Connecticut 2019 Regular Session

Connecticut Senate Bill SB01084 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	LCO No. 5974 1 of 4
4	4
5	5	General Assembly Raised Bill No. 1084
6	6	January Session, 2019
7	7	LCO No. 5974
8	8
9	9
10	10	Referred to Committee on JUDICIARY
11	11
12	12
13	13	Introduced by:
14	14	(JUD)
15	15
16	16
17	17
18	18
19	19	AN ACT CONCERNING SH ORT-TERM HEALTH INSURANCE
20	20	BENEFITS AND THE AUT HORITY OF THE INSURANCE
21	21	COMMISSIONER TO IMPO SE FINES AGAINST AN INSURER OR
22	22	HEALTH CARE CENTER.
23	23	Be it enacted by the Senate and House of Representatives in General
24	24	Assembly convened:
25	25
26	26	Section 1. Section 38a-476 of the general statutes is repealed and the 1
27	27	following is substituted in lieu thereof (Effective October 1, 2019): 2
28	28	(a) For the purposes of this section: 3
29	29	(1) "Health insurance plan" means any hospital and medical expense 4
30	30	incurred policy, hospital or medical service plan contract and health 5
31	31	care center subscriber contract. "Health insurance plan" does not 6
32	32	include (A) short-term health insurance issued on a nonrenewable 7
33	33	basis with a duration of [six months] three hundred sixty-four days or 8
34	34	less, accident only, credit, dental, vision, Medicare supplement, long-9
35	35	term care or disability insurance, hospital indemnity coverage, 10
36	36	coverage issued as a supplement to liability insurance, insurance 11
37	37	arising out of a workers' compensation or similar law, automobile 12
38	38	medical payments insurance, or insurance under which beneficiaries 13 Raised Bill No. 1084
39	39
40	40
41	41
42	42	LCO No. 5974 2 of 4
43	43
44	44	are payable without regard to fault and which is statutorily required to 14
45	45	be contained in any liability insurance policy or equivalent self-15
46	46	insurance, or (B) policies of specified disease or limited benefit health 16
47	47	insurance, provided the carrier offering such policies files on or before 17
48	48	March first of each year a certification with the Insurance 18
49	49	Commissioner that contains the following: (i) A statement from the 19
50	50	carrier certifying that such policies are being offered and marketed as 20
51	51	supplemental health insurance and not as a substitute for hospital or 21
52	52	medical expense insurance; (ii) a summary description of each such 22
53	53	policy including the average annual premium rates, or range of 23
54	54	premium rates in cases where premiums vary by age, gender or other 24
55	55	factors, charged for such policies in the state; and (iii) in the case of a 25
56	56	policy that is described in this subparagraph and that is offered for the 26
57	57	first time in this state on or after October 1, 1993, the carrier files with 27
58	58	the commissioner the information and statement required in this 28
59	59	subparagraph at least thirty days prior to the date such policy is issued 29
60	60	or delivered in this state. 30
61	61	(2) "Insurance arrangement" means any "multiple employer welfare 31
62	62	arrangement", as defined in Section 3 of the Employee Retirement 32
63	63	Income Security Act of 1974, as amended from time to time, except for 33
64	64	any such arrangement that is fully insured within the meaning of 34
65	65	Section 514(b)(6) of said act, as amended from time to time. 35
66	66	(3) "Preexisting conditions provision" means a policy provision that 36
67	67	limits or excludes benefits relating to a condition based on the fact that 37
68	68	the condition was present before the effective date of coverage, for 38
69	69	which any medical advice, diagnosis, care or treatment was 39
70	70	recommended or received before such effective date. Routine follow-40
71	71	up care to determine whether a breast cancer has reoccurred in a 41
72	72	person who has been previously determined to be breast cancer free 42
73	73	shall not be considered as medical advice, diagnosis, care or treatment 43
74	74	for purposes of this section unless evidence of breast cancer is found 44
75	75	during or as a result of such follow-up. Genetic information shall not 45
76	76	be treated as a condition in the absence of a diagnosis of the condition 46
77	77	related to such information. Pregnancy shall not be considered a 47 Raised Bill No. 1084
78	78
79	79
80	80
81	81	LCO No. 5974 3 of 4
