrollees and prospective enrollees 236
evaluate qualified health plans offered through the exchange; 237
(7) Publish the average costs of licensing, regulatory fees and any 238
other payments required by the exchange and the administrative costs 239
of the exchange, including information on moneys lost to waste, fraud 240
and abuse, on an Internet web site to educate individuals on such 241
costs; 242
(8) On or before the open enrollment period for plan year 2017, 243
assign a rating to each qualified health plan offered through the 244
exchange in accordance with the criteria developed by the Secretary 245
under Section 1311(c)(3) of the Affordable Care Act, and determine 246
each qualified health plan's level of coverage in accordance with 247
regulations issued by the Secretary under Section 1302(d)(2)(A) of the 248
Affordable Care Act; 249
(9) Use a standardized format for presenting health benefit options 250 Substitute Bill No. 984
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in the exchange, including the use of the uniform outline of coverage 251
established under Section 2715 of the Public Health Service Act, 42 252
USC 300gg-15, as amended from time to time; 253
(10) Inform individuals, in accordance with Section 1413 of the 254
Affordable Care Act, of eligibility requirements for the Medicaid 255
program under Title XIX of the Social Security Act, as amended from 256
time to time, the Children's Health Insurance Program (CHIP) under 257
Title XXI of the Social Security Act, as amended from time to time, or 258
any applicable state or local public program, and enroll an individual 259
in such program if the exchange determines, through screening of the 260
application by the exchange, that such individual is eligible for any 261
such program; 262
(11) Collaborate with the Department of Social Services, to the 263
extent possible, to allow an enrollee who loses premium tax credit 264
eligibility under Section 36B of the Internal Revenue Code and is 265
eligible for HUSKY A or any other state or local public program, to 266
remain enrolled in a qualified health plan; 267
(12) Establish and make available by electronic means a calculator to 268
determine the actual cost of coverage after application of any premium 269
tax credit under Section 36B of the Internal Revenue Code and any 270
cost-sharing reduction under Section 1402 of the Affordable Care Act; 271
(13) Establish a program for small employers through which 272
qualified employers may access coverage for their employees and that 273
shall enable any qualified employer to specify a level of coverage so 274
that any of its employees may enroll in any qualified health plan 275
offered through the exchange at the specified level of coverage; 276
(14) Offer enrollees and small employers the option of having the 277
exchange collect and administer premiums, including through 278
allocation of premiums among the various insurers and qualified 279
health plans chosen by individual employers; 280
(15) (A) Grant a certification, subject to Section 1411 of the 281 Substitute Bill No. 984
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Affordable Care Act, attesting that, for purposes of the individual 282
responsibility penalty under Section 5000A of the Internal Revenue 283
Code, an individual is exempt from the individual responsibility 284
requirement or from the penalty imposed by said Section 5000A 285
because: 286
[(A)] (i) There is no affordable qualified health plan available 287
through the exchange, or the individual's employer, covering the 288
individual; or 289
[(B)] (ii) The individual meets the requirements for any other such 290
exemption from the individual responsibility requirement or penalty; 291
(B) Grant a certification, subject to section 1 of this act, attesting that, 292
for purposes of said section, an individual is exempt from the 293
requirement that the individual maintain minimum essential coverage 294
pursuant to said section because such individual meets the 295
requirements for an exemption from such requirement; 296
(16) (A) Provide to the Secretary of the Treasury of the United States 297
the following: 298
[(A)] (i) A list of the individuals granted a certification under 299
subparagraph (A) of subdivision (15) of this section, including the 300
name and taxpayer identification number of each individual; 301
[(B)] (ii) The name and taxpayer identification number of each 302
individual who was an employee of an employer but who was 303
determined to be eligible for the premium tax credit under Section 36B 304
of the Internal Revenue Code because: 305
[(i)] (I) The employer did not provide minimum essential health 306
benefits coverage; or 307
[(ii)] (II) The employer provided the minimum essential coverage 308
but it was determined under Section 36B(c)(2)(C) of the Internal 309
Revenue Code to be unaffordable to the employee or not provide the 310 Substitute Bill No. 984
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required minimum actuarial value; and 311
[(C)] (iii) The name and taxpayer identification number of: 312
[(i)] (I) Each individual who notifies the exchange under Section 313
1411(b)(4) of the Affordable Care Act that such individual has changed 314
employers; and 315
[(ii)] (II) Each individual who ceases coverage under a qualified 316
health plan during a plan year and the effective date of that cessation; 317
(B) Provide to the Commissioner of Revenue Services the following: 318
(i) The information described in subparagraph (A) of this 319
subdivision; and 320
(ii) A list of the individuals granted a certification under 321
