Connecticut 2021 Regular Session

Connecticut Senate Bill SB01041 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
3		-	LCO 3375 \\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-R01-
4		-	SB.docx
5		-	1 of 15
	3	+
	4	+	LCO No. 3375 1 of 15
6	5
7	6		General Assembly Raised Bill No. 1041
8	7		January Session, 2021
9	8		LCO No. 3375
10	9
11	10
12	11		Referred to Committee on INSURANCE AND REAL ESTATE
13	12
14	13
15	14		Introduced by:
16	15		(INS)
	16	+
17	17
18	18
19	19
20	20		AN ACT CONCERNING HE ALTH CARE SHARING PL ANS AND
21	21		HEALTH CARE SHARING MINISTRIES.
22	22		Be it enacted by the Senate and House of Representatives in General
23	23		Assembly convened:
24	24
25	25		Section 1. Section 38a-1 of the general statutes is repealed and the 1
26	26		following is substituted in lieu thereof (Effective October 1, 2021): 2
27	27		Terms used in this title and sections 2 and 4 of this act, unless it 3
28	28		appears from the context to the contrary, shall have a scope and 4
29	29		meaning as set forth in this section. 5
30	30		(1) "Affiliate" or "affiliated" means a person that directly, or indirectly 6
31	31		through one or more intermediaries, controls, is controlled by or is 7
32	32		under common control with another person. 8
33	33		(2) "Alien insurer" means any insurer that has been chartered by or 9
34	34		organized or constituted within or under the laws of any jurisdiction or 10
35	35		country without the United States. 11
36	36		(3) "Annuities" means all agreements to make periodical payments 12
37	37		where the making or continuance of all or some of the series of the 13 Raised Bill No. 1041
38	38
39	39
40		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
41		-	R01-SB.docx }
42		-	2 of 15
	40	+
	41	+	LCO No. 3375 2 of 15
43	42
44	43		payments, or the amount of the payment, is dependent upon the 14
45	44		continuance of human life or is for a specified term of years. This 15
46	45		definition does not apply to payments made under a policy of life 16
47	46		insurance. 17
48	47		(4) "Commissioner" means the Insurance Commissioner. 18
49	48		(5) "Control", "controlled by" or "under common control with" means 19
50	49		the possession, direct or indirect, of the power to direct or cause the 20
51	50		direction of the management and policies of a person, whether through 21
52	51		the ownership of voting securities, by contract other than a commercial 22
53	52		contract for goods or nonmanagement services, or otherwise, unless the 23
54	53		power is the result of an official position with the person. 24
55	54		(6) "Domestic insurer" means any insurer that has been chartered by, 25
56	55		incorporated, organized or constituted within or under the laws of this 26
57	56		state. 27
58	57		(7) "Domestic surplus lines insurer" means any domestic insurer that 28
59	58		has been authorized by the commissioner to write surplus lines 29
60	59		insurance. 30
61	60		(8) "Foreign country" means any jurisdiction not in any state, district 31
62	61		or territory of the United States. 32
63	62		(9) "Foreign insurer" means any insurer that has been chartered by or 33
64	63		organized or constituted within or under the laws of another state or a 34
65	64		territory of the United States. 35
66	65		(10) "Insolvency" or "insolvent" means, for any insurer, that it is 36
67	66		unable to pay its obligations when they are due, or when its admitted 37
68	67		assets do not exceed its liabilities plus the greater of: (A) Capital and 38
69	68		surplus required by law for its organization and continued operation; 39
70	69		or (B) the total par or stated value of its authorized and issued capital 40
71	70		stock. For purposes of this subdivision "liabilities" shall include but not 41
72	71		be limited to reserves required by statute or by regulations adopted by 42
73	72		the commissioner in accordance with the provisions of chapter 54 or 43 Raised Bill No. 1041
74	73
75	74
76		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
77		-	R01-SB.docx }
78		-	3 of 15
	75	+
	76	+	LCO No. 3375 3 of 15
79	77
80	78		specific requirements imposed by the commissioner upon a subject 44
81	79		company at the time of admission or subsequent thereto. 45
82	80		(11) "Insurance" means any agreement to pay a sum of money, 46
83	81		provide services or any other thing of value on the happening of a 47
84	82		particular event or contingency or to provide indemnity for loss in 48
85	83		respect to a specified subject by specified perils in return for a 49
86	84		consideration. In any contract of insurance, an insured shall have an 50
87	85		interest which is subject to a risk of loss through destruction or 51
88	86		impairment of that interest, which risk is assumed by the insurer and 52
89	87		such assumption shall be part of a general scheme to distribute losses 53
90	88		among a large group of persons bearing similar risks in return for a 54
91	89		ratable contribution or other consideration. 55
92	90		(12) "Insurer" or "insurance company" includes any person or 56
93	91		combination of persons doing any kind or form of insurance business 57
94	92		other than a fraternal benefit society, and shall include a receiver of any 58
95	93		insurer when the context reasonably permits. 59
