Connecticut 2021 Regular Session

Connecticut Senate Bill SB01003 Compare Versions

Version 1 (Old)

Version 2 (New)

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4		-	Senate Bill No. 1003
	7	+	General Assembly Raised Bill No. 1003
	8	+	January Session, 2021
	9	+	LCO No. 3653
5	10
6		-	Public Act No. 21-14
	11	+
	12	+	Referred to Committee on INSURANCE AND REAL ESTATE
	13	+
	14	+
	15	+	Introduced by:
	16	+	(INS)
	17	+
7	18
8	19
9	20		AN ACT PROHIBITING CERTAIN HEALTH CARRIERS AND
10	21		PHARMACY BENEFITS MA NAGERS FROM EMPLOYIN G COPAY
11	22		ACCUMULATOR PROGRAMS .
12	23		Be it enacted by the Senate and House of Representatives in General
13	24		Assembly convened:
14	25
15		-	Section 1. Section 38a-1 of the general statutes is repealed and the
16		-	following is substituted in lieu thereof (Effective January 1, 2022):
17		-	Terms used in this title and sections 2, 4 and 5 of this act, unless it
18		-	appears from the context to the contrary, shall have a scope and
19		-	meaning as set forth in this section.
20		-	(1) "Affiliate" or "affiliated" means a person that directly, or indirectly
21		-	through one or more intermediaries, controls, is controlled by or is
22		-	under common control with another person.
23		-	(2) "Alien insurer" means any insurer that has been chartered by or
24		-	organized or constituted within or under the laws of any jurisdiction or
25		-	country without the United States.
26		-	(3) "Annuities" means all agreements to make periodical payments
27		-	where the making or continuance of all or some of the series of the
28		-	payments, or the amount of the payment, is dependent upon the
29		-	continuance of human life or is for a specified term of years. This Senate Bill No. 1003
	26	+	Section 1. Section 38a-1 of the general statutes is repealed and the 1
	27	+	following is substituted in lieu thereof (Effective January 1, 2022): 2
	28	+	Terms used in this title and sections 2, 4 and 5 of this act, unless it 3
	29	+	appears from the context to the contrary, shall have a scope and 4
	30	+	meaning as set forth in this section. 5
	31	+	(1) "Affiliate" or "affiliated" means a person that directly, or indirectly 6
	32	+	through one or more intermediaries, controls, is controlled by or is 7
	33	+	under common control with another person. 8
	34	+	(2) "Alien insurer" means any insurer that has been chartered by or 9
	35	+	organized or constituted within or under the laws of any jurisdiction or 10
	36	+	country without the United States. 11
	37	+	(3) "Annuities" means all agreements to make periodical payments 12 Raised Bill No. 1003
30	38
31		-	Public Act No. 21-14 2 of 7
32	39
33		-	definition does not apply to payments made under a policy of life
34		-	insurance.
35		-	(4) "Commissioner" means the Insurance Commissioner.
36		-	(5) "Control", "controlled by" or "under common control with" means
37		-	the possession, direct or indirect, of the power to direct or cause the
38		-	direction of the management and policies of a person, whether through
39		-	the ownership of voting securities, by contract other than a commercial
40		-	contract for goods or nonmanagement services, or otherwise, unless the
41		-	power is the result of an official position with the person.
42		-	(6) "Domestic insurer" means any insurer that has been chartered by,
43		-	incorporated, organized or constituted within or under the laws of this
44		-	state.
45		-	(7) "Domestic surplus lines insurer" means any domestic insurer that
46		-	has been authorized by the commissioner to write surplus lines
47		-	insurance.
48		-	(8) "Foreign country" means any jurisdiction not in any state, district
49		-	or territory of the United States.
50		-	(9) "Foreign insurer" means any insurer that has been chartered by or
51		-	organized or constituted within or under the laws of another state or a
52		-	territory of the United States.
