Senate Bill No. 1003
Public Act No. 21-14
AN ACT PROHIBITING CERTAIN HEALTH CARRIERS AND
PHARMACY BENEFITS MANAGERS FROM EMPLOYING COPAY
ACCUMULATOR PROGRAMS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 38a-1 of the general statutes is repealed and the
following is substituted in lieu thereof (Effective January 1, 2022):
Terms used in this title and sections 2, 4 and 5 of this act, unless it
appears from the context to the contrary, shall have a scope and
meaning as set forth in this section.
(1) "Affiliate" or "affiliated" means a person that directly, or indirectly
through one or more intermediaries, controls, is controlled by or is
under common control with another person.
(2) "Alien insurer" means any insurer that has been chartered by or
organized or constituted within or under the laws of any jurisdiction or
country without the United States.
(3) "Annuities" means all agreements to make periodical payments
where the making or continuance of all or some of the series of the
payments, or the amount of the payment, is dependent upon the
continuance of human life or is for a specified term of years. This Senate Bill No. 1003
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definition does not apply to payments made under a policy of life
insurance.
(4) "Commissioner" means the Insurance Commissioner.
(5) "Control", "controlled by" or "under common control with" means
the possession, direct or indirect, of the power to direct or cause the
direction of the management and policies of a person, whether through
the ownership of voting securities, by contract other than a commercial
contract for goods or nonmanagement services, or otherwise, unless the
power is the result of an official position with the person.
(6) "Domestic insurer" means any insurer that has been chartered by,
incorporated, organized or constituted within or under the laws of this
state.
(7) "Domestic surplus lines insurer" means any domestic insurer that
has been authorized by the commissioner to write surplus lines
insurance.
(8) "Foreign country" means any jurisdiction not in any state, district
or territory of the United States.
(9) "Foreign insurer" means any insurer that has been chartered by or
organized or constituted within or under the laws of another state or a
territory of the United States.
(10) "Insolvency" or "insolvent" means, for any insurer, that it is
unable to pay its obligations when they are due, or when its admitted
assets do not exceed its liabilities plus the greater of: (A) Capital and
surplus required by law for its organization and continued operation;
or (B) the total par or stated value of its authorized and issued capital
stock. For purposes of this subdivision "liabilities" shall include but not
be limited to reserves required by statute or by regulations adopted by
the commissioner in accordance with the provisions of chapter 54 or Senate Bill No. 1003
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specific requirements imposed by the commissioner upon a subject
company at the time of admission or subsequent thereto.
(11) "Insurance" means any agreement to pay a sum of money,
provide services or any other thing of value on the happening of a
particular event or contingency or to provide indemnity for loss in
respect to a specified subject by specified perils in return for a
consideration. In any contract of insurance, an insured shall have an
interest which is subject to a risk of loss through destruction or
impairment of that interest, which risk is assumed by the insurer and
such assumption shall be part of a general scheme to distribute losses
among a large group of persons bearing similar risks in return for a
ratable contribution or other consideration.
(12) "Insurer" or "insurance company" includes any person or
combination of persons doing any kind or form of insurance business
other than a fraternal benefit society, and shall include a receiver of any
insurer when the context reasonably permits.
(13) "Insured" means a person to whom or for whose benefit an
insurer makes a promise in an insurance policy. The term includes
policyholders, subscribers, members and beneficiaries. This definition
applies only to the provisions of this title and does not define the
meaning of this word as used in insurance policies or certificates.
(14) "Life insurance" means insurance on human lives and insurances
pertaining to or connected with human life. The business of life
insurance includes granting endowment benefits, granting additional
benefits in the event of death by accident or accidental means, granting
additional benefits in the event of the total and permanent disability of
the insured, and providing optional methods of settlement of proceeds.
Life insurance includes burial contracts to the extent provided by
section 38a-464. Senate Bill No. 1003
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(15) "Mutual insurer" means any insurer without capital stock, the
managing directors or officers of which are elected by its members.
(16) "Person" means an individual, a corporation, a partnership, a
limited liability company, an association, a joint stock company, a
business trust, an unincorporated organization or other legal entity.
(17) "Policy" means any document, including attached endorsements
and riders, purporting to be an enforceable contract, which
memorializes in writing some or all of the terms of an insurance
contract.
(18) "State" means any state, district, or territory of the United States.