96	94		(13) "Insured" means a person to whom or for whose benefit an 60
97	95		insurer makes a promise in an insurance policy. The term includes 61
98	96		policyholders, subscribers, members and beneficiaries. This definition 62
99	97		applies only to the provisions of this title and does not define the 63
100	98		meaning of this word as used in insurance policies or certificates. 64
101	99		(14) "Life insurance" means insurance on human lives and insurances 65
102	100		pertaining to or connected with human life. The business of life 66
103	101		insurance includes granting endowment benefits, granting additional 67
104	102		benefits in the event of death by accident or accidental means, granting 68
105	103		additional benefits in the event of the total and permanent disability of 69
106	104		the insured, and providing optional methods of settlement of proceeds. 70
107	105		Life insurance includes burial contracts to the extent provided by 71
108	106		section 38a-464. 72
109	107		(15) "Mutual insurer" means any insurer without capital stock, the 73
110	108		managing directors or officers of which are elected by its members. 74 Raised Bill No. 1041
111	109
112	110
113		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
114		-	R01-SB.docx }
115		-	4 of 15
	111	+
	112	+	LCO No. 3375 4 of 15
116	113
117	114		(16) "Person" means an individual, a corporation, a partnership, a 75
118	115		limited liability company, an association, a joint stock company, a 76
119	116		business trust, an unincorporated organization or other legal entity. 77
120	117		(17) "Policy" means any document, including attached endorsements 78
121	118		and riders, purporting to be an enforceable contract, which 79
122	119		memorializes in writing some or all of the terms of an insurance 80
123	120		contract. 81
124	121		(18) "State" means any state, district, or territory of the United States. 82
125	122		(19) "Subsidiary" of a specified person means an affiliate controlled 83
126	123		by the person directly, or indirectly through one or more intermediaries. 84
127	124		(20) "Unauthorized insurer" or "nonadmitted insurer" means an 85
128	125		insurer that has not been granted a certificate of authority by the 86
129	126		commissioner to transact the business of insurance in this state or an 87
130	127		insurer transacting business not authorized by a valid certificate. 88
131	128		(21) "United States" means the United States of America, its territories 89
132	129		and possessions, the Commonwealth of Puerto Rico and the District of 90
133	130		Columbia. 91
134	131		Sec. 2. (NEW) (Effective October 1, 2021) (a) For the purposes of this 92
135	132		section, "health care sharing plan" means an arrangement of members 93
136	133		that encourages its members, or an affiliation or network of individuals 94
137	134		that encourages such individuals, to cover, in whole or in part, the 95
138	135		medical, health care, assisted living or prescription drug costs, or 96
139	136		wellness expenses, of other such members or individuals. 97
140	137		(b) Notwithstanding any provision of the general statutes, no person 98
141	138		shall receive a fee or anything of value in exchange for: 99
142	139		(1) Selling or soliciting a health care sharing plan for a resident of this 100
143	140		state; 101
144		-	(2) Negotiating a health care sharing plan on behalf of a resident of 102 Raised Bill No. 1041
	141	+	(2) Negotiating a health care sharing plan on behalf of a resident of 102
	142	+	this state; or 103 Raised Bill No. 1041
145	143
146	144
147		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
148		-	R01-SB.docx }
149		-	5 of 15
150	145
151		-	this state; or 103
	146	+	LCO No. 3375 5 of 15
	147	+
152	148		(3) Administering a health care sharing plan that includes a resident 104
153	149		of this state. 105
154	150		(c) Any violation of this section shall be deemed an unfair method of 106
155	151		competition and unfair and deceptive act or practice in the business of 107
156	152		insurance under section 38a-816 of the general statutes, as amended by 108
157	153		this act. 109
158	154		Sec. 3. Section 38a-816 of the general statutes is repealed and the 110
159	155		following is substituted in lieu thereof (Effective October 1, 2021): 111
160	156		The following are defined as unfair methods of competition and 112
161	157		unfair and deceptive acts or practices in the business of insurance: 113
162	158		(1) Misrepresentations and false advertising of insurance policies. 114
163	159		Making, issuing or circulating, or causing to be made, issued or 115
164	160		circulated, any estimate, illustration, circular or statement, sales 116
165	161		presentation, omission or comparison which: (A) Misrepresents the 117
166	162		benefits, advantages, conditions or terms of any insurance policy; (B) 118
167	163		misrepresents the dividends or share of the surplus to be received, on 119
168	164		any insurance policy; (C) makes any false or misleading statements as 120
169	165		to the dividends or share of surplus previously paid on any insurance 121
170	166		policy; (D) is misleading or is a misrepresentation as to the financial 122
171	167		condition of any person, or as to the legal reserve system upon which 123
