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.
As Amended by Senate "A" (LCO 8993)
House Calendar No.: 539
Senate Calendar No.: 208
Primary Analyst: AN 5/21/21
Contributing Analyst(s):
OFA Fiscal Note
State Impact:
Agency Affected Fund-Effect FY 22 $ FY 23 $
Comptroller GF - Cost None See Below
ACA 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 as amended 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 certain dependents until the
age of 26; coverage is currently until age 18. The state dental plan is
fully insured with new rates effective each July 1
st
. Therefore, there is
likely no impact to the state plan in FY 22. The bill will increase dental
premiums for fully insured municipalities and will be realized in
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-R01-FN.DOCX Page 2 of 2
premiums when they enter into a new policy after January 1, 2022.
Pursuant to federal law, the state employee and retiree health plans
are exempt from state health mandates. However, the plans have
traditionally adopted such mandates.
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 will 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
Senate "A" strikes the underlying bill and results in the fiscal impact
described above.
The preceding Fiscal Impact statement is prepared for the benefit of the members of the General Assembly,
solely for the purposes of information, summarization and explanation and does not represent the intent of the
General Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety
of informational sources, including the analyst’s professional knowledge. Whenever applicable, agency data is
consulted as part of the analysis, however final products do not necessarily reflect an assessment from any
specific department.
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.