(19) "Subsidiary" of a specified person means an affiliate controlled
by the person directly, or indirectly through one or more intermediaries.
(20) "Unauthorized insurer" or "nonadmitted insurer" means an
insurer that has not been granted a certificate of authority by the
commissioner to transact the business of insurance in this state or an
insurer transacting business not authorized by a valid certificate.
(21) "United States" means the United States of America, its territories
and possessions, the Commonwealth of Puerto Rico and the District of
Columbia.
Sec. 2. (NEW) (Effective January 1, 2022) Each insurer, health care
center, hospital service corporation, medical service corporation,
fraternal benefit society or other entity that delivers, issues for delivery,
renews, amends or continues an individual or group health insurance
policy in this state on or after January 1, 2022, providing coverage of the
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469
of the general statutes shall, when calculating an insured's liability for a
coinsurance, copayment, deductible or other out-of-pocket expense for
a covered benefit, give credit for any discount provided or payment Senate Bill No. 1003
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made by a third party for the amount of, or any portion of the amount
of, the coinsurance, copayment, deductible or other out-of-pocket
expense for the covered benefit.
Sec. 3. Section 38a-478 of the general statutes is repealed and the
following is substituted in lieu thereof (Effective January 1, 2022):
As used in this section, sections 38a-478a to 38a-478o, inclusive, [and]
subsection (a) of section 38a-478s and section 4 of this act:
(1) "Commissioner" means the Insurance Commissioner.
(2) "Covered benefit" or "benefit" means a health care service to which
an enrollee is entitled under the terms of a health benefit plan.
(3) "Enrollee" means a person who has contracted for or who
participates in a managed care plan for such person or such person's
eligible dependents.
(4) "Health care services" means services for the diagnosis,
prevention, treatment, cure or relief of a health condition, illness, injury
or disease.
(5) "Managed care organization" means an insurer, health care center,
hospital service corporation, medical service corporation or other
organization delivering, issuing for delivery, renewing, amending or
continuing any individual or group health managed care plan in this
state.
(6) "Managed care plan" means a product offered by a managed care
organization that provides for the financing or delivery of health care
services to persons enrolled in the plan through: (A) Arrangements with
selected providers to furnish health care services; (B) explicit standards
for the selection of participating providers; (C) financial incentives for
enrollees to use the participating providers and procedures provided for Senate Bill No. 1003
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by the plan; or (D) arrangements that share risks with providers,
provided the organization offering a plan described under
subparagraph (A), (B), (C) or (D) of this subdivision is licensed by the
Insurance Department pursuant to chapter 698, 698a or 700 and the plan
includes utilization review, as defined in section 38a-591a.
(7) "Preferred provider network" has the same meaning as provided
in section 38a-479aa.
(8) "Provider" or "health care provider" means a person licensed to
provide health care services under chapters 370 to 373, inclusive, 375 to
383c, inclusive, 384a to 384c, inclusive, or chapter 400j.
(9) "Utilization review" has the same meaning as provided in section
38a-591a.
(10) "Utilization review company" has the same meaning as provided
in section 38a-591a.
Sec. 4. (NEW) (Effective January 1, 2022) For any contract delivered,
issued for delivery, renewed, amended or continued in this state on or
after January 1, 2022, each managed care organization shall, when
calculating an enrollee's liability for a coinsurance, copayment,
deductible or other out-of-pocket expense for a covered benefit, give
credit for any discount provided or payment made by a third party for
the amount of, or any portion of the amount of, the coinsurance,
copayment, deductible or other out-of-pocket expense for the covered
benefit.
Sec. 5. (NEW) (Effective January 1, 2022) On and after January 1, 2022,
each contract entered into between a health carrier, as defined in section
38a-591a of the general statutes, and a pharmacy benefits manager, as
defined in section 38a-479aaa of the general statutes, for the
administration of the pharmacy benefit portion of a health benefit plan
in this state on behalf of plan sponsors shall require that the pharmacy Senate Bill No. 1003
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benefits manager, when calculating an insured's or enrollee's liability for
a coinsurance, copayment, deductible or other out-of-pocket expense for
a covered prescription drug benefit, give credit for any discount
provided or payment made by a third party for the amount of, or any
portion of the amount of, the coinsurance, copayment, deductible or
other out-of-pocket expense for the covered prescription drug benefit.