Connecticut 2024 Regular Session

Connecticut House Bill HB05247 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
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2	2
3	3	LCO No. 1731 1 of 32
4	4
5	5	General Assembly Raised Bill No. 5247
6	6	February Session, 2024
7	7	LCO No. 1731
8	8
9	9
10	10	Referred to Committee on INSURANCE AND REAL ESTATE
11	11
12	12
13	13	Introduced by:
14	14	(INS)
15	15
16	16
17	17
18	18
19	19	AN ACT CONCERNING EMPLOYEE HEALTH BENEFIT
20	20	CONSORTIUMS.
21	21	Be it enacted by the Senate and House of Representatives in General
22	22	Assembly convened:
23	23
24	24	Section 1. Section 38a-1 of the general statutes is repealed and the 1
25	25	following is substituted in lieu thereof (Effective October 1, 2024): 2
26	26	Terms used in this title, and sections 2 and 3 of this act, unless it 3
27	27	appears from the context to the contrary, shall have a scope and 4
28	28	meaning as set forth in this section. 5
29	29	(1) "Affiliate" or "affiliated" means a person that directly, or indirectly 6
30	30	through one or more intermediaries, controls, is controlled by or is 7
31	31	under common control with another person. 8
32	32	(2) "Alien insurer" means any insurer that has been chartered by or 9
33	33	organized or constituted within or under the laws of any jurisdiction or 10
34	34	country without the United States. 11
35	35	(3) "Annuities" means all agreements to make periodical payments 12
36	36	where the making or continuance of all or some of the series of the 13 Raised Bill No. 5247
37	37
38	38
39	39
40	40	LCO No. 1731 2 of 32
41	41
42	42	payments, or the amount of the payment, is dependent upon the 14
43	43	continuance of human life or is for a specified term of years. This 15
44	44	definition does not apply to payments made under a policy of life 16
45	45	insurance. 17
46	46	(4) "Commissioner" means the Insurance Commissioner. 18
47	47	(5) "Control", "controlled by" or "under common control with" means 19
48	48	the possession, direct or indirect, of the power to direct or cause the 20
49	49	direction of the management and policies of a person, whether through 21
50	50	the ownership of voting securities, by contract other than a commercial 22
51	51	contract for goods or nonmanagement services, or otherwise, unless the 23
52	52	power is the result of an official position with the person. 24
53	53	(6) "Domestic insurer" means any insurer that has been chartered by, 25
54	54	incorporated, organized or constituted within or under the laws of this 26
55	55	state. 27
56	56	(7) "Domestic surplus lines insurer" means any domestic insurer that 28
57	57	has been authorized by the commissioner to write surplus lines 29
58	58	insurance. 30
59	59	(8) "Foreign country" means any jurisdiction not in any state, district 31
60	60	or territory of the United States. 32
61	61	(9) "Foreign insurer" means any insurer that has been chartered by or 33
62	62	organized or constituted within or under the laws of another state or a 34
63	63	territory of the United States. 35
64	64	(10) "Insolvency" or "insolvent" means, for any insurer, that it is 36
65	65	unable to pay its obligations when they are due, or when its admitted 37
66	66	assets do not exceed its liabilities plus the greater of: (A) Capital and 38
67	67	surplus required by law for its organization and continued operation; 39
68	68	or (B) the total par or stated value of its authorized and issued capital 40
69	69	stock. For purposes of this subdivision "liabilities" shall include but not 41
70	70	be limited to reserves required by statute or by regulations adopted by 42
71	71	the commissioner in accordance with the provisions of chapter 54 or 43 Raised Bill No. 5247
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73	73
74	74
75	75	LCO No. 1731 3 of 32
76	76
77	77	specific requirements imposed by the commissioner upon a subject 44
78	78	company at the time of admission or subsequent thereto. 45
79	79	(11) "Insurance" means any agreement to pay a sum of money, 46
80	80	provide services or any other thing of value on the happening of a 47
81	81	particular event or contingency or to provide indemnity for loss in 48
82	82	respect to a specified subject by specified perils in return for a 49
83	83	consideration. In any contract of insurance, an insured shall have an 50
84	84	interest which is subject to a risk of loss through destruction or 51
85	85	impairment of that interest, which risk is assumed by the insurer and 52
86	86	such assumption shall be part of a general scheme to distribute losses 53
87	87	among a large group of persons bearing similar risks in return for a 54
88	88	ratable contribution or other consideration. 55
89	89	(12) "Insurer" or "insurance company" includes any person or 56
90	90	combination of persons doing any kind or form of insurance business 57
91	91	other than a fraternal benefit society, and shall include a receiver of any 58
92	92	insurer when the context reasonably permits. 59
93	93	(13) "Insured" means a person to whom or for whose benefit an 60
94	94	insurer makes a promise in an insurance policy. The term includes 61
95	95	policyholders, subscribers, members and beneficiaries. This definition 62
96	96	applies only to the provisions of this title and does not define the 63
97	97	meaning of this word as used in insurance policies or certificates. 64
98	98	(14) "Life insurance" means insurance on human lives and insurances 65
99	99	pertaining to or connected with human life. The business of life 66
100	100	insurance includes granting endowment benefits, granting additional 67
101	101	benefits in the event of death by accident or accidental means, granting 68
102	102	additional benefits in the event of the total and permanent disability of 69
103	103	the insured, and providing optional methods of settlement of proceeds. 70
104	104	Life insurance includes burial contracts to the extent provided by 71
105	105	section 38a-464. 72
106	106	(15) "Mutual insurer" means any insurer without capital stock, the 73
107	107	managing directors or officers of which are elected by its members. 74 Raised Bill No. 5247
108	108
109	109
110	110
111	111	LCO No. 1731 4 of 32
112	112
113	113	(16) "Person" means an individual, a corporation, a partnership, a 75
114	114	limited liability company, an association, a joint stock company, a 76
115	115	business trust, an unincorporated organization or other legal entity. 77
116	116	(17) "Policy" means any document, including attached endorsements 78
117	117	and riders, purporting to be an enforceable contract, which 79
118	118	memorializes in writing some or all of the terms of an insurance 80
119	119	contract. 81
120	120	(18) "State" means any state, district, or territory of the United States. 82
121	121	(19) "Subsidiary" of a specified person means an affiliate controlled 83
122	122	by the person directly, or indirectly through one or more intermediaries. 84
123	123	(20) "Unauthorized insurer" or "nonadmitted insurer" means an 85
124	124	insurer that has not been granted a certificate of authority by the 86
125	125	commissioner to transact the business of insurance in this state or an 87
126	126	insurer transacting business not authorized by a valid certificate. 88
127	127	(21) "United States" means the United States of America, its territories 89
128	128	and possessions, the Commonwealth of Puerto Rico and the District of 90
129	129	Columbia. 91
130	130	Sec. 2. (NEW) (Effective October 1, 2024) For the purposes of this 92
131	131	section and section 3 of this act: 93
132	132	(1) "Actuarial value" means a level of coverage provided by a health 94
133	133	plan design that is offered as a percentage of the full value of the benefits 95
134	134	provided under such plan; 96
135	135	(2) "Commercial domicile" means the headquarters of a trade or 97
136	136	business that is the place from which such trade or business is 98
137	137	principally managed and directed; 99
138	138	(3) "Employer member" means an entity domiciled in this state or that 100
139	139	maintains such entity's commercial domicile in this state, is a member 101
140	140	of a sponsoring association and employs more than one individual in 102
141	141	this state. "Employer member" may include such employer member's 103 Raised Bill No. 5247
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143	143
144	144
145	145	LCO No. 1731 5 of 32
146	146
147	147	sponsoring association, provided such sponsoring association is 104
148	148	domiciled in this state and employs more than one individual in this 105
149	149	state; 106
150	150	(4) "ERISA" means the Employee Retirement Income Security Act of 107
151	151	1974, as amended from time to time; 108
152	152	(5) "Health benefit plan" means a contract, certificate or agreement 109
153	153	offered, delivered, issued for delivery, renewed, amended or continued 110
154	154	in this state by a self-funded multiple employer welfare arrangement 111
155	155	trust to provide, deliver, arrange for, pay for or reimburse any of the 112
156	156	costs of the diagnosis, prevention, treatment, cure or relief of a health 113