172	168		any life insurer operates; (E) uses any name or title of any insurance 124
173	169		policy or class of insurance policies misrepresenting the true nature 125
174	170		thereof; (F) is a misrepresentation, including, but not limited to, an 126
175	171		intentional misquote of a premium rate, for the purpose of inducing or 127
176	172		tending to induce to the purchase, lapse, forfeiture, exchange, 128
177	173		conversion or surrender of any insurance policy; (G) is a 129
178	174		misrepresentation for the purpose of effecting a pledge or assignment of 130
179	175		or effecting a loan against any insurance policy; or (H) misrepresents 131
180	176		any insurance policy as being shares of stock. 132
181		-	(2) False information and advertising generally. Making, publishing, 133 Raised Bill No. 1041
	177	+	(2) False information and advertising generally. Making, publishing, 133
	178	+	disseminating, circulating or placing before the public, or causing, 134
	179	+	directly or indirectly, to be made, published, disseminated, circulated or 135 Raised Bill No. 1041
182	180
183	181
184		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
185		-	R01-SB.docx }
186		-	6 of 15
187	182
188		-	~~disseminating, circulating or placing before the public,~~ ~~or causing,~~ ~~134~~
189		-	~~directly or indirectly, to be made, published, disseminated, circulated or 135~~
	183	+	LCO No. 3375 6 of 15
	184	+
190	185		placed before the public, in a newspaper, magazine or other publication, 136
191	186		or in the form of a notice, circular, pamphlet, letter or poster, or over any 137
192	187		radio or television station, or in any other way, an advertisement, 138
193	188		announcement or statement containing any assertion, representation or 139
194	189		statement with respect to the business of insurance or with respect to 140
195	190		any person in the conduct of his insurance business, which is untrue, 141
196	191		deceptive or misleading. 142
197	192		(3) Defamation. Making, publishing, disseminating or circulating, 143
198	193		directly or indirectly, or aiding, abetting or encouraging the making, 144
199	194		publishing, disseminating or circulating of, any oral or written 145
200	195		statement or any pamphlet, circular, article or literature which is false 146
201	196		or maliciously critical of or derogatory to the financial condition of an 147
202	197		insurer, and which is calculated to injure any person engaged in the 148
203	198		business of insurance. 149
204	199		(4) Boycott, coercion and intimidation. Entering into any agreement 150
205	200		to commit, or by any concerted action committing, any act of boycott, 151
206	201		coercion or intimidation resulting in or tending to result in unreasonable 152
207	202		restraint of, or monopoly in, the business of insurance. 153
208	203		(5) False financial statements. Filing with any supervisory or other 154
209	204		public official, or making, publishing, disseminating, circulating or 155
210	205		delivering to any person, or placing before the public, or causing, 156
211	206		directly or indirectly, to be made, published, disseminated, circulated or 157
212	207		delivered to any person, or placed before the public, any false statement 158
213	208		of financial condition of an insurer with intent to deceive; or making any 159
214	209		false entry in any book, report or statement of any insurer with intent to 160
215	210		deceive any agent or examiner lawfully appointed to examine into its 161
216	211		condition or into any of its affairs, or any public official to whom such 162
217	212		insurer is required by law to report, or who has authority by law to 163
218	213		examine into its condition or into any of its affairs, or, with like intent, 164
219	214		wilfully omitting to make a true entry of any material fact pertaining to 165
220		-	the business of such insurer in any book, report or statement of such 166 Raised Bill No. 1041
	215	+	the business of such insurer in any book, report or statement of such 166
	216	+	insurer. 167 Raised Bill No. 1041
221	217
222	218
223		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
224		-	R01-SB.docx }
225		-	7 of 15
226	219
227		-	insurer. 167
	220	+	LCO No. 3375 7 of 15
	221	+
228	222		(6) Unfair claim settlement practices. Committing or performing with 168
229	223		such frequency as to indicate a general business practice any of the 169
230	224		following: (A) Misrepresenting pertinent facts or insurance policy 170
231	225		provisions relating to coverages at issue; (B) failing to acknowledge and 171
232	226		act with reasonable promptness upon communications with respect to 172
233	227		claims arising under insurance policies; (C) failing to adopt and 173
234	228		implement reasonable standards for the prompt investigation of claims 174
235	229		arising under insurance policies; (D) refusing to pay claims without 175
236	230		conducting a reasonable investigation based upon all available 176
237	231		information; (E) failing to affirm or deny coverage of claims within a 177
238	232		reasonable time after proof of loss statements have been completed; (F) 178
239	233		not attempting in good faith to effectuate prompt, fair and equitable 179