53		-	(10) "Insolvency" or "insolvent" means, for any insurer, that it is
54		-	unable to pay its obligations when they are due, or when its admitted
55		-	assets do not exceed its liabilities plus the greater of: (A) Capital and
56		-	surplus required by law for its organization and continued operation;
57		-	or (B) the total par or stated value of its authorized and issued capital
58		-	stock. For purposes of this subdivision "liabilities" shall include but not
59		-	be limited to reserves required by statute or by regulations adopted by
60		-	the commissioner in accordance with the provisions of chapter 54 or Senate Bill No. 1003
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61	43
62		-	Public Act No. 21-14 3 of 7
	44	+	where the making or continuance of all or some of the series of the 13
	45	+	payments, or the amount of the payment, is dependent upon the 14
	46	+	continuance of human life or is for a specified term of years. This 15
	47	+	definition does not apply to payments made under a policy of life 16
	48	+	insurance. 17
	49	+	(4) "Commissioner" means the Insurance Commissioner. 18
	50	+	(5) "Control", "controlled by" or "under common control with" means 19
	51	+	the possession, direct or indirect, of the power to direct or cause the 20
	52	+	direction of the management and policies of a person, whether through 21
	53	+	the ownership of voting securities, by contract other than a commercial 22
	54	+	contract for goods or nonmanagement services, or otherwise, unless the 23
	55	+	power is the result of an official position with the person. 24
	56	+	(6) "Domestic insurer" means any insurer that has been chartered by, 25
	57	+	incorporated, organized or constituted within or under the laws of this 26
	58	+	state. 27
	59	+	(7) "Domestic surplus lines insurer" means any domestic insurer that 28
	60	+	has been authorized by the commissioner to write surplus lines 29
	61	+	insurance. 30
	62	+	(8) "Foreign country" means any jurisdiction not in any state, district 31
	63	+	or territory of the United States. 32
	64	+	(9) "Foreign insurer" means any insurer that has been chartered by or 33
	65	+	organized or constituted within or under the laws of another state or a 34
	66	+	territory of the United States. 35
	67	+	(10) "Insolvency" or "insolvent" means, for any insurer, that it is 36
	68	+	unable to pay its obligations when they are due, or when its admitted 37
	69	+	assets do not exceed its liabilities plus the greater of: (A) Capital and 38
	70	+	surplus required by law for its organization and continued operation; 39
	71	+	or (B) the total par or stated value of its authorized and issued capital 40
	72	+	stock. For purposes of this subdivision "liabilities" shall include but not 41
	73	+	be limited to reserves required by statute or by regulations adopted by 42 Raised Bill No. 1003
63	74
64		-	specific requirements imposed by the commissioner upon a subject
65		-	company at the time of admission or subsequent thereto.
66		-	(11) "Insurance" means any agreement to pay a sum of money,
67		-	provide services or any other thing of value on the happening of a
68		-	particular event or contingency or to provide indemnity for loss in
69		-	respect to a specified subject by specified perils in return for a
70		-	consideration. In any contract of insurance, an insured shall have an
71		-	interest which is subject to a risk of loss through destruction or
72		-	impairment of that interest, which risk is assumed by the insurer and
73		-	such assumption shall be part of a general scheme to distribute losses
74		-	among a large group of persons bearing similar risks in return for a
75		-	ratable contribution or other consideration.
76		-	(12) "Insurer" or "insurance company" includes any person or
77		-	combination of persons doing any kind or form of insurance business
78		-	other than a fraternal benefit society, and shall include a receiver of any
79		-	insurer when the context reasonably permits.
80		-	(13) "Insured" means a person to whom or for whose benefit an
81		-	insurer makes a promise in an insurance policy. The term includes
82		-	policyholders, subscribers, members and beneficiaries. This definition
83		-	applies only to the provisions of this title and does not define the
84		-	meaning of this word as used in insurance policies or certificates.
85		-	(14) "Life insurance" means insurance on human lives and insurances
86		-	pertaining to or connected with human life. The business of life
87		-	insurance includes granting endowment benefits, granting additional
88		-	benefits in the event of death by accident or accidental means, granting
89		-	additional benefits in the event of the total and permanent disability of
90		-	the insured, and providing optional methods of settlement of proceeds.
91		-	Life insurance includes burial contracts to the extent provided by
92		-	section 38a-464. Senate Bill No. 1003
93	75
94		-	Public Act No. 21-14 4 of 7
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95	79
96		-	(15) "Mutual insurer" means any insurer without capital stock, the
97		-	managing directors or officers of which are elected by its members.
98		-	(16) "Person" means an individual, a corporation, a partnership, a
99		-	limited liability company, an association, a joint stock company, a
100		-	business trust, an unincorporated organization or other legal entity.
101		-	(17) "Policy" means any document, including attached endorsements
102		-	and riders, purporting to be an enforceable contract, which
103		-	memorializes in writing some or all of the terms of an insurance
104		-	contract.
105		-	(18) "State" means any state, district, or territory of the United States.
106		-	(19) "Subsidiary" of a specified person means an affiliate controlled
107		-	by the person directly, or indirectly through one or more intermediaries.
108		-	(20) "Unauthorized insurer" or "nonadmitted insurer" means an
109		-	insurer that has not been granted a certificate of authority by the
110		-	commissioner to transact the business of insurance in this state or an
111		-	insurer transacting business not authorized by a valid certificate.