157	157	condition, illness, injury or disease. "Health benefit plan" does not 114
158	158	include insurance products; 115
159	159	(6) "Health enhancement program" has the same meaning as 116
160	160	provided in section 38a- 477ll of the general statutes; 117
161	161	(7) "Participating employee" means any employee of a participating 118
162	162	employer that enrolls in a health benefit plan offered by a self-funded 119
163	163	multiple employer welfare arrangement trust; 120
164	164	(8) "Participating employer" means any employer member that 121
165	165	participates in a self-funded multiple employer welfare arrangement; 122
166	166	(9) "Preexisting conditions provision" has the same meaning as 123
167	167	provided in section 38a-476 of the general statutes; 124
168	168	(10) "Self-funded multiple employer welfare arrangement" means a 125
169	169	program established or maintained on behalf of employer members and 126
170	170	offered by a self-funded multiple employer welfare arrangement trust 127
171	171	for the purpose of providing one or more health benefit plans for such 128
172	172	employer member's employees and such employees' dependents; 129
173	173	(11) "Self-funded multiple employer welfare arrangement trust" 130
174	174	means any trust established by a sponsoring association in accordance 131
175	175	with subsection (e) of section 3 of this act; 132 Raised Bill No. 5247
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177	177
178	178
179	179	LCO No. 1731 6 of 32
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181	181	(12) "Sponsoring association" means any industry trade group or any 133
182	182	other trade group with employer members representing multiple trades 134
183	183	domiciled in this state that (A) is organized and has a written 135
184	184	constitution or bylaws, (B) has not less than five hundred employees of 136
185	185	not less than twenty-five employer members, and (C) has been 137
186	186	maintained in good faith for not less than the immediately preceding 138
187	187	five years for purposes other than obtaining or providing insurance; and 139
188	188	(13) "Value-based health benefit plan design" means any material 140
189	189	term in a health benefit plan that is designed to increase the quality of 141
190	190	covered benefits or health care services while reducing the cost of such 142
191	191	health benefit plan or health care services. 143
192	192	Sec. 3. (NEW) (Effective October 1, 2024) (a) No person, other than a 144
193	193	self-funded multiple employer welfare arrangement trust, shall 145
194	194	establish or operate a self-funded multiple employer welfare 146
195	195	arrangement in this state. 147
196	196	(b) Any self-funded multiple employer welfare arrangement trust, 148
197	197	prior to establishing a self-funded multiple employer welfare 149
198	198	arrangement in this state, shall apply for and obtain a license from the 150
199	199	commissioner. The commissioner shall issue a license to such self-151
200	200	funded multiple employer welfare arrangement trust, provided such 152
201	201	trust satisfies all licensing requirements applicable to a health insurance 153
202	202	company pursuant to chapter 698 of the general statutes. Upon the 154
203	203	issuance of a license by the commissioner to a self-funded multiple 155
204	204	employer welfare arrangement trust, in accordance with the provisions 156
205	205	of this subsection, such trust shall comply with all requirements 157
206	206	applicable to health insurance companies set forth in title 38a of the 158
207	207	general statutes, and any regulations adopted by the commissioner, in 159
208	208	accordance with the provisions of chapter 54 of the general statutes. 160
209	209	(c) (1) The commissioner shall not issue a license to a self-funded 161
210	210	multiple employer welfare arrangement trust pursuant to subsection (b) 162
211	211	of this section, unless such trust has an initial combined capital and 163
212	212	surplus of not less than four million dollars. 164 Raised Bill No. 5247
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214	214
215	215
216	216	LCO No. 1731 7 of 32
217	217
218	218	(2) Beginning on April 1, 2025, any self-funded multiple employer 165
219	219	welfare arrangement trust that meets the licensing requirements 166
220	220	pursuant to subdivision (1) of this subsection and subsection (b) of this 167
221	221	section may offer a health benefit plan to participating employees of one 168
222	222	or more participating employers. 169
223	223	(d) Any health benefit plan issued by a self-funded multiple 170
224	224	employer welfare arrangement trust that covers participating 171
225	225	employees of one or more participating employers shall: 172
226	226	(1) Provide coverage for (A) essential health benefits as defined in the 173
227	227	Patient Protection and Affordable Care Act, P.L. 111-148, as amended 174
228	228	from time to time, or regulations adopted thereunder, and (B) the group 175
229	229	state-mandated coverage requirements under chapter 700c of the 176
230	230	general statutes; 177
231	231	(2) Offer to each participating employer health benefit plans with a 178
232	232	minimum level of coverage designed to provide health benefits that are 179
233	233	actuarially equivalent, respectively, to not less than sixty per cent, not 180
234	234	less than sixty-eight per cent and not less than seventy-eight per cent of 181
235	235	the full actuarial value of the benefits provided under each health 182
236	236	benefit plan; 183
237	237	(3) Not limit or exclude coverage for any individual by imposing a 184
238	238	preexisting conditions provision on such individual; 185
239	239	(4) Not establish discriminatory rules based on the health status of an 186
240	240	individual related to health benefit plan eligibility, or rate or 187
241	241	contribution requirements; 188
242	242	(5) Establish base rates formed on an actuarially sound, modified 189
243	243	community rating methodology that considers the pooling of all 190
244	244	participating employees' claims; 191
245	245	(6) Utilize each participating employer's risk profile to determine 192
246	246	rates by actuarially adjusting above or below established base rates, and 193
247	247	utilize pooling or reinsurance of individual large claims to reduce the 194 Raised Bill No. 5247
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249	249
250	250
251	251	LCO No. 1731 8 of 32
252	252
253	253	adverse impact on any specific participating employer's rates. The self-195
254	254	funded multiple employer welfare arrangement trust shall establish the 196
255	255	applicable pooling point, which shall consistently apply to all such 197
256	256	participating employers; 198
257	257	(7) Utilize actuarially sound underwriting methodologies for pricing 199
258	258	and renewing health benefit plans for participating employers; 200
259	259	(8) Adopt and maintain underwriting guidelines for evaluating 201
260	260	applicants and accepting such applicants as new participating 202
261	261	employers; 203
262	262	(9) Adopt and maintain renewal methodologies, which may be 204
263	263	reviewed by the commissioner; 205
264	264	(10) Use surplus in excess of an amount to be determined by the 206
265	265	commissioner on an annual basis, to reduce health benefit plan 207
266	266	contribution amounts paid by participating employers and 208
267	267	participating employees; 209
268	268	(11) Make any health benefit plan available to all participating 210
269	269	employers regardless of any factor relating to the health status of such 211
270	270	participating employer or individuals eligible for coverage through any 212
271	271	participating employer; 213
272	272	(12) (A) Implement value-based health benefit plan design and value-214
273	273	based contracting by administering programs, which may include, but 215
274	274	need not be limited to, centers of excellence, wellness programs, health 216
275	275	enhancement programs, alternative payment models, chronic disease 217
276	276	navigation and patient-centered medical homes. (B) Beginning on 218
277	277	August 1, 2025, each self-funded multiple employer welfare 219
278	278	arrangement trust shall annually report, on a form provided by the 220
279	279	Insurance Commissioner, such implementation of value-based health 221
280	280	benefit plan design and value-based contracting pursuant to this 222
281	281	subdivision. Such report to the Insurance Commissioner shall include 223
282	282	the following: (i) A description of such value-based health benefit plan 224
283	283	design and value-based contracting programs; (ii) the number of 225 Raised Bill No. 5247
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285	285
286	286
287	287	LCO No. 1731 9 of 32
288	288
289	289	participating employees enrolled in such value-based health benefit 226
290	290	plan design and value-based contracting programs; (iii) the percentage 227
291	291	of dollars spent on such value-based health benefit plan design and 228
