OFFICE OF FISCAL ANALYSIS
Legislative Office Building, Room 5200
Hartford, CT 06106 (860) 240-0200
http://www.cga.ct.gov/ofa
SB-1004
AN ACT CONCERNING DENTAL AND VISION INSURANCE
COVERAGE FOR CHILDREN, STEPCHILDREN AND OTHER
DEPENDENT CHILDREN.
Primary Analyst: AN 4/5/21
Contributing Analyst(s):
OFA Fiscal Note
State Impact:
Agency Affected Fund-Effect FY 22 $ FY 23 $
State Comptroller - Fringe
Benefits
GF - Cost None See Below
ACA – State Mandate GF - Cost See Below See Below
Note: GF=General Fund
Municipal Impact:
Municipalities Effect FY 22 $ FY 23 $
Various Municipalities STATE
MANDATE
1
- Cost
See Below See Below
Explanation
The bill will result in a cost starting in FY 23 from requiring both the
state employee and retiree dental and health plans to maintain dental
and vision coverage for dependents until the earlier of a dependent
gaining coverage through their own employment or the age of 26;
coverage is currently until age 19. The state dental plan is fully insured
with new rates effective each July 1
st
. Therefore there is no impact to
the state plan in FY 22. The bill will increase dental premiums for fully
1
State mandate is defined in Sec. 2-32b(2) of the Connecticut General Statutes, "state
mandate" means any state initiated constitutional, statutory or executive action that
requires a local government to establish, expand or modify its activities in such a
way as to necessitate additional expenditures from local revenues. 2021SB-01004-R000323-FN.DOCX Page 2 of 2
insured municipalities and will be realized in premiums when they
enter into a new policy after January 1, 2022.
In addition, many municipal health plans are recognized as
“grandfathered” health plans under the Affordable Care Act (ACA).
2
It
is unclear what effect the adoption of certain health mandates will
have on the grandfathered status of certain municipal plans under
ACA. Pursuant to federal law, municipalities with self-insured plans
are exempt from state insurance mandates.
Lastly, the bill may result in a cost to the state pursuant to the ACA,
to the extent the provisions of the bill are interpreted to require the
expansion of the pediatric dental and vision benefits provided to
comply with the essential health benefit (EHB) requirement.
3
While
states are allowed to mandate benefits in excess of the EHB, federal
law requires the state to defray the cost of any such additional
mandated benefits for all plans sold in the Exchange, by reimbursing
the carrier or the insured for the excess coverage. Absent further
federal guidance, state mandated benefits enacted after December 31,
2011 cannot be considered part of the EHB unless they are already part
of the benchmark plan.
4
The Out Years
The fiscal impact described above will continue into the future and
be reflected in future dental premiums. In addition, the potential cost
to the state pursuant to the ACA will depend on the cost to provide the
benefit to Exchange plan members, as reflected in premiums.
2
Grandfathered plans include most group insurance plans and some individual
health plans created or purchased on or before March 23, 2010.
3
There are approximately 9,000 Exchange plan members between the ages of 19-26.
(Source: Access Health CT)
4
The ACA provision does not apply to stand alone dental polices or those policies
provided as a rider to the health policy.