240	234		settlements of claims in which liability has become reasonably clear; (G) 180
241	235		compelling insureds to institute litigation to recover amounts due under 181
242	236		an insurance policy by offering substantially less than the amounts 182
243	237		ultimately recovered in actions brought by such insureds; (H) 183
244	238		attempting to settle a claim for less than the amount to which a 184
245	239		reasonable man would have believed he was entitled by reference to 185
246	240		written or printed advertising material accompanying or made part of 186
247	241		an application; (I) attempting to settle claims on the basis of an 187
248	242		application which was altered without notice to, or knowledge or 188
249	243		consent of the insured; (J) making claims payments to insureds or 189
250	244		beneficiaries not accompanied by statements setting forth the coverage 190
251	245		under which the payments are being made; (K) making known to 191
252	246		insureds or claimants a policy of appealing from arbitration awards in 192
253	247		favor of insureds or claimants for the purpose of compelling them to 193
254	248		accept settlements or compromises less than the amount awarded in 194
255	249		arbitration; (L) delaying the investigation or payment of claims by 195
256	250		requiring an insured, claimant, or the physician of either to submit a 196
257	251		preliminary claim report and then requiring the subsequent submission 197
258	252		of formal proof of loss forms, both of which submissions contain 198
259	253		substantially the same information; (M) failing to promptly settle claims, 199
260		-	where liability has become reasonably clear, under one portion of the 200 Raised Bill No. 1041
	254	+	where liability has become reasonably clear, under one portion of the 200
	255	+	insurance policy coverage in order to influence settlements under other 201
	256	+	portions of the insurance policy coverage; (N) failing to promptly 202 Raised Bill No. 1041
261	257
262	258
263		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
264		-	R01-SB.docx }
265		-	8 of 15
266	259
267		-	~~insurance policy coverage in order to influence settlements under other 201~~
268		-	~~portions of the insurance policy coverage; (N) failing to promptly 202~~
	260	+	LCO No. 3375 8 of 15
	261	+
269	262		provide a reasonable explanation of the basis in the insurance policy in 203
270	263		relation to the facts or applicable law for denial of a claim or for the offer 204
271	264		of a compromise settlement; (O) using as a basis for cash settlement with 205
272	265		a first party automobile insurance claimant an amount which is less than 206
273	266		the amount which the insurer would pay if repairs were made unless 207
274	267		such amount is agreed to by the insured or provided for by the 208
275	268		insurance policy. 209
276	269		(7) Failure to maintain complaint handling procedures. Failure of any 210
277	270		person to maintain complete record of all the complaints which it has 211
278	271		received since the date of its last examination. This record shall indicate 212
279	272		the total number of complaints, their classification by line of insurance, 213
280	273		the nature of each complaint, the disposition of these complaints, and 214
281	274		the time it took to process each complaint. For purposes of this 215
282	275		[subsection] subdivision, "complaint" means any written 216
283	276		communication primarily expressing a grievance. 217
284	277		(8) Misrepresentation in insurance applications. Making false or 218
285	278		fraudulent statements or representations on or relative to an application 219
286	279		for an insurance policy for the purpose of obtaining a fee, commission, 220
287	280		money or other benefit from any insurer, producer or individual. 221
288	281		(9) Any violation of any one of sections 38a-358, 38a-446, 38a-447, 38a-222
289	282		488, 38a-825, 38a-826, 38a-828 and 38a-829. None of the following 223
290	283		practices shall be considered discrimination within the meaning of 224
291	284		section 38a-446 or 38a-488 or a rebate within the meaning of section 38a-225
292	285		825: (A) Paying bonuses to policyholders or otherwise abating their 226
293	286		premiums in whole or in part out of surplus accumulated from 227
294	287		nonparticipating insurance, provided any such bonuses or abatement of 228
295	288		premiums shall be fair and equitable to policyholders and for the best 229
296	289		interests of the company and its policyholders; (B) in the case of policies 230
297	290		issued on the industrial debit plan, making allowance to policyholders 231
298	291		who have continuously for a specified period made premium payments 232
299		-	directly to an office of the insurer in an amount which fairly represents 233 Raised Bill No. 1041
	292	+	directly to an office of the insurer in an amount which fairly represents 233
	293	+	the saving in collection expense; (C) readjustment of the rate of premium 234
	294	+	for a group insurance policy based on loss or expense experience, or 235 Raised Bill No. 1041
300	295
301	296
302		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
303		-	R01-SB.docx }