112		-	(21) "United States" means the United States of America, its territories
113		-	and possessions, the Commonwealth of Puerto Rico and the District of
114		-	Columbia.
115		-	Sec. 2. (NEW) (Effective January 1, 2022) Each insurer, health care
116		-	center, hospital service corporation, medical service corporation,
117		-	fraternal benefit society or other entity that delivers, issues for delivery,
118		-	renews, amends or continues an individual or group health insurance
119		-	policy in this state on or after January 1, 2022, providing coverage of the
120		-	type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469
121		-	of the general statutes shall, when calculating an insured's liability for a
122		-	coinsurance, copayment, deductible or other out-of-pocket expense for
123		-	a covered benefit, give credit for any discount provided or payment Senate Bill No. 1003
	80	+	the commissioner in accordance with the provisions of chapter 54 or 43
	81	+	specific requirements imposed by the commissioner upon a subject 44
	82	+	company at the time of admission or subsequent thereto. 45
	83	+	(11) "Insurance" means any agreement to pay a sum of money, 46
	84	+	provide services or any other thing of value on the happening of a 47
	85	+	particular event or contingency or to provide indemnity for loss in 48
	86	+	respect to a specified subject by specified perils in return for a 49
	87	+	consideration. In any contract of insurance, an insured shall have an 50
	88	+	interest which is subject to a risk of loss through destruction or 51
	89	+	impairment of that interest, which risk is assumed by the insurer and 52
	90	+	such assumption shall be part of a general scheme to distribute losses 53
	91	+	among a large group of persons bearing similar risks in return for a 54
	92	+	ratable contribution or other consideration. 55
	93	+	(12) "Insurer" or "insurance company" includes any person or 56
	94	+	combination of persons doing any kind or form of insurance business 57
	95	+	other than a fraternal benefit society, and shall include a receiver of any 58
	96	+	insurer when the context reasonably permits. 59
	97	+	(13) "Insured" means a person to whom or for whose benefit an 60
	98	+	insurer makes a promise in an insurance policy. The term includes 61
	99	+	policyholders, subscribers, members and beneficiaries. This definition 62
	100	+	applies only to the provisions of this title and does not define the 63
	101	+	meaning of this word as used in insurance policies or certificates. 64
	102	+	(14) "Life insurance" means insurance on human lives and insurances 65
	103	+	pertaining to or connected with human life. The business of life 66
	104	+	insurance includes granting endowment benefits, granting additional 67
	105	+	benefits in the event of death by accident or accidental means, granting 68
	106	+	additional benefits in the event of the total and permanent disability of 69
	107	+	the insured, and providing optional methods of settlement of proceeds. 70
	108	+	Life insurance includes burial contracts to the extent provided by 71
	109	+	section 38a-464. 72
	110	+	(15) "Mutual insurer" means any insurer without capital stock, the 73 Raised Bill No. 1003
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125		-	Public Act No. 21-14 5 of 7
126	112
127		-	made by a third party for the amount of, or any portion of the amount
128		-	of, the coinsurance, copayment, deductible or other out-of-pocket
129		-	expense for the covered benefit.
130		-	Sec. 3. Section 38a-478 of the general statutes is repealed and the
131		-	following is substituted in lieu thereof (Effective January 1, 2022):
132		-	As used in this section, sections 38a-478a to 38a-478o, inclusive, [and]
133		-	subsection (a) of section 38a-478s and section 4 of this act:
134		-	(1) "Commissioner" means the Insurance Commissioner.
135		-	(2) "Covered benefit" or "benefit" means a health care service to which
136		-	an enrollee is entitled under the terms of a health benefit plan.
137		-	(3) "Enrollee" means a person who has contracted for or who
138		-	participates in a managed care plan for such person or such person's
139		-	eligible dependents.
140		-	(4) "Health care services" means services for the diagnosis,
141		-	prevention, treatment, cure or relief of a health condition, illness, injury
142		-	or disease.
143		-	(5) "Managed care organization" means an insurer, health care center,
144		-	hospital service corporation, medical service corporation or other
145		-	organization delivering, issuing for delivery, renewing, amending or
146		-	continuing any individual or group health managed care plan in this
147		-	state.
