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General Assembly Raised Bill No. 357
February Session, 2022
LCO No. 2234
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING COPAY ACCUMULATOR PROGRAMS AND
HIGH DEDUCTIBLE HEALTH PLANS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 38a-477ff of the 2022 supplement to the general 1
statutes is repealed and the following is substituted in lieu thereof 2
(Effective from passage and applicable to policies delivered, issued for delivery, 3
renewed, amended or continued on or after January 1, 2022): 4
(a) Each insurer, health care center, hospital service corporation, 5
medical service corporation, fraternal benefit society or other entity that 6
delivers, issues for delivery, renews, amends or continues an individual 7
or group health insurance policy in this state on or after January 1, 2022, 8
providing coverage of the type specified in subdivisions (1), (2), (4), (11) 9
and (12) of section 38a-469 shall, when calculating an insured's liability 10
for a coinsurance, copayment, deductible or other out-of-pocket expense 11
for a covered benefit, give credit for any discount provided or payment 12
made by a third party for the amount of, or any portion of the amount 13
of, the coinsurance, copayment, deductible or other out-of-pocket 14
expense for the covered benefit. 15 Raised Bill No. 357
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(b) The provisions of subsection (a) of this section shall apply to a 16
high deductible health plan, as that term is used in subsection (f) of 17
section 38a-493 or subsection (f) of section 38a-520, as applicable, to the 18
maximum extent permitted by federal law, except if such plan is used 19
to establish a medical savings account or an Archer MSA pursuant to 20
Section 220 of the Internal Revenue Code of 1986, or any subsequent 21
corresponding internal revenue code of the United States, as amended 22
from time to time, or a health savings account pursuant to Section 223 23
of said Internal Revenue Code, as amended from time to time, the 24
provisions of said subsection (a) shall apply to such plan to the 25
maximum extent that (1) is permitted by federal law, and (2) does not 26
disqualify such account for the deduction allowed under said Section 27
220 or 223, as applicable. 28
Sec. 2. Section 38a-477gg of the 2022 supplement to the general 29
statutes is repealed and the following is substituted in lieu thereof 30
(Effective from passage and applicable to contracts entered into on or after 31
January 1, 2022): 32
(a) On and after January 1, 2022, each contract entered into between 33
a health carrier, as defined in section 38a-591a, and a pharmacy benefits 34
manager, as defined in section 38a-479aaa, for the administration of the 35
pharmacy benefit portion of a health benefit plan in this state on behalf 36
of plan sponsors shall require that the pharmacy benefits manager, 37
when calculating an insured's or enrollee's liability for a coinsurance, 38
copayment, deductible or other out-of-pocket expense for a covered 39
prescription drug benefit, give credit for any discount provided or 40
payment made by a third party for the amount of, or any portion of the 41
amount of, the coinsurance, copayment, deductible or other out-of-42
pocket expense for the covered prescription drug benefit. 43
(b) The provisions of subsection (a) of this section shall apply to a 44
high deductible health plan, as that term is used in subsection (f) of 45
section 38a-493 or subsection (f) of section 38a-520, as applicable, to the 46
maximum extent permitted by federal law, except if such plan is used 47
to establish a medical savings account or an Archer MSA pursuant to 48 Raised Bill No. 357
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Section 220 of the Internal Revenue Code of 1986, or any subsequent 49
corresponding internal revenue code of the United States, as amended 50
from time to time, or a health savings account pursuant to Section 223 51
of said Internal Revenue Code, as amended from time to time, the 52
provisions of said subsection (a) shall apply to such plan to the 53
maximum extent that (1) is permitted by federal law, and (2) does not 54
disqualify such account for the deduction allowed under said Section 55
220 or 223, as applicable. 56
Sec. 3. Section 38a-478w of the 2022 supplement to the general 57
statutes is repealed and the following is substituted in lieu thereof 58
(Effective from passage and applicable to contracts delivered, issued for 59
delivery, renewed, amended or continued on or after January 1, 2022): 60
(a) For any contract delivered, issued for delivery, renewed, amended 61
or continued in this state on or after January 1, 2022, each managed care 62
organization shall, when calculating an enrollee's liability for a 63
coinsurance, copayment, deductible or other out-of-pocket expense for 64
a covered benefit, give credit for any discount provided or payment 65
made by a third party for the amount of, or any portion of the amount 66
of, the coinsurance, copayment, deductible or other out-of-pocket 67
expense for the covered benefit. 68
(b) The provisions of subsection (a) of this section shall apply to a 69
high deductible health plan, as that term is used in subsection (f) of 70
section 38a-493 or subsection (f) of section 38a-520, as applicable, to the 71
maximum extent permitted by federal law, except if such plan is used 72
to establish a medical savings account or an Archer MSA pursuant to 73
Section 220 of the Internal Revenue Code of 1986, or any subsequent 74
corresponding internal revenue code of the United States, as amended 75
from time to time, or a health savings account pursuant to Section 223 76
of said Internal Revenue Code, as amended from time to time, the 77
provisions of said subsection (a) shall apply to such plan to the 78
maximum extent that (1) is permitted by federal law, and (2) does not 79
disqualify such account for the deduction allowed under said Section 80
220 or 223, as applicable. 81 Raised Bill No. 357
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This act shall take effect as follows and shall amend the following
sections:
Section 1 from passage and
applicable to policies
delivered, issued for
delivery, renewed,
amended or continued on
or after January 1, 2022
38a-477ff
Sec. 2 from passage and
applicable to contracts
entered into on or after
January 1, 2022
38a-477gg
Sec. 3 from passage and
applicable to contracts
delivered, issued for
delivery, renewed,
amended or continued on
or after January 1, 2022
38a-478w
INS Joint Favorable