304		-	9 of 15
305	297
306		-	~~the saving in collection expense;~~ ~~(C) readjustment~~ of ~~the rate of premium 234~~
307		-	~~for a group insurance policy based on loss or expense experience, or 235~~
	298	+	LCO No. 3375 9 of 15
	299	+
308	300		both, at the end of the first or any subsequent policy year, which may be 236
309	301		made retroactive for such policy year. 237
310	302		(10) Notwithstanding any provision of any policy of insurance, 238
311	303		certificate or service contract, whenever such insurance policy or 239
312	304		certificate or service contract provides for reimbursement for any 240
313	305		services which may be legally performed by any practitioner of the 241
314	306		healing arts licensed to practice in this state, reimbursement under such 242
315	307		insurance policy, certificate or service contract shall not be denied 243
316	308		because of race, color or creed nor shall any insurer make or permit any 244
317	309		unfair discrimination against particular individuals or persons so 245
318	310		licensed. 246
319	311		(11) Favored agent or insurer: Coercion of debtors. (A) No person 247
320	312		may (i) require, as a condition precedent to the lending of money or 248
321	313		extension of credit, or any renewal thereof, that the person to whom 249
322	314		such money or credit is extended or whose obligation the creditor is to 250
323	315		acquire or finance, negotiate any policy or contract of insurance through 251
324	316		a particular insurer or group of insurers or producer or group of 252
325	317		producers; (ii) unreasonably disapprove the insurance policy provided 253
326	318		by a borrower for the protection of the property securing the credit or 254
327	319		lien; (iii) require directly or indirectly that any borrower, mortgagor, 255
328	320		purchaser, insurer or producer pay a separate charge, in connection 256
329	321		with the handling of any insurance policy required as security for a loan 257
330	322		on real estate or pay a separate charge to substitute the insurance policy 258
331	323		of one insurer for that of another; or (iv) use or disclose information 259
332	324		resulting from a requirement that a borrower, mortgagor or purchaser 260
333	325		furnish insurance of any kind on real property being conveyed or used 261
334	326		as collateral security to a loan, when such information is to the 262
335	327		advantage of the mortgagee, vendor or lender, or is to the detriment of 263
336	328		the borrower, mortgagor, purchaser, insurer or the producer complying 264
337	329		with such a requirement. 265
338		-	(B) (i) Subparagraph (A)(iii) of this subdivision shall not include the 266 Raised Bill No. 1041
	330	+	(B) (i) Subparagraph (A)(iii) of this subdivision shall not include the 266
	331	+	interest which may be charged on premium loans or premium 267
	332	+	advancements in accordance with the security instrument. (ii) For 268 Raised Bill No. 1041
339	333
340	334
341		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
342		-	R01-SB.docx }
343		-	10 of 15
344	335
345		-	~~interest which may be charged on premium loans or premium 267~~
346		-	~~advancements in accordance with the security instrument. (ii) For 268~~
	336	+	LCO No. 3375 10 of 15
	337	+
347	338		purposes of subparagraph (A)(ii) of this subdivision, such disapproval 269
348	339		shall be deemed unreasonable if it is not based solely on reasonable 270
349	340		standards uniformly applied, relating to the extent of coverage required 271
350	341		and the financial soundness and the services of an insurer. Such 272
351	342		standards shall not discriminate against any particular type of insurer, 273
352	343		nor shall such standards call for the disapproval of an insurance policy 274
353	344		because such policy contains coverage in addition to that required. (iii) 275
354	345		The commissioner may investigate the affairs of any person to whom 276
355	346		this subdivision applies to determine whether such person has violated 277
356	347		this subdivision. If a violation of this subdivision is found, the person in 278
357	348		violation shall be subject to the same procedures and penalties as are 279
358	349		applicable to other provisions of section 38a-815, subsections (b) and (e) 280
359	350		of section 38a-817 and this section. (iv) For purposes of this section, 281
360	351		"person" includes any individual, corporation, limited liability 282
361	352		company, association, partnership or other legal entity. 283
362	353		(12) Refusing to insure, refusing to continue to insure or limiting the 284
363	354		amount, extent or kind of coverage available to an individual or 285
364	355		charging an individual a different rate for the same coverage because of 286
365	356		physical disability, mental or nervous condition as set forth in section 287
366	357		38a-488a or intellectual disability, except where the refusal, limitation or 288
367	358		rate differential is based on sound actuarial principles or is related to 289
368	359		actual or reasonably anticipated experience. 290
369	360		(13) Refusing to insure, refusing to continue to insure or limiting the 291
370	361		amount, extent or kind of coverage available to an individual or 292