148		-	(6) "Managed care plan" means a product offered by a managed care
149		-	organization that provides for the financing or delivery of health care
150		-	services to persons enrolled in the plan through: (A) Arrangements with
151		-	selected providers to furnish health care services; (B) explicit standards
152		-	for the selection of participating providers; (C) financial incentives for
153		-	enrollees to use the participating providers and procedures provided for Senate Bill No. 1003
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155		-	Public Act No. 21-14 6 of 7
	117	+	managing directors or officers of which are elected by its members. 74
	118	+	(16) "Person" means an individual, a corporation, a partnership, a 75
	119	+	limited liability company, an association, a joint stock company, a 76
	120	+	business trust, an unincorporated organization or other legal entity. 77
	121	+	(17) "Policy" means any document, including attached endorsements 78
	122	+	and riders, purporting to be an enforceable contract, which 79
	123	+	memorializes in writing some or all of the terms of an insurance 80
	124	+	contract. 81
	125	+	(18) "State" means any state, district, or territory of the United States. 82
	126	+	(19) "Subsidiary" of a specified person means an affiliate controlled 83
	127	+	by the person directly, or indirectly through one or more intermediaries. 84
	128	+	(20) "Unauthorized insurer" or "nonadmitted insurer" means an 85
	129	+	insurer that has not been granted a certificate of authority by the 86
	130	+	commissioner to transact the business of insurance in this state or an 87
	131	+	insurer transacting business not authorized by a valid certificate. 88
	132	+	(21) "United States" means the United States of America, its territories 89
	133	+	and possessions, the Commonwealth of Puerto Rico and the District of 90
	134	+	Columbia. 91
	135	+	Sec. 2. (NEW) (Effective January 1, 2022) Each insurer, health care 92
	136	+	center, hospital service corporation, medical service corporation, 93
	137	+	fraternal benefit society or other entity that delivers, issues for delivery, 94
	138	+	renews, amends or continues an individual or group health insurance 95
	139	+	policy in this state on or after January 1, 2022, providing coverage of the 96
	140	+	type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 97
	141	+	of the general statutes shall, when calculating an insured's liability for a 98
	142	+	coinsurance, copayment, deductible or other out-of-pocket expense for 99
	143	+	a covered benefit, give credit for any payment made by a third party for 100
	144	+	the amount of, or any portion of the amount of, the coinsurance, 101
	145	+	copayment, deductible or other out-of-pocket expense for the covered 102
	146	+	benefit. 103 Raised Bill No. 1003
156	147
157		-	by the plan; or (D) arrangements that share risks with providers,
158		-	provided the organization offering a plan described under
159		-	subparagraph (A), (B), (C) or (D) of this subdivision is licensed by the
160		-	Insurance Department pursuant to chapter 698, 698a or 700 and the plan
161		-	includes utilization review, as defined in section 38a-591a.
162		-	(7) "Preferred provider network" has the same meaning as provided
163		-	in section 38a-479aa.
164		-	(8) "Provider" or "health care provider" means a person licensed to
165		-	provide health care services under chapters 370 to 373, inclusive, 375 to
166		-	383c, inclusive, 384a to 384c, inclusive, or chapter 400j.
167		-	(9) "Utilization review" has the same meaning as provided in section
168		-	38a-591a.
169		-	(10) "Utilization review company" has the same meaning as provided
170		-	in section 38a-591a.
171		-	Sec. 4. (NEW) (Effective January 1, 2022) For any contract delivered,
172		-	issued for delivery, renewed, amended or continued in this state on or
173		-	after January 1, 2022, each managed care organization shall, when
174		-	calculating an enrollee's liability for a coinsurance, copayment,
175		-	deductible or other out-of-pocket expense for a covered benefit, give
176		-	credit for any discount provided or payment made by a third party for
177		-	the amount of, or any portion of the amount of, the coinsurance,
178		-	copayment, deductible or other out-of-pocket expense for the covered
179		-	benefit.
180		-	Sec. 5. (NEW) (Effective January 1, 2022) On and after January 1, 2022,
181		-	each contract entered into between a health carrier, as defined in section
182		-	38a-591a of the general statutes, and a pharmacy benefits manager, as
183		-	defined in section 38a-479aaa of the general statutes, for the
184		-	administration of the pharmacy benefit portion of a health benefit plan
185		-	in this state on behalf of plan sponsors shall require that the pharmacy Senate Bill No. 1003
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189		-	benefits manager, when calculating an insured's or enrollee's liability for
190		-	a coinsurance, copayment, deductible or other out-of-pocket expense for
191		-	a covered prescription drug benefit, give credit for any discount
192		-	provided or payment made by a third party for the amount of, or any
193		-	portion of the amount of, the coinsurance, copayment, deductible or
194		-	other out-of-pocket expense for the covered prescription drug benefit.