subparagraph (B) of subdivision (15) of this section, including the 322
name and taxpayer identification number of each individual; 323
(17) Provide to each employer the name of each employee, as 324
described in subparagraph [(B)] (A)(ii) of subdivision (16) of this 325
section, of the employer who ceases coverage under a qualified health 326
plan during a plan year and the effective date of the cessation; 327
(18) Perform duties required of, or delegated to, the exchange by the 328
Secretary or the Secretary of the Treasury of the United States related 329
to determining eligibility for premium tax credits, reduced cost-330
sharing or individual responsibility requirement exemptions; 331
(19) Select entities qualified to serve as Navigators in accordance 332
with Section 1311(i) of the Affordable Care Act and award grants to 333
enable Navigators to: 334
(A) Conduct public education activities to raise awareness of the 335
availability of qualified health plans; 336
(B) Distribute fair and impartial information concerning enrollment 337 Substitute Bill No. 984
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in qualified health plans and the availability of premium tax credits 338
under Section 36B of the Internal Revenue Code and cost-sharing 339
reductions under Section 1402 of the Affordable Care Act; 340
(C) Facilitate enrollment in qualified health plans; 341
(D) Provide referrals to the Office of the Healthcare Advocate or 342
health insurance ombudsman established under Section 2793 of the 343
Public Health Service Act, 42 USC 300gg-93, as amended from time to 344
time, or any other appropriate state agency or agencies, for any 345
enrollee with a grievance, complaint or question regarding the 346
enrollee's health benefit plan, coverage or a determination under that 347
plan or coverage; and 348
(E) Provide information in a manner that is culturally and 349
linguistically appropriate to the needs of the population being served 350
by the exchange; 351
(20) Review the rate of premium growth within and outside the 352
exchange and consider such information in developing 353
recommendations on whether to continue limiting qualified employer 354
status to small employers; 355
(21) Credit the amount, in accordance with Section 10108 of the 356
Affordable Care Act, of any free choice voucher to the monthly 357
premium of the plan in which a qualified employee is enrolled and 358
collect the amount credited from the offering employer; 359
(22) Consult with stakeholders relevant to carrying out the activities 360
required under sections 38a-1080 to 38a-1090, inclusive, as amended by 361
this act, including, but not limited to: 362
(A) Individuals who are knowledgeable about the health care 363
system, have background or experience in making informed decisions 364
regarding health, medical and scientific matters and are enrollees in 365
qualified health plans; 366 Substitute Bill No. 984
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(B) Individuals and entities with experience in facilitating 367
enrollment in qualified health plans; 368
(C) Representatives of small employers and self-employed 369
individuals; 370
(D) The Department of Social Services; and 371
(E) Advocates for enrolling hard-to-reach populations; 372
(23) Meet the following financial integrity requirements: 373
(A) Keep an accurate accounting of all activities, receipts and 374
expenditures and annually submit to the Secretary, the Governor, the 375
Insurance Commissioner and the General Assembly a report 376
concerning such accountings; 377
(B) Fully cooperate with any investigation conducted by the 378
Secretary pursuant to the Secretary's authority under the Affordable 379
Care Act and allow the Secretary, in coordination with the Inspector 380
General of the United States Department of Health and Human 381
Services, to: 382
(i) Investigate the affairs of the exchange; 383
(ii) Examine the properties and records of the exchange; and 384
(iii) Require periodic reports in relation to the activities undertaken 385
by the exchange; and 386
(C) Not use any funds in carrying out its activities under sections 387
38a-1080 to 38a-1089, inclusive, as amended by this act, that are 388
intended for the administrative and operational expenses of the 389
exchange, for staff retreats, promotional giveaways, excessive 390
executive compensation or promotion of federal or state legislative and 391
regulatory modifications; 392
(24) (A) Seek to include the most comprehensive health benefit 393 Substitute Bill No. 984
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plans that offer high quality benefits at the most affordable price in the 394
exchange, (B) encourage health carriers to offer tiered health care 395
provider network plans that have different cost-sharing rates for 396
different health care provider tiers and reward enrollees for choosing 397
low-cost, high-quality health care providers by offering lower 398
copayments, deductibles or other out-of-pocket expenses, and (C) offer 399
any such tiered health care provider network plans through the 400
exchange; [and] 401
(25) Report at least annually to the General Assembly on the effect 402
of adverse selection on the operations of the exchange and make 403
legislative recommendations, if necessary, to reduce the negative 404
impact from any such adverse selection on the sustainability of the 405
exchange, including recommendations to ensure that regulation of 406
insurers and health benefit plans are similar for qualified health plans 407
offered through the exchange and health benefit plans offered outside 408
the exchange. The exchange shall evaluate whether adverse selection is 409