371	362		charging an individual a different rate for the same coverage solely 293
372	363		because of blindness or partial blindness. For purposes of this 294
373	364		subdivision, "refusal to insure" includes the denial by an insurer of 295
374	365		disability insurance coverage on the grounds that the policy defines 296
375	366		"disability" as being presumed in the event that the insured is blind or 297
376	367		partially blind, except that an insurer may exclude from coverage any 298
377		-	disability, consisting solely of blindness or partial blindness, when such 299 Raised Bill No. 1041
	368	+	disability, consisting solely of blindness or partial blindness, when such 299
	369	+	condition existed at the time the policy was issued. Any individual who 300
	370	+	is blind or partially blind shall be subject to the same standards of sound 301
	371	+	actuarial principles or actual or reasonably anticipated experience as are 302 Raised Bill No. 1041
378	372
379	373
380		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
381		-	R01-SB.docx }
382		-	11 of 15
383	374
384		-	condition existed at the time the policy was issued. Any individual who 300
385		-	is blind or partially blind shall be subject to the same standards of sound 301
386		-	actuarial principles or actual or reasonably anticipated experience as are 302
	375	+	LCO No. 3375 11 of 15
	376	+
387	377		sighted persons with respect to all other conditions, including the 303
388	378		underlying cause of the blindness or partial blindness. 304
389	379		(14) Refusing to insure, refusing to continue to insure or limiting the 305
390	380		amount, extent or kind of coverage available to an individual or 306
391	381		charging an individual a different rate for the same coverage because of 307
392	382		exposure to diethylstilbestrol through the female parent. 308
393	383		(15) (A) Failure by an insurer, or any other entity responsible for 309
394	384		providing payment to a health care provider pursuant to an insurance 310
395	385		policy, to pay accident and health claims, including, but not limited to, 311
396	386		claims for payment or reimbursement to health care providers, within 312
397	387		the time periods set forth in subparagraph (B) of this subdivision, unless 313
398	388		the Insurance Commissioner determines that a legitimate dispute exists 314
399	389		as to coverage, liability or damages or that the claimant has fraudulently 315
400	390		caused or contributed to the loss. Any insurer, or any other entity 316
401	391		responsible for providing payment to a health care provider pursuant 317
402	392		to an insurance policy, who fails to pay such a claim or request within 318
403	393		the time periods set forth in subparagraph (B) of this subdivision shall 319
404	394		pay the claimant or health care provider the amount of such claim plus 320
405	395		interest at the rate of fifteen per cent per annum, in addition to any other 321
406	396		penalties which may be imposed pursuant to sections 38a-11, 38a-25, 322
407	397		38a-41 to 38a-53, inclusive, 38a-57 to 38a-60, inclusive, 38a-62 to 38a-64, 323
408	398		inclusive, 38a-76, 38a-83, 38a-84, 38a-117 to 38a-124, inclusive, 38a-129 324
409	399		to 38a-140, inclusive, 38a-146 to 38a-155, inclusive, 38a-283, 38a-288 to 325
410	400		38a-290, inclusive, 38a-319, 38a-320, 38a-459, 38a-464, 38a-815 to 38a-819, 326
411	401		inclusive, 38a-824 to 38a-826, inclusive, and 38a-828 to 38a-830, 327
412	402		inclusive. Whenever the interest due a claimant or health care provider 328
413	403		pursuant to this section is less than one dollar, the insurer shall deposit 329
414	404		such amount in a separate interest-bearing account in which all such 330
415	405		amounts shall be deposited. At the end of each calendar year each such 331
416		-	insurer shall donate such amount to The University of Connecticut 332 Raised Bill No. 1041
	406	+	insurer shall donate such amount to The University of Connecticut 332
	407	+	Health Center. 333
	408	+	(B) Each insurer or other entity responsible for providing payment to 334
	409	+	a health care provider pursuant to an insurance policy subject to this 335 Raised Bill No. 1041
417	410
418	411
419		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
420		-	R01-SB.docx }
421		-	12 of 15
422	412
423		-	Health Center. 333
424		-	(B) Each insurer or other entity responsible for providing payment to 334
425		-	a health care provider pursuant to an insurance policy subject to this 335
	413	+	LCO No. 3375 12 of 15
	414	+
426	415		section, shall pay claims not later than: 336
427	416		(i) For claims filed in paper format, sixty days after receipt by the 337
428	417		insurer of the claimant's proof of loss form or the health care provider's 338
429	418		request for payment filed in accordance with the insurer's practices or 339
430	419		procedures, except that when there is a deficiency in the information 340
431	420		needed for processing a claim, as determined in accordance with section 341
432	421		38a-477, the insurer shall (I) send written notice to the claimant or health 342
433	422		care provider, as the case may be, of all alleged deficiencies in 343
434	423		information needed for processing a claim not later than thirty days 344