292	292	value-based contracting programs; and (iv) a description that explains 229
293	293	how such value-based health benefit plan design and value-based 230
294	294	contracting programs lower costs for participating employees enrolled 231
295	295	in such programs; and 232
296	296	(13) With regard to participating employees, comply with the 233
297	297	notification requirements set forth in sections 38a-591c to 38a-591g, 234
298	298	inclusive, of the general statutes with respect to utilization review and 235
299	299	benefit determinations of a benefit request or claim. 236
300	300	(e) A sponsoring association shall form a self-funded multiple 237
301	301	employer welfare arrangement trust that shall establish, maintain and 238
302	302	offer health benefit plans for the self-funded multiple employer welfare 239
303	303	arrangement. Such trust shall be authorized to sell health benefit plans 240
304	304	to participating employers exclusively through insurance producers 241
305	305	licensed in accordance with chapter 702 of the general statutes, provided 242
306	306	such trust meets the following conditions: 243
307	307	(1) The self-funded multiple employer welfare arrangement trust 244
308	308	shall be subject to ERISA and any regulations or standards prescribed 245
309	309	by the United States Department of Labor pertaining to multiple 246
310	310	employer welfare arrangements; 247
311	311	(2) A Form M-1 shall be filed each year by such trust with the United 248
312	312	States Department of Labor. For purposes of this subdivision, "Form M-249
313	313	1" means an annual report required by the United States Department of 250
314	314	Labor for multiple employer welfare arrangements that includes, but is 251
315	315	not limited to, the following: (A) Identification of the sponsoring 252
316	316	association and the self-funded multiple employer welfare arrangement 253
317	317	trust; and (B) a description of the health benefit plans offered through 254
318	318	such self-funded multiple employer welfare arrangement trust; 255
319	319	(3) Any organizational documents for a self-funded multiple 256
320	320	employer welfare arrangement trust shall: 257 Raised Bill No. 5247
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323	323
324	324	LCO No. 1731 10 of 32
325	325
326	326	(A) State that such self-funded multiple employer welfare 258
327	327	arrangement trust is sponsored by the sponsoring association; 259
328	328	(B) State that the purpose of such self-funded multiple employer 260
329	329	welfare arrangement trust is to provide health benefit plans to eligible 261
330	330	employers; 262
331	331	(C) Provide that self-funded multiple employer welfare arrangement 263
332	332	trust funds shall be used for the benefit of eligible employers through (i) 264
333	333	self-funding of claims or the purchase of reinsurance, or any 265
334	334	combination thereof, and (ii) defraying the costs and expenses of 266
335	335	administering and operating such self-funded multiple employer 267
336	336	welfare arrangement trust and any health benefit plan issued by such 268
337	337	trust; 269
338	338	(D) Limit participation in any health benefit plan to eligible 270
339	339	employers; 271
340	340	(E) Establish and maintain a board of trustees, composed of not less 272
341	341	than five trustees, that shall have fiscal control over such self-funded 273
342	342	multiple employer welfare arrangement trust for the purpose of 274
343	343	managing all health benefit plans established, maintained and offered 275
344	344	by such self-funded multiple employer welfare arrangement trust. Any 276
345	345	board of trustees shall have the authority to contract with any licensed 277
346	346	administrator or service company to administer the daily operations of 278
347	347	the health benefit plans; 279
348	348	(F) Implement a process for the election of trustees to the board of 280
349	349	trustees; and 281
350	350	(G) Require each trustee to discharge such trustee's duties in 282
351	351	accordance with generally accepted fiduciary standards; 283
352	352	(4) The self-funded multiple employer welfare arrangement trust 284
353	353	shall establish and maintain reserves in accordance with any financial 285
354	354	and solvency requirements applicable to health insurance companies set 286
355	355	forth in title 38a of the general statutes, and any regulations adopted by 287 Raised Bill No. 5247
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357	357
358	358
359	359	LCO No. 1731 11 of 32
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361	361	the commissioner, in accordance with the provisions of chapter 54 of the 288
362	362	general statutes; 289
363	363	(5) The self-funded multiple employer welfare arrangement trust 290
364	364	shall purchase and maintain an insurance policy providing coverage for 291
365	365	stop-loss insurance for each health benefit plan with retention levels 292
366	366	determined in accordance with actuarial principles from insurers 293
367	367	licensed to transact the business of insurance in this state; 294
368	368	(6) The self-funded multiple employer welfare arrangement trust 295
369	369	shall purchase and maintain an aggregate stop-loss insurance policy 296
370	370	with an attachment point equal to one hundred twenty-five per cent of 297
371	371	losses. The self-funded multiple employer welfare arrangement trust 298
372	372	may submit a written request to the commissioner to modify the 299
373	373	aggregate stop-loss policy. Not later than thirty calendar days after the 300
374	374	commissioner receives such request, the commissioner shall issue a 301
375	375	decision granting or denying such request; 302
376	376	(7) The self-funded multiple employer welfare arrangement trust 303
377	377	shall purchase and maintain commercially reasonable fiduciary liability 304
378	378	insurance from insurers licensed to transact the business of insurance in 305
379	379	this state; 306
380	380	(8) The self-funded multiple employer welfare arrangement trust 307
381	381	shall purchase and maintain commercially reasonable directors' and 308
382	382	officers' liability insurance from insurers licensed to transact the 309
383	383	business of insurance in this state; 310
384	384	(9) The self-funded multiple employer welfare arrangement trust 311
385	385	shall purchase and maintain a bond in an amount and form approved 312
386	386	by the commissioner; and 313
387	387	(10) No self-funded multiple employer welfare arrangement trust 314
388	388	shall include in its name the words "insurance", "insurer", "underwriter", 315
389	389	"mutual" or any other word or term or combination of words or terms 316
390	390	that is descriptive of an insurance company or insurance business, 317
391	391	unless the context of such words or terms indicates that such self-funded 318 Raised Bill No. 5247
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393	393
394	394
395	395	LCO No. 1731 12 of 32
396	396
397	397	multiple employer welfare arrangement trust is not an insurance 319
398	398	company and is not transacting the business of insurance. 320
399	399	(f) Any board of trustees established pursuant to subsection (e) of this 321
400	400	section shall: 322
401	401	(1) Operate any health benefit plan in accordance with the fiduciary 323
402	402	standards set forth in the Consolidated Appropriations Act of 2021, P.L. 324
403	403	116-260, as amended from time to time, and all other generally accepted 325
404	404	fiduciary standards; 326
405	405	(2) Pay all costs assessed by the commissioner in accordance with title 327
406	406	38a of the general statutes. Such board of trustees shall have the 328
407	407	authority to collect fees on a pro rata basis from the participating 329
408	408	employers. No self-funded multiple employer welfare arrangement 330
409	409	trust shall be subject to (A) the health and welfare fee required under 331
410	410	section 19a-7j of the general statutes, (B) the public health fee required 332
411	411	under section 19a-7p of the general statutes, (C) any payment required 333
412	412	under section 38a-48 of the general statutes, or (D) the premium tax 334
413	413	required under section 12-202 of the general statutes. 335
414	414	(g) Each participating employer shall be (1) liable for such 336
415	415	participating employer's allocated share of the liabilities arising under a 337
416	416	health benefit plan provided by the self-funded multiple employer 338
417	417	welfare arrangement trust, as determined by the board of trustees, and 339
418	418	(2) jointly and severally liable for additional amounts if the annual 340
419	419	health benefit plan subscription amounts paid by all participating 341
420	420	employers of such plan result in a deficit of funds for the self-funded 342
421	421	multiple employer welfare arrangement trust. Each participating 343
422	422	employer's liability under this subsection shall not be assessed to 344
423	423	participating employees of such participating employer. 345
424	424	(h) Health benefit plan documents issued by any self-funded multiple 346