occurring with respect to health benefit plans that are grandfathered 410
under the Affordable Care Act, self-insured plans, plans sold through 411
the exchange and plans sold outside the exchange; [.] and 412
(26) Establish and administer the "Connecticut Health Insurance 413
Exchange Fund" pursuant to section 5 of this act. 414
Sec. 7. (NEW) (Effective October 1, 2019) (a) For the purposes of this 415
section: 416
(1) "Exchange" means the Connecticut Health Insurance Exchange 417
established pursuant to section 38a-1081 of the general statutes; 418
(2) "Plan year" has the same meaning as that term is used in section 419
38a-1084 of the general statutes, as amended by this act; and 420
(3) "Qualified health plan" has the same meaning as provided in 421
section 38a-1080 of the general statutes, as amended by this act. 422
(b) Each insurer, health care center, fraternal benefit society, hospital 423 Substitute Bill No. 984
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service corporation, medical service corporation or other entity that 424
delivers, issues for delivery, renews, amends or continues not fewer 425
than five thousand individual or group health insurance policies in 426
this state that provide coverage of the type specified in subdivision (1), 427
(2), (4), (11) or (12) of section 38a-469 of the general statutes during a 428
calendar year beginning on or after January 1, 2020, shall, for the 429
immediately following plan year, offer not fewer than one qualified 430
health plan through the exchange. 431
(c) The Insurance Commissioner may adopt regulations, in 432
accordance with chapter 54 of the general statutes, to implement the 433
provisions of this section. 434
Sec. 8. Subdivisions (1) and (2) of subsection (m) of section 5-259 of 435
the general statutes are repealed and the following is substituted in 436
lieu thereof (Effective October 1, 2019): 437
(m) (1) Notwithstanding any provision of the general statutes, the 438
Comptroller shall begin procedures to convert the group 439
hospitalization and medical and surgical insurance plans set forth in 440
subsection (a) of this section, including any prescription drug plan 441
offered in connection with or in addition to such insurance plans, to 442
self-insured plans, except that any dental plan offered in connection 443
with or in addition to such self-insured plans may be fully insured. 444
(2) The Comptroller may enter into contracts with third-party 445
administrators to provide administrative services only for the self-446
insured plans set forth in subdivision (1) of this subsection. Any such 447
third-party administrator shall be required under such contract to: 448
[charge] 449
(A) Charge such third-party administrator's lowest available rate for 450
such services; [.] and 451
(B) Offer not fewer than one qualified health plan, as defined in 452
section 38a-1080, as amended by this act, through the exchange 453
established pursuant to section 38a-1081 for each plan year, as that 454 Substitute Bill No. 984
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term is used in section 38a-1084, as amended by this act, during the 455
term of such contract if: 456
(i) Such contract is entered into, renewed or amended on or after 457
October 1, 2019; 458
(ii) Such plan year begins on or after January 1, 2020, and on or after 459
the date that such contract is entered into, renewed or amended; and 460
(iii) Such third-party administrator is an insurer, health care center, 461
fraternal benefit society, hospital service corporation, medical service 462
corporation or other entity that (I) is authorized to transact health 463
insurance business in this state, and (II) delivered, issued for delivery, 464
renewed, amended or continued not fewer than five thousand 465
individual or group health insurance policies in this state that 466
provided coverage of the type specified in subdivision (1), (2), (4), (11) 467
or (12) of section 38a-469 during the calendar year immediately 468
preceding such plan year. 469
Sec. 9. (Effective July 1, 2019) Not later than October 1, 2019, the 470
Office of Health Strategy, in consultation with the Insurance 471
Commissioner, the Healthcare Advocate, the Connecticut Health 472
Insurance Exchange established pursuant to section 38a-1081 of the 473
general statutes and the insurance industry, shall submit a report, in 474
accordance with section 11-4a of the general statutes, to the joint 475
standing committee of the General Assembly having cognizance of 476
matters relating to insurance. Such report shall include the Office of 477
Health Strategy's recommendations concerning the implementation of 478
state-financed health insurance premium and cost-sharing subsidies 479
and a reinsurance program for the purpose of decreasing the cost of 480
health insurance in this state. 481
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 Substitute Bill No. 984
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2019SB-00984-
R02-SB.docx }
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Sec. 3 July 1, 2019 New section
Sec. 4 July 1, 2019 38a-1080
Sec. 5 July 1, 2019 New section
Sec. 6 July 1, 2019 38a-1084
Sec. 7 October 1, 2019 New section
Sec. 8 October 1, 2019 5-259(m)(1) and (2)
Sec. 9 July 1, 2019 New section
Statement of Legislative Commissioners:
In Section 7(b), "subdivision" was substituted for "subdivisions" and
"or" was substituted for "and" for clarity; in Section 8(m)(2)(B), "that
term is" was deleted for conciseness; and in Section 8(m)(2)(B)(iii),
"subdivision" was substituted for "subdivisions" and "or" was
substituted for "and" for clarity.
INS Joint Favorable Subst.