	153	+	Sec. 3. Section 38a-478 of the general statutes is repealed and the 104
	154	+	following is substituted in lieu thereof (Effective January 1, 2022): 105
	155	+	As used in this section, sections 38a-478a to 38a-478o, inclusive, [and] 106
	156	+	subsection (a) of section 38a-478s and section 4 of this act: 107
	157	+	(1) "Commissioner" means the Insurance Commissioner. 108
	158	+	(2) "Covered benefit" or "benefit" means a health care service to which 109
	159	+	an enrollee is entitled under the terms of a health benefit plan. 110
	160	+	(3) "Enrollee" means a person who has contracted for or who 111
	161	+	participates in a managed care plan for such person or such person's 112
	162	+	eligible dependents. 113
	163	+	(4) "Health care services" means services for the diagnosis, 114
	164	+	prevention, treatment, cure or relief of a health condition, illness, injury 115
	165	+	or disease. 116
	166	+	(5) "Managed care organization" means an insurer, health care center, 117
	167	+	hospital service corporation, medical service corporation or other 118
	168	+	organization delivering, issuing for delivery, renewing, amending or 119
	169	+	continuing any individual or group health managed care plan in this 120
	170	+	state. 121
	171	+	(6) "Managed care plan" means a product offered by a managed care 122
	172	+	organization that provides for the financing or delivery of health care 123
	173	+	services to persons enrolled in the plan through: (A) Arrangements with 124
	174	+	selected providers to furnish health care services; (B) explicit standards 125
	175	+	for the selection of participating providers; (C) financial incentives for 126
	176	+	enrollees to use the participating providers and procedures provided for 127
	177	+	by the plan; or (D) arrangements that share risks with providers, 128
	178	+	provided the organization offering a plan described under 129
	179	+	subparagraph (A), (B), (C) or (D) of this subdivision is licensed by the 130
	180	+	Insurance Department pursuant to chapter 698, 698a or 700 and the plan 131
	181	+	includes utilization review, as defined in section 38a-591a. 132 Raised Bill No. 1003
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	187	+
	188	+	(7) "Preferred provider network" has the same meaning as provided 133
	189	+	in section 38a-479aa. 134
	190	+	(8) "Provider" or "health care provider" means a person licensed to 135
	191	+	provide health care services under chapters 370 to 373, inclusive, 375 to 136
	192	+	383c, inclusive, 384a to 384c, inclusive, or chapter 400j. 137
	193	+	(9) "Utilization review" has the same meaning as provided in section 138
	194	+	38a-591a. 139
	195	+	(10) "Utilization review company" has the same meaning as provided 140
	196	+	in section 38a-591a. 141
	197	+	Sec. 4. (NEW) (Effective January 1, 2022) For any contract delivered, 142
	198	+	issued for delivery, renewed, amended or continued in this state on or 143
	199	+	after January 1, 2022, each managed care organization shall, when 144
	200	+	calculating an enrollee's liability for a coinsurance, copayment, 145
	201	+	deductible or other out-of-pocket expense for a covered benefit, give 146
	202	+	credit for any payment made by a third party for the amount of, or any 147
	203	+	portion of the amount of, the coinsurance, copayment, deductible or 148
	204	+	other out-of-pocket expense for the covered benefit. 149
	205	+	Sec. 5. (NEW) (Effective January 1, 2022) On and after January 1, 2022, 150
	206	+	each contract entered into between a health carrier, as defined in section 151
	207	+	38a-591a of the general statutes, and a pharmacy benefits manager, as 152
	208	+	defined in section 38a-479aaa of the general statutes, for the 153
	209	+	administration of the pharmacy benefit portion of a health benefit plan 154
	210	+	in this state on behalf of plan sponsors shall require that the pharmacy 155
	211	+	benefits manager, when calculating an insured's or enrollee's liability for 156
	212	+	a coinsurance, copayment, deductible or other out-of-pocket expense for 157
	213	+	a covered prescription drug benefit, give credit for any payment made 158
	214	+	by a third party for the amount of, or any portion of the amount of, the 159
	215	+	coinsurance, copayment, deductible or other out-of-pocket expense for 160
	216	+	the covered prescription drug benefit. 161 Raised Bill No. 1003
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	222	+
	223	+	This act shall take effect as follows and shall amend the following
	224	+	sections:
	225	+
	226	+	Section 1 January 1, 2022 38a-1
	227	+	Sec. 2 January 1, 2022 New section
	228	+	Sec. 3 January 1, 2022 38a-478
	229	+	Sec. 4 January 1, 2022 New section
	230	+	Sec. 5 January 1, 2022 New section
	231	+
	232	+	INS Joint Favorable
195	233