425	425	employer welfare arrangement trust to participating employers shall 347
426	426	have the following statement printed on the first page in fourteen-point 348
427	427	boldface type: "This health benefit plan is provided by a trust 349
428	428	established to provide health benefit plans to employees of employers 350 Raised Bill No. 5247
429	429
430	430
431	431
432	432	LCO No. 1731 13 of 32
433	433
434	434	participating in a self-funded multiple employer welfare arrangement. 351
435	435	This health benefit plan is not insurance and is not offered through an 352
436	436	insurance company. This health benefit plan is not required to comply 353
437	437	with certain federal market requirements for health insurance, and is 354
438	438	not required to comply with certain state laws for health insurance. Each 355
439	439	participating employer shall be liable for such participating employer's 356
440	440	allocated share of the liabilities of the trust under all health benefit plans 357
441	441	offered by the trust, as determined by the board of trustees. Each 358
442	442	participating employer shall be jointly and severally liable for additional 359
443	443	amounts if the annual health benefit plan subscription amounts paid by 360
444	444	all participating employers and participating employees of such 361
445	445	participating employer result in a deficit of funds for the trust and for 362
446	446	any assessments by state regulators. The trust's financial statements 363
447	447	shall be made available upon request by any participating employer in 364
448	448	the self-funded multiple employer welfare arrangement.". 365
449	449	(i) Health benefit plan documents issued by any self-funded multiple 366
450	450	employer welfare arrangement trust to participating employees shall 367
451	451	have the following statement printed on the first page in fourteen-point 368
452	452	boldface type: "This health benefit plan is provided by a trust 369
453	453	established to provide health benefit plans to employees of employers 370
454	454	participating in a self-funded multiple employer welfare arrangement, 371
455	455	including your employer. This health benefit plan is not insurance and 372
456	456	is not offered through an insurance company. This health benefit plan is 373
457	457	not required to comply with certain federal market requirements for 374
458	458	health insurance, and is not required to comply with certain state laws 375
459	459	for health insurance. Your employer shall be liable for such employer's 376
460	460	allocated share of the liabilities of the trust under all health benefit plans 377
461	461	offered by the trust, as determined by the board of trustees. Your 378
462	462	employer shall be jointly and severally liable for additional amounts if 379
463	463	the annual health benefit plan subscription amounts paid by all 380
464	464	participating employers and participating employees of such 381
465	465	participating employer result in a deficit of funds for the trust and for 382
466	466	any assessments by state regulators. The trust's financial statements 383
467	467	shall be made available to you upon request. The Consumer Affairs 384 Raised Bill No. 5247
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469	469
470	470
471	471	LCO No. 1731 14 of 32
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473	473	Division within the Insurance Department is available to assist you with 385
474	474	questions that you may have concerning this health benefit plan.". The 386
475	475	notice shall include the telephone number and electronic mail address 387
476	476	for the Consumer Affairs Division. 388
477	477	(j) No self-funded multiple employer welfare arrangement trust shall 389
478	478	be subject to the Connecticut Insurance Guaranty Association pursuant 390
479	479	to sections 38a-836 to 38a-853, inclusive, of the general statutes. 391
480	480	(k) The commissioner may adopt regulations, in accordance with the 392
481	481	provisions of chapter 54 of the general statutes, to implement the 393
482	482	provisions of this section. 394
483	483	Sec. 4. Section 38a-567 of the general statutes is repealed and the 395
484	484	following is substituted in lieu thereof (Effective April 1, 2025): 396
485	485	Health insurance plans, associations of small employers and other 397
486	486	insurance arrangements covering small employers and insurers and 398
487	487	producers marketing such plans and arrangements shall be subject to 399
488	488	the following provisions: 400
489	489	(1) (A) Any such plan or arrangement shall be offered on a 401
490	490	guaranteed issue basis with respect to all eligible [employees or 402
491	491	dependents of such employees] employees, at the option of the small 403
492	492	employer, policyholder or contractholder, as the case may be. 404
493	493	(B) Any such plan or arrangement shall be renewable with respect to 405
494	494	all eligible employees, [or dependents at the option of the small 406
495	495	employer, policyholder or contractholder, as the case may be,] except: 407
496	496	(i) For nonpayment of the required premiums by the small employer, 408
497	497	policyholder or contractholder; (ii) for fraud or misrepresentation of the 409
498	498	small employer, policyholder or contractholder or, with respect to 410
499	499	coverage of individual insured, the insureds or their representatives; 411
500	500	(iii) for noncompliance with plan or arrangement provisions; (iv) when 412
501	501	the number of insureds covered under the plan or arrangement is less 413
502	502	than the number of insureds or percentage of insureds required by 414
503	503	participation requirements under the plan or arrangement; or (v) when 415 Raised Bill No. 5247
504	504
505	505
506	506
507	507	LCO No. 1731 15 of 32
508	508
509	509	the small employer, policyholder or contractholder is no longer actively 416
510	510	engaged in the business in which it was engaged on the effective date of 417
511	511	the plan or arrangement. 418
512	512	(C) Renewability of coverage may be effected by either continuing in 419
513	513	effect a plan or arrangement covering a small employer or by 420
514	514	substituting upon renewal for the prior plan or arrangement the plan or 421
515	515	arrangement then offered by the carrier that most closely corresponds 422
516	516	to the prior plan or arrangement and is available to other small 423
517	517	employers. Such substitution shall only be made under conditions 424
518	518	approved by the commissioner. A carrier may substitute a plan or 425
519	519	arrangement as set forth in this subparagraph only if the carrier effects 426
520	520	the same substitution upon renewal for all small employers previously 427
521	521	covered under the particular plan or arrangement, unless otherwise 428
522	522	approved by the commissioner. The substitute plan or arrangement 429
523	523	shall be subject to the rating restrictions specified in this section on the 430
524	524	same basis as if no substitution had occurred, except for an adjustment 431
525	525	based on coverage differences. 432
526	526	(D) Any such plan or arrangement shall provide special enrollment 433
527	527	periods (i) to all eligible employees or dependents as set forth in 45 CFR 434
528	528	147.104, as amended from time to time, and (ii) for coverage under such 435
529	529	plan or arrangement ordered by a court for a spouse or minor child of 436
530	530	an eligible employee where request for enrollment is made not later than 437
531	531	thirty days after the issuance of such court order. 438
532	532	(2) (A) As used in this subdivision, "grandfathered plan" has the same 439
533	533	meaning as "grandfathered health plan" as provided in the Patient 440
534	534	Protection and Affordable Care Act, P.L. 111-148, as amended from time 441
535	535	to time. 442
536	536	(B) With respect to grandfathered plans issued to small employers, 443
537	537	except as a member of an association of small employers, the premium 444
538	538	rates charged or offered shall be established on the basis of a single pool 445
539	539	of all grandfathered plans, adjusted to reflect one or more of the 446
540	540	following classifications: 447 Raised Bill No. 5247
541	541
542	542
543	543
544	544	LCO No. 1731 16 of 32
545	545
546	546	(i) Age, provided age brackets of less than five years shall not be 448
547	547	utilized; 449
548	548	(ii) Gender; 450
549	549	(iii) Geographic area, provided an area smaller than a county shall 451
550	550	not be utilized; 452
551	551	(iv) Industry, provided the rate factor associated with any industry 453
552	552	classification shall not vary from the arithmetic average of the highest 454
553	553	and lowest rate factors associated with all industry classifications by 455
554	554	greater than fifteen per cent of such average, and provided further, the 456
555	555	rate factors associated with any industry shall not be increased by more 457
556	556	than five per cent per year; 458