435	424		after the insurer receives a claim for payment or reimbursement under 345
436	425		the contract, and (II) pay claims for payment or reimbursement under 346
437	426		the contract not later than thirty days after the insurer receives the 347
438	427		information requested; and 348
439	428		(ii) For claims filed in electronic format, twenty days after receipt by 349
440	429		the insurer of the claimant's proof of loss form or the health care 350
441	430		provider's request for payment filed in accordance with the insurer's 351
442	431		practices or procedures, except that when there is a deficiency in the 352
443	432		information needed for processing a claim, as determined in accordance 353
444	433		with section 38a-477, the insurer shall (I) notify the claimant or health 354
445	434		care provider, as the case may be, of all alleged deficiencies in 355
446	435		information needed for processing a claim not later than ten days after 356
447	436		the insurer receives a claim for payment or reimbursement under the 357
448	437		contract, and (II) pay claims for payment or reimbursement under the 358
449	438		contract not later than ten days after the insurer receives the information 359
450	439		requested. 360
451	440		(C) As used in this subdivision, "health care provider" means a person 361
452	441		licensed to provide health care services under chapter 368d, chapter 362
453	442		368v, chapters 370 to 373, inclusive, 375 to 383c, inclusive, 384a to 384c, 363
454		-	inclusive, or chapter 400j. 364 Raised Bill No. 1041
	443	+	inclusive, or chapter 400j. 364
	444	+	(16) Failure to pay, as part of any claim for a damaged motor vehicle 365
	445	+	under any automobile insurance policy where the vehicle has been 366
	446	+	declared to be a constructive total loss, an amount equal to the sum of 367 Raised Bill No. 1041
455	447
456	448
457		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
458		-	R01-SB.docx }
459		-	13 of 15
460	449
461		-	(16) Failure to pay, as part of any claim for a damaged motor vehicle 365
462		-	under any automobile insurance policy where the vehicle has been 366
463		-	declared to be a constructive total loss, an amount equal to the sum of 367
	450	+	LCO No. 3375 13 of 15
	451	+
464	452		(A) the settlement amount on such vehicle plus, whenever the insurer 368
465	453		takes title to such vehicle, (B) an amount determined by multiplying 369
466	454		such settlement amount by a percentage equivalent to the current sales 370
467	455		tax rate established in section 12-408. For purposes of this subdivision, 371
468	456		"constructive total loss" means the cost to repair or salvage damaged 372
469	457		property, or the cost to both repair and salvage such property, equals or 373
470	458		exceeds the total value of the property at the time of the loss. 374
471	459		(17) Any violation of section 42-260, by an extended warranty 375
472	460		provider subject to the provisions of said section, including, but not 376
473	461		limited to: (A) Failure to include all statements required in subsections 377
474	462		(c) and (f) of section 42-260 in an issued extended warranty; (B) offering 378
475	463		an extended warranty without being (i) insured under an adequate 379
476	464		extended warranty reimbursement insurance policy or (ii) able to 380
477	465		demonstrate that reserves for claims contained in the provider's 381
478	466		financial statements are not in excess of one-half the provider's audited 382
479	467		net worth; (C) failure to submit a copy of an issued extended warranty 383
480	468		form or a copy of such provider's extended warranty reimbursement 384
481	469		policy form to the Insurance Commissioner. 385
482	470		(18) With respect to an insurance company, hospital service 386
483	471		corporation, health care center or fraternal benefit society providing 387
484	472		individual or group health insurance coverage of the types specified in 388
485	473		subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 38a-469, 389
486	474		refusing to insure, refusing to continue to insure or limiting the amount, 390
487	475		extent or kind of coverage available to an individual or charging an 391
488	476		individual a different rate for the same coverage because such 392
489	477		individual has been a victim of family violence. 393
490	478		(19) With respect to an insurance company, hospital service 394
491	479		corporation, health care center or fraternal benefit society providing 395
492	480		individual or group health insurance coverage of the types specified in 396
493		-	subdivisions (1), (2), (3), (4), (6), (9), (10), (11) and (12) of section 38a-469, 397 Raised Bill No. 1041
	481	+	subdivisions (1), (2), (3), (4), (6), (9), (10), (11) and (12) of section 38a-469, 397
	482	+	refusing to insure, refusing to continue to insure or limiting the amount, 398
	483	+	extent or kind of coverage available to an individual or charging an 399
	484	+	individual a different rate for the same coverage because of genetic 400 Raised Bill No. 1041
494	485
495	486
496		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
497		-	R01-SB.docx }
498		-	14 of 15
499	487