82	82
83	83	preexisting condition. 48
84	84	(4) "Applicable waiting period" means the period of time imposed 49
85	85	by the group policyholder or contractholder before an individual is 50
86	86	eligible for participating in the group policy or contract. 51
87	87	(b) (1) No group health insurance plan or insurance arrangement 52
88	88	shall impose a preexisting conditions provision on any individual. 53
89	89	(2) No individual health insurance plan or insurance arrangement 54
90	90	shall impose a preexisting conditions provision on any individual. 55
91	91	(3) No insurance company, fraternal benefit society, hospital service 56
92	92	corporation, medical service corporation or health care center shall 57
93	93	refuse to issue an individual health insurance plan or insurance 58
94	94	arrangement to any individual solely on the basis that such individual 59
95	95	has a preexisting condition. 60
96	96	(c) (1) Notwithstanding the provisions of subsection (a) of this 61
97	97	section, a short-term health insurance policy issued on a nonrenewable 62
98	98	basis for [six months] three hundred sixty-four days or less that 63
99	99	imposes a preexisting conditions provision shall be subject to the 64
100	100	following conditions: (A) No such preexisting conditions provision 65
101	101	shall exclude coverage beyond twelve months following the insured's 66
102	102	effective date of coverage; (B) such preexisting conditions provision 67
103	103	may only relate to conditions, whether physical or mental, for which 68
104	104	medical advice, diagnosis, care or treatment was recommended or 69
105	105	received during the twenty-four months immediately preceding the 70
106	106	effective date of coverage; and (C) any policy, application or sales 71
107	107	brochure issued for such short-term health insurance policy that 72
108	108	imposes such preexisting conditions provision shall disclose in a 73
109	109	conspicuous manner in not less than fourteen-point boldface type the 74
110	110	following statement: 75
111	111	"THIS POLICY EXCLUDES COVERAGE FOR CONDITIONS FOR 76
112	112	WHICH MEDICAL ADVICE, DIAGNOSIS, CARE OR TREATMENT 77
113	113	WAS RECOMMENDED OR RECEIVED DURING THE TWENTY -78 Raised Bill No. 1084
114	114
115	115
116	116
117	117	LCO No. 5974 4 of 4
118	118
119	119	FOUR MONTHS IMMEDIATELY PRECEDING THE EFFECTIVE 79
120	120	DATE OF COVERAGE." 80
121	121	(2) In the event an insurer or health care center issues two 81
122	122	consecutive short-term health insurance policies on a nonrenewable 82
123	123	basis for [six months] three hundred sixty-four days or less that 83
124	124	impose a preexisting conditions provision to the same individual, the 84
125	125	insurer or health care center shall reduce the preexisting conditions 85
126	126	exclusion period in the second policy by the period of time such 86
127	127	individual was covered under the first policy. If the same insurer or 87
128	128	health care center issues a third or subsequent such short-term health 88
129	129	insurance policy to the same individual, such insurer or health care 89
130	130	center shall reduce the preexisting conditions exclusion period in the 90
131	131	third or subsequent policy by the cumulative time covered under the 91
132	132	prior policies. Nothing in this section shall be construed to require 92
133	133	such short-term health insurance policy to be issued on a guaranteed 93
134	134	issue or guaranteed renewable basis. 94
135	135	(d) In accordance with the provisions of section 38a-2, the Insurance 95
136	136	Commissioner may impose a fine of not more than fifteen thousand 96
137	137	dollars against an insurer or health care center that violates the 97
138	138	provisions of this section. 98
139	139	This act shall take effect as follows and shall amend the following
140	140	sections:
141	141
142	142	Section 1 October 1, 2019 38a-476
143	143
144	144	Statement of Purpose:
145	145	To extend the duration of short-term health insurance policies and
146	146	permit the Insurance Commissioner to impose a fine against an insurer
147	147	or health care center that violates a statutory provision relating to such
148	148	policies.
149	149	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
150	150	except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
151	151	not underlined.]
152	152