557	557	(v) Group size, provided the highest rate factor associated with group 459
558	558	size shall not vary from the lowest rate factor associated with group size 460
559	559	by a ratio of greater than 1.25 to 1.0; 461
560	560	(vi) Administrative cost savings resulting from the administration of 462
561	561	an association group plan or a plan written pursuant to section 5-259, 463
562	562	provided the savings reflect a reduction to the small employer carrier's 464
563	563	overall retention that is measurable and specifically realized on items 465
564	564	such as marketing, billing or claims paying functions taken on directly 466
565	565	by the plan administrator or association, except that such savings may 467
566	566	not reflect a reduction realized on commissions; 468
567	567	(vii) Savings resulting from a reduction in the profit of a carrier that 469
568	568	writes small business plans or arrangements for an association group 470
569	569	plan or a plan written pursuant to section 5-259, provided any loss in 471
570	570	overall revenue due to a reduction in profit is not shifted to other small 472
571	571	employers; and 473
572	572	(viii) Family composition, provided the small employer carrier shall 474
573	573	utilize only one or more of the following billing classifications: (I) 475
574	574	Employee; (II) employee plus family; (III) employee and spouse; (IV) 476
575	575	employee and child; (V) employee plus one dependent; and (VI) 477 Raised Bill No. 5247
576	576
577	577
578	578
579	579	LCO No. 1731 17 of 32
580	580
581	581	employee plus two or more dependents. 478
582	582	(C) (i) With respect to nongrandfathered plans issued to small 479
583	583	employers, except as a member of an association of small employers, the 480
584	584	premium rates charged or offered shall be established on the basis of a 481
585	585	single pool of all nongrandfathered plans, adjusted to reflect one or 482
586	586	more of the following classifications: 483
587	587	(I) Age, in accordance with a uniform age rating curve established by 484
588	588	the commissioner; or 485
589	589	(II) Geographic area, as defined by the commissioner. 486
590	590	(ii) Total premium rates for family coverage for nongrandfathered 487
591	591	plans shall be determined by adding the premiums for each individual 488
592	592	family member, except that with respect to family members under 489
593	593	twenty-one years of age, the premiums for only the three oldest covered 490
594	594	children shall be taken into account in determining the total premium 491
595	595	rate for such family. 492
596	596	(iii) Premium rates for employees and dependents for 493
597	597	nongrandfathered plans shall be calculated for each covered individual 494
598	598	and premium rates for the small employer group shall be calculated by 495
599	599	totaling the premiums attributable to each covered individual. 496
600	600	(iv) Premium rates for any given plan may vary by (I) actuarially 497
601	601	justified differences in plan design, and (II) actuarially justified amounts 498
602	602	to reflect the policy's provider network and administrative expense 499
603	603	differences that can be reasonably allocated to such policy. 500
604	604	(3) No small employer carrier or producer shall, directly or indirectly, 501
605	605	engage in the following activities: 502
606	606	(A) Encouraging or directing small employers to refrain from filing 503
607	607	an application for coverage with the small employer carrier because of 504
608	608	the health status, claims experience, industry, occupation or geographic 505
609	609	location of the small employer, except the provisions of this 506
610	610	subparagraph shall not apply to information provided by a small 507 Raised Bill No. 5247
611	611
612	612
613	613
614	614	LCO No. 1731 18 of 32
615	615
616	616	employer carrier or producer to a small employer regarding the carrier's 508
617	617	established geographic service area or a restricted network provision of 509
618	618	a small employer carrier; or 510
619	619	(B) Encouraging or directing small employers to seek coverage from 511
620	620	another carrier because of the health status, claims experience, industry, 512
621	621	occupation or geographic location of the small employer. 513
622	622	(4) No small employer carrier shall, directly or indirectly, enter into 514
623	623	any contract, agreement or arrangement with a producer that provides 515
624	624	for or results in the compensation paid to a producer for the sale of a 516
625	625	health benefit plan to be varied because of the health status, claims 517
626	626	experience, industry, occupation or geographic area of the small 518
627	627	employer. A small employer carrier shall provide reasonable 519
628	628	compensation, as provided under the plan of operation of the program, 520
629	629	to a producer, if any, for the sale of a health care plan. No small 521
630	630	employer carrier shall terminate, fail to renew or limit its contract or 522
631	631	agreement of representation with a producer for any reason related to 523
632	632	the health status, claims experience, occupation, or geographic location 524
633	633	of the small employers placed by the producer with the small employer 525
634	634	carrier. 526
635	635	(5) No small employer carrier or producer shall induce or otherwise 527
636	636	encourage a small employer to separate or otherwise exclude an 528
637	637	employee from health coverage or benefits provided in connection with 529
638	638	the employee's employment. 530
639	639	(6) No small employer carrier or producer shall disclose (A) to a small 531
640	640	employer the fact that any or all of the eligible employees of such small 532
641	641	employer have been or will be reinsured with the pool, or (B) to any 533
642	642	eligible employee or dependent the fact that he has been or will be 534
643	643	reinsured with the pool. 535
644	644	(7) If a small employer carrier enters into a contract, agreement or 536
645	645	other arrangement with another party to provide administrative, 537
646	646	marketing or other services related to the offering of health benefit plans 538
647	647	to small employers in this state, the other party shall be subject to the 539 Raised Bill No. 5247
648	648
649	649
650	650
651	651	LCO No. 1731 19 of 32
652	652
653	653	provisions of this section. 540
654	654	(8) The commissioner may adopt regulations, in accordance with the 541
655	655	provisions of chapter 54, setting forth additional standards to provide 542
656	656	for the fair marketing and broad availability of health benefit plans to 543
657	657	small employers. 544
658	658	(9) Any violation of subdivisions (3) to (7), inclusive, of this section 545
659	659	and of any regulations established under subdivision (8) of this section 546
660	660	shall be an unfair and prohibited practice under sections 38a-815 to 38a-547
661	661	830, inclusive. 548
662	662	Sec. 5. Subsection (a) of section 38a-9 of the general statutes is 549
663	663	repealed and the following is substituted in lieu thereof (Effective October 550
664	664	1, 2024): 551
665	665	(a) Notwithstanding the provisions of section 4-8, there shall be a 552
666	666	Division of Consumer Affairs within the Insurance Department, which 553
667	667	division shall act on the Insurance Commissioner's behalf and at his 554
668	668	direction in order to carry out his responsibilities under this title with 555
669	669	respect to such matters. The division shall receive and review 556
670	670	complaints from residents of this state concerning their insurance 557
671	671	problems and problems arising out of health benefit plans, as defined in 558
672	672	section 2 of this act, including claims disputes, and serve as a mediator 559
673	673	in such disputes in order to assist the commissioner in determining 560
674	674	whether statutory requirements and contractual obligations within the 561
675	675	commissioner's jurisdiction have been fulfilled. There shall be a director 562
676	676	of said division, who shall be provided with sufficient staff. The division 563
677	677	shall serve to coordinate all appropriate facilities in the department in 564
678	678	addressing such complaints, and conduct any outreach programs 565
679	679	deemed necessary to properly inform and educate the public on 566
680	680	insurance matters. The director shall submit quarterly reports to the 567
681	681	commissioner, which shall state the number of complaints received by 568
682	682	the division in such calendar quarter, the Connecticut premium or 569
683	683	premium equivalent volume of the appropriate line of each insurance 570
684	684	company or multiple employer welfare arrangement trust, as defined in 571 Raised Bill No. 5247
685	685
686	686
687	687
688	688	LCO No. 1731 20 of 32
689	689
690	690	section 2 of this act, against which a complaint has been filed, the types 572
691	691	of complaints received, and the number of such complaints which have 573
692	692	been resolved. Such reports shall be published every six months and 574
