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 Section 38a-476 of the general statutes is repealed and the 1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