500		-	refusing to insure, refusing to continue to insure or limiting the amount, 398
501		-	extent or kind of coverage available to an individual or charging an 399
502		-	individual a different rate for the same coverage because of genetic 400
	488	+	LCO No. 3375 14 of 15
	489	+
503	490		information. Genetic information indicating a predisposition to a 401
504	491		disease or condition shall not be deemed a preexisting condition in the 402
505	492		absence of a diagnosis of such disease or condition that is based on other 403
506	493		medical information. An insurance company, hospital service 404
507	494		corporation, health care center or fraternal benefit society providing 405
508	495		individual health coverage of the types specified in subdivisions (1), (2), 406
509	496		(3), (4), (6), (9), (10), (11) and (12) of section 38a-469, shall not be 407
510	497		prohibited from refusing to insure or applying a preexisting condition 408
511	498		limitation, to the extent permitted by law, to an individual who has been 409
512	499		diagnosed with a disease or condition based on medical information 410
513	500		other than genetic information and has exhibited symptoms of such 411
514	501		disease or condition. For the purposes of this [subsection] subdivision, 412
515	502		"genetic information" means the information about genes, gene 413
516	503		products or inherited characteristics that may derive from an individual 414
517	504		or family member. 415
518	505		(20) Any violation of sections 38a-465 to 38a-465q, inclusive. 416
519	506		(21) With respect to a managed care organization, as defined in 417
520	507		section 38a-478, failing to establish a confidentiality procedure for 418
521	508		medical record information, as required by section 38a-999. 419
522	509		(22) Any violation of sections 38a-591d to 38a-591f, inclusive. 420
523	510		(23) Any violation of section 38a-472j. 421
524	511		(24) Any violation of section 2 of this act. 422
525	512		Sec. 4. (NEW) (Effective October 1, 2021) (a) For the purposes of this 423
526	513		section: 424
527	514		(1) "Health care sharing ministry" means any person that (A) is not a 425
528	515		health carrier, (B) uses the phrase health care sharing ministry, health 426
529		-	sharing ministry or any similar phrase to refer to itself, and (C) holds 427 Raised Bill No. 1041
	516	+	sharing ministry or any similar phrase to refer to itself, and (C) holds 427
	517	+	itself out as offering a means of, or alternative to, maintaining minimum 428
	518	+	essential coverage; 429
	519	+	(2) "Health care sharing plan" has the same meaning as provided in 430 Raised Bill No. 1041
530	520
531	521
532		-	LCO 3375 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01041-
533		-	R01-SB.docx }
534		-	15 of 15
535	522
536		-	itself out as offering a means of, or alternative to, maintaining minimum 428
537		-	essential coverage; 429
538		-	(2) "Health care sharing plan" has the same meaning as provided in 430
	523	+	LCO No. 3375 15 of 15
	524	+
539	525		section 2 of this act; 431
540	526		(3) "Health carrier" has the same meaning as provided in section 38a-432
541	527		1080 of the general statutes; and 433
542	528		(4) "Minimum essential coverage" has the same meaning as provided 434
543	529		in Section 5000A of the Internal Revenue Code of 1986. 435
544	530		(b) Notwithstanding any provision of the general statutes, no person 436
545	531		licensed by the department shall conduct any business with, or conduct 437
546	532		any act requiring a license issued by the department on behalf of, a 438
547	533		health care sharing ministry or health care sharing plan. The provisions 439
548	534		of this subsection shall remain effective regardless of whether the 440
549	535		requirement that an individual maintain minimum essential coverage, 441
550	536		or any provision of the Patient Protection and Affordable Care Act, P.L. 442
551	537		111-148, is repealed or rendered ineffective by operation of law. 443
552	538		This act shall take effect as follows and shall amend the following
553	539		sections:
554	540
555	541		Section 1 October 1, 2021 38a-1
556	542		Sec. 2 October 1, 2021 New section
557	543		Sec. 3 October 1, 2021 38a-816
558	544		Sec. 4 October 1, 2021 New section
559	545
560		-	INS Joint Favorable
	546	+	Statement of Purpose:
	547	+	To provide that: (1) No person shall receive a fee or anything of value in
	548	+	exchange for (A) selling or soliciting a health care sharing plan for a
	549	+	resident of this state, (B) negotiating a health care sharing plan on behalf
	550	+	of a resident of this state, or (C) administering a health care sharing plan
	551	+	that includes a resident of this state; (2) certain prohibited transactions
	552	+	with, or on behalf of, health care sharing plans violate the Connecticut
	553	+	Unfair Insurance Practices Act; and (3) no person licensed by the
	554	+	Insurance Department shall conduct any business with, or conduct any
	555	+	act requiring a license issued by the department on behalf of, a health
	556	+	care sharing ministry or health care sharing plan.
	557	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	558	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	559	+	underlined.]
561	560