693	693	copies shall be made available to any interested resident of this state 575
694	694	upon request. The commissioner shall report, in accordance with section 576
695	695	11-4a, to the joint standing committee of the General Assembly having 577
696	696	cognizance of matters relating to insurance on or before January 578
697	697	fifteenth annually, concerning the findings of such reports and 579
698	698	suggestions for legislative initiatives to address recurring problems. 580
699	699	Sec. 6. Section 38a-14 of the general statutes is repealed and the 581
700	700	following is substituted in lieu thereof (Effective October 1, 2024): 582
701	701	(a) For the purposes of this section, "company" means any insurance 583
702	702	company, multiple employer welfare arrangement trust, as defined in 584
703	703	section 2 of this act, or health care center doing business in this state, any 585
704	704	corporation or association collecting data utilized by any such insurance 586
705	705	company in the underwriting of insurance policies and any corporation 587
706	706	organized under any law of this state or having an office in this state, 588
707	707	which corporation is engaged in, or claiming or advertising that it is 589
708	708	engaged in, organizing or receiving subscriptions for or disposing of 590
709	709	stock of, or in any manner aiding or taking part in the formation or 591
710	710	business of, an insurance company or companies, or that is holding the 592
711	711	capital stock of one or more insurance corporations for the purpose of 593
712	712	controlling the management thereof, as voting trustees or otherwise. 594
713	713	(b) The commissioner shall, as often as the commissioner deems it 595
714	714	expedient, examine into the affairs of any company. In scheduling and 596
715	715	determining the nature, scope and frequency of the examinations, the 597
716	716	commissioner shall consider such matters as the results of financial 598
717	717	statement analyses and ratios, changes in management or ownership, 599
718	718	actuarial opinions, reports of independent certified public accountants 600
719	719	and such other criteria as set forth in the examiners' handbook adopted 601
720	720	by the National Association of Insurance Commissioners and in effect 602
721	721	at the time the commissioner exercises discretion under this section. 603 Raised Bill No. 5247
722	722
723	723
724	724
725	725	LCO No. 1731 21 of 32
726	726
727	727	(c) (1) To carry out examinations under this section, the commissioner 604
728	728	may appoint one or more competent persons as examiners, who shall 605
729	729	not be officers of, connected with or interested in any company, other 606
730	730	than as policyholders. The commissioner may engage the services of 607
731	731	attorneys, appraisers, independent actuaries, independent certified 608
732	732	public accountants or other professionals and specialists as examiners 609
733	733	to assist the commissioner in conducting the examinations under this 610
734	734	section, the cost of which shall be borne by the company that is the 611
735	735	subject of the examination. 612
736	736	(2) In conducting the examination, the commissioner, the 613
737	737	commissioner's actuary or any examiner authorized by the 614
738	738	commissioner may examine, under oath, the officers and agents of such 615
739	739	a company, and all persons deemed to have material information 616
740	740	regarding the company's property or business. Each such company or 617
741	741	its officers and agents shall produce the books and papers in its or their 618
742	742	possession, relating to its business or affairs, and any other person may 619
743	743	be required to produce any book or paper in such person's custody that 620
744	744	is deemed to be relevant to such examination, for inspection by the 621
745	745	commissioner, the commissioner's actuary or examiners. The officers 622
746	746	and agents of the company shall facilitate the examination and aid the 623
747	747	examiners in making the same so far as it is in their power to do so. The 624
748	748	refusal of any company, by its officers, directors, employees or agents, 625
749	749	to submit to examination or to comply with any reasonable written 626
750	750	request of the examiners shall be grounds for suspension of, refusal of 627
751	751	or nonrenewal of any license or authority held by the company to 628
752	752	engage in an insurance or other business subject to the commissioner's 629
753	753	jurisdiction. Any such proceedings for suspension, revocation or refusal 630
754	754	of any license or authority shall be conducted pursuant to subsection (c) 631
755	755	of section 38a-41. 632
756	756	(3) In conducting the examination, the examiner shall observe those 633
757	757	guidelines and procedures set forth in the examiners' handbook 634
758	758	adopted by the National Association of Insurance Commissioners. The 635
759	759	commissioner may also adopt such other guidelines or procedures as 636
760	760	the commissioner may deem appropriate. 637 Raised Bill No. 5247
761	761
762	762
763	763
764	764	LCO No. 1731 22 of 32
765	765
766	766	(d) In lieu of an examination under this section of any foreign or alien 638
767	767	insurer licensed in this state, the commissioner may accept an 639
768	768	examination report on such insurer prepared by the insurance 640
769	769	department for the insurer's state of domicile or port-of-entry state if (1) 641
770	770	such state's insurance department was, at the time of the examination, 642
771	771	accredited under the National Association of Insurance Commissioners' 643
772	772	financial regulation standards and accreditation program, or (2) the 644
773	773	examination is performed under the supervision of an accredited 645
774	774	insurance department or with the participation of one or more 646
775	775	examiners who are employed by such an accredited state insurance 647
776	776	department and who, after a review of the examination workpapers and 648
777	777	report, state under oath that the examination was performed in a 649
778	778	manner consistent with the standards and procedures required by their 650
779	779	insurance department. 651
780	780	(e) (1) Nothing contained in this section shall be construed to limit the 652
781	781	commissioner's authority to terminate or suspend any examination in 653
782	782	order to pursue legal or regulatory action pursuant to the insurance 654
783	783	laws of this state. Findings of fact and conclusions made pursuant to any 655
784	784	examination shall be prima facie evidence in any legal or regulatory 656
785	785	action. 657
786	786	(2) Nothing contained in this section shall be construed to limit the 658
787	787	commissioner's authority in such legal or regulatory action to use and, 659
788	788	if appropriate, to make public any final or preliminary examination 660
789	789	report, any examiner or company workpapers or other documents, or 661
790	790	any other information discovered or developed during the course of any 662
791	791	examination. 663
792	792	(3) Not later than sixty days following completion of the examination, 664
793	793	the examiner in charge shall file, under oath, with the Insurance 665
794	794	Department a verified written report of examination. Upon receipt of 666
795	795	the verified report, the Insurance Department shall transmit the report 667
796	796	to the company examined, together with a notice that shall afford the 668
797	797	company examined a reasonable opportunity, not to exceed thirty days, 669
798	798	to make a written submission or rebuttal with respect to any matters 670 Raised Bill No. 5247
799	799
800	800
801	801
802	802	LCO No. 1731 23 of 32
803	803
804	804	contained in the examination report. Not later than thirty days after the 671
805	805	period allowed for the receipt of written submissions or rebuttals, the 672
806	806	commissioner shall fully consider and review the report, together with 673
807	807	any written submissions or rebuttals and any relevant portions of the 674
808	808	examiner's workpapers and enter an order: (A) Adopting the 675
809	809	examination report as filed or with modification or corrections. If the 676
810	810	examination report reveals that the company is operating in violation of 677
811	811	any law, regulation or prior order of the commissioner, the 678
812	812	commissioner may order the company to take any action the 679
813	813	commissioner considers necessary and appropriate to cure such 680
814	814	violation; (B) rejecting the examination report with directions to the 681
815	815	examiners to reopen the examination for purposes of obtaining 682
816	816	additional data, documentation or information, and refiling pursuant to 683
817	817	this subdivision; or (C) calling for an investigatory hearing with not less 684
818	818	than twenty days' notice to the company for purposes of obtaining 685
819	819	additional documentation, data, information and testimony. 686
820	820	(4) (A) The commissioner shall transmit the examination report 687
821	821	adopted pursuant to subparagraph (A) of subdivision (3) of this 688
822	822	subsection or a summary thereof to the company examined, together 689
823	823	with any recommendations or written statements from the 690
824	824	commissioner or the examiner. The secretary of the board of directors or 691
825	825	similar governing body of the company shall provide a copy of the 692
826	826	report or summary to each director and shall certify to the 693
827	827	commissioner, in writing, that a copy of the report or summary has been 694
828	828	provided to each director. 695
829	829	(B) Not later than one hundred twenty days after receiving the report 696
830	830	or summary, the chief executive officer or the chief financial officer of 697
831	831	the company examined shall present the report or summary to the 698
832	832	company's board of directors or similar governing body at a regular or 699
833	833	special meeting. 700
834	834	(f) (1) All orders entered pursuant to subdivision (3) of subsection (e) 701
835	835	of this section shall be accompanied by findings and conclusions 702
836	836	resulting from the commissioner's consideration and review of the 703 Raised Bill No. 5247
837	837
838	838
839	839
840	840	LCO No. 1731 24 of 32
841	841
842	842	examination report, relevant examiner workpapers and any written 704
843	843	submissions or rebuttals. The findings and conclusions that form the 705
844	844	basis of any such order of the commissioner shall be subject to review as 706
845	845	provided in section 38a-19. 707
846	846	(2) Any investigatory hearing conducted under subparagraph (C) of 708
847	847	subdivision (3) of subsection (e) of this section by the commissioner or 709
848	848	the commissioner's authorized representative, shall be conducted as a 710
849	849	nonadversarial confidential investigatory proceeding as necessary for 711
850	850	the resolution of any inconsistencies, discrepancies or disputed issues 712
851	851	apparent (A) upon the filed examination report, (B) raised by or as a 713
852	852	result of the commissioner's review of relevant workpapers, or (C) by 714
853	853	the written submission or rebuttal of the company. Not later than 715
854	854	twenty days after the conclusion of any such hearing, the commissioner 716
855	855	shall enter an order pursuant to subparagraph (A) of subdivision (3) of 717
856	856	subsection (e) of this section. The commissioner shall not appoint an 718
857	857	examiner as an authorized representative to conduct the hearing. The 719
858	858	hearing shall proceed expeditiously with discovery by the company 720
859	859	limited to the examiner's workpapers that tend to substantiate any 721
860	860	assertions set forth in any written submission or rebuttal. The 722
861	861	commissioner or the commissioner's authorized representative may 723
862	862	issue subpoenas for the attendance of any witnesses or the production 724
863	863	of any documents deemed relevant to the investigation, whether under 725
864	864	the control of the department, the company or other persons. The 726
865	865	documents produced shall be included in the record and testimony 727
866	866	taken by the commissioner or the commissioner's authorized 728
867	867	representative shall be under oath and preserved for the record. 729
868	868	Nothing contained in this section shall require the department to 730
869	869	disclose any information or records that would indicate or show the 731
870	870	existence or content of any investigation or activity of a criminal justice 732
871	871	agency. The hearing shall proceed with the commissioner or the 733
872	872	commissioner's authorized representative posing questions to the 734
873	873	persons subpoenaed. Thereafter, the company and the Insurance 735
874	874	Department may present testimony relevant to the investigation. Cross-736
875	875	examination shall be conducted only by the commissioner or the 737 Raised Bill No. 5247
876	876
877	877
878	878
879	879	LCO No. 1731 25 of 32
880	880
881	881	commissioner's authorized representative. The company and the 738
882	882	Insurance Department shall be permitted to make closing statements 739
883	883	and may be represented by counsel of their choice. 740
884	884	(g) The commissioner may, if the commissioner deems it in the public 741
885	885	interest, publish any such report, or the result of any such examination 742
886	886	contained therein, in one or more newspapers of the state. 743
887	887	(h) The commissioner shall, at least once in every five years, visit and 744
888	888	examine the affairs of each domestic insurer, domestic health care 745
889	889	center, domestic fraternal benefit society, multiple employer welfare 746
890	890	arrangement trust, as defined in section 2 of this act and foreign and 747
891	891	alien insurer doing business in this state. Notwithstanding subdivision 748
892	892	(1) of subsection (c) of this section, no domestic insurer or such other 749
893	893	domestic entity subject to examination under this section shall pay as 750
894	894	costs associated with the examination the salaries, fringe benefits or 751
895	895	travel and maintenance expenses of examining personnel of the 752
896	896	Insurance Department engaged in such examination if such domestic 753
897	897	insurer or domestic entity is otherwise liable to assessment levied under 754
898	898	section 38a-47, except that a domestic insurer or such other domestic 755
899	899	entity shall pay the travel and maintenance expenses of examining 756
900	900	personnel of the Insurance Department when such insurer or entity is 757
901	901	examined outside the state. 758
902	902	(i) Nothing contained in this section shall prevent or be construed as 759
903	903	prohibiting the commissioner from disclosing the content of an 760
904	904	examination report, preliminary examination report or results, or any 761
905	905	matter relating thereto, to the Insurance Department of this or any other 762
906	906	state or country, or to law enforcement officials of this or any other state 763
907	907	or to any agency of the federal government at any time, so long as such 764
908	908	agency or office receiving the report or matters relating thereto agrees, 765
909	909	in writing, to hold such report and matters relating thereto confidential. 766
910	910	(j) All workpapers, recorded information, documents and copies 767
911	911	thereof produced by, obtained by or disclosed to the commissioner or 768
912	912	any other person in the course of an examination made under this 769 Raised Bill No. 5247
913	913
914	914
915	915
916	916	LCO No. 1731 26 of 32
917	917
918	918	section shall be confidential, shall not be subject to subpoena and shall 770
919	919	not be made public by the commissioner or any other person, except to 771
920	920	the extent provided in subsection (i) of this section. The commissioner 772
921	921	may grant access to such workpapers, recorded information, documents 773
922	922	and copies thereof to the National Association of Insurance 774
923	923	Commissioners, provided said association agrees, in writing, to hold 775
924	924	such workpapers, recorded information, documents and copies thereof 776
925	925	confidential. 777
926	926	(k) (1) The commissioner may from time to time engage, on an 778
927	927	individual basis, the services of qualified actuaries, certified public 779
928	928	accountants or other similar individuals who are independently 780
929	929	practicing their professions, even though said persons may from time to 781
930	930	time be similarly employed or retained by persons subject to 782
931	931	examination under this section. 783
932	932	(2) No cause of action shall arise nor shall any liability be imposed 784
933	933	against the commissioner, the commissioner's authorized 785
934	934	representatives or any examiner appointed by the commissioner for any 786
935	935	statements made or conduct performed in good faith while carrying out 787
936	936	the provisions of this section. 788
937	937	(3) No cause of action shall arise, nor shall any liability be imposed 789
938	938	against any person for the act of communicating or delivering 790
939	939	information or data to the commissioner or the commissioner's 791
940	940	authorized representative examiner pursuant to an examination made 792
941	941	under this section, if such act of communication or delivery was 793
942	942	performed in good faith and without fraudulent intent or the intent to 794
943	943	deceive. 795
944	944	(4) This section shall not abrogate or modify in any way any common 796
945	945	law or statutory privilege or immunity heretofore enjoyed by any 797
946	946	person identified in subdivision (2) of this subsection. 798
947	947	(5) A person identified in subdivision (2) of this subsection shall be 799
948	948	entitled to an award of attorney's fees and costs if such person is the 800
949	949	prevailing party in a civil action for libel, slander or any other relevant 801 Raised Bill No. 5247
950	950
951	951
952	952
953	953	LCO No. 1731 27 of 32
954	954
955	955	tort arising out of activities in carrying out the provisions of this section 802
956	956	and the party bringing the action was not substantially justified in doing 803
957	957	so. For purposes of this section, a proceeding is "substantially justified" 804
958	958	if it had a reasonable basis in law or fact at the time that it was initiated. 805
959	959	Sec. 7. Section 38a-15 of the general statutes is repealed and the 806
960	960	following is substituted in lieu thereof (Effective October 1, 2024): 807
961	961	(a) The commissioner shall, as often as the commissioner deems it 808
962	962	expedient, undertake a market conduct examination of the affairs of any 809
963	963	insurance company, health care center, multiple employer welfare 810
964	964	arrangement trust, as defined in section 2 of this act, third-party 811
965	965	administrator, as defined in section 38a-720, or fraternal benefit society 812
966	966	doing business in this state. Any such examination may be conducted in 813
967	967	accordance with the procedures and definitions set forth in the National 814
968	968	Association of Insurance Commissioners' Market Regulation 815
969	969	Handbook. 816
970	970	(b) To carry out the examinations under this section, the 817
971	971	commissioner may appoint, as market conduct examiners, one or more 818
972	972	competent persons, who shall not be officers of, or connected with or 819
973	973	interested in, any insurance company, health care center, multiple 820
974	974	employer welfare arrangement trust, third-party administrator or 821
975	975	fraternal benefit society, other than as a policyholder. In conducting the 822
976	976	examination, the commissioner, the commissioner's actuary or any 823
977	977	examiner authorized by the commissioner may examine, under oath, 824
978	978	the officers and agents of such insurance company, health care center, 825
979	979	multiple employer welfare arrangement trust, third-party administrator 826
980	980	or fraternal benefit society and all persons deemed to have material 827
981	981	information regarding the company's, center's, multiple employer 828
982	982	welfare arrangement trust's, administrator's or society's property or 829
983	983	business. Each such company, center, multiple employer welfare 830
984	984	arrangement trust, administrator or society, its officers and agents, shall 831
985	985	produce the books and papers, in its or their possession, relating to its 832
986	986	business or affairs, and any other person may be required to produce 833
987	987	any book or paper in such person's custody, deemed to be relevant to 834 Raised Bill No. 5247
988	988
989	989
990	990
991	991	LCO No. 1731 28 of 32
992	992
993	993	the examination, for the inspection of the commissioner, the 835
994	994	commissioner's actuary or examiners, when required. The officers and 836
995	995	agents of the company, center, multiple employer welfare arrangement 837
996	996	trust, administrator or society shall facilitate the examination and aid 838
997	997	the examiners in making the same so far as it is in their power to do so. 839
998	998	(c) Each market conduct examiner shall make a full and true report 840
999	999	of each market conduct examination made by such examiner, which 841
1000	1000	shall comprise only facts appearing upon the books, papers, records or 842
1001	1001	documents of the examined company, center, multiple employer 843
1002	1002	welfare arrangement trust, administrator or society or ascertained from 844
1003	1003	the sworn testimony of its officers or agents or of other persons 845
1004	1004	examined under oath concerning its affairs. The examiner's report shall 846
1005	1005	be presumptive evidence of the facts therein stated in any action or 847
1006	1006	proceeding in the name of the state against the company, center, 848
1007	1007	multiple employer welfare arrangement trust, administrator or society, 849
1008	1008	its officers or agents. The commissioner shall grant a hearing to the 850
1009	1009	company, center, multiple employer welfare arrangement trust, 851
1010	1010	administrator or society examined before filing any such report and may 852
1011	1011	withhold any such report from public inspection for such time as the 853
1012	1012	commissioner deems proper. The commissioner may, if the 854
1013	1013	commissioner deems it in the public interest, publish any such report, 855
1014	1014	or the result of any such examination contained therein, in one or more 856
1015	1015	newspapers of the state. 857
1016	1016	(d) (1) All the expense of any examination made under the authority 858
1017	1017	of this section, other than examinations of domestic insurance 859
1018	1018	companies and domestic health care centers, shall be paid by the 860
1019	1019	company, center, multiple employer welfare arrangement trust, 861
1020	1020	administrator or society examined. 862
1021	1021	(2) No domestic insurance company or domestic health care center 863
1022	1022	subject to an examination under this section shall pay as costs associated 864
1023	1023	with the examination the salaries, fringe benefits or travel and 865
1024	1024	maintenance expenses of examining personnel of the Insurance 866
1025	1025	Department engaged in such examination if such domestic insurance 867 Raised Bill No. 5247
1026	1026
1027	1027
1028	1028
1029	1029	LCO No. 1731 29 of 32
1030	1030
1031	1031	company or domestic health care center is otherwise liable to 868
1032	1032	assessment levied under section 38a-47, except that domestic insurance 869
1033	1033	companies and domestic health care centers examined outside the state 870
1034	1034	shall pay the travel and maintenance expenses of such examining 871
1035	1035	personnel. 872
1036	1036	(e) (1) No cause of action shall arise nor shall any liability be imposed 873
1037	1037	against the commissioner, the commissioner's authorized representative 874
1038	1038	or any examiner appointed or engaged by the commissioner for any 875
1039	1039	statements made or conduct performed in good faith while carrying out 876
1040	1040	the provisions of this section. 877
1041	1041	(2) No cause of action shall arise nor shall any liability be imposed 878
1042	1042	against any person for the act of communicating or delivering 879
1043	1043	information or data pursuant to an examination made under the 880
1044	1044	authority of this section to the commissioner, the commissioner's 881
1045	1045	authorized representative or an examiner if such communication or 882
1046	1046	delivery was performed in good faith and without fraudulent intent or 883
1047	1047	the intent to deceive. 884
1048	1048	(3) The provisions of this subsection shall not abrogate or modify any 885
1049	1049	common law or statutory privilege or immunity heretofore enjoyed by 886
1050	1050	any person identified in subdivision (1) of this subsection. 887
1051	1051	(f) Nothing in this section shall be construed to prevent or prohibit 888
1052	1052	the commissioner from disclosing at any time the content or results of 889
1053	1053	an examination report or a preliminary examination report or any 890
1054	1054	matter relating to such report, to (1) the insurance regulatory officials of 891
1055	1055	this state or any other state or country, (2) law enforcement officials of 892
1056	1056	this or any other state, or (3) any agency of this or any other state or of 893
1057	1057	the federal government, provided such officials or agency receiving the 894
1058	1058	report or matters relating to the report agrees, in writing, to hold such 895
1059	1059	report or matters confidential. 896
1060	1060	(g) All workpapers, recorded information, documents and copies 897
1061	1061	thereof produced by, obtained by or disclosed to the commissioner or 898
1062	1062	any other person in the course of an examination made under the 899 Raised Bill No. 5247
1063	1063
1064	1064
1065	1065
1066	1066	LCO No. 1731 30 of 32
1067	1067
1068	1068	authority of this section shall be confidential, shall not be subject to 900
1069	1069	subpoena and shall not be made public by the commissioner or any 901
1070	1070	other person, except to the extent provided in subsection (f) of this 902
1071	1071	section. The commissioner may grant access to such workpapers, 903
1072	1072	recorded information, documents and copies to the National 904
1073	1073	Association of Insurance Commissioners, provided said association 905
1074	1074	agrees, in writing, to hold such workpapers, recorded information, 906
1075	1075	documents and copies thereof confidential. 907
1076	1076	Sec. 8. Subsection (a) of section 19a-755a of the general statutes is 908
1077	1077	repealed and the following is substituted in lieu thereof (Effective October 909
1078	1078	1, 2024): 910
1079	1079	(a) As used in this section: 911
1080	1080	(1) "All-payer claims database" means a database that receives and 912
1081	1081	stores data from a reporting entity relating to medical insurance claims, 913
1082	1082	dental insurance claims, pharmacy claims and other insurance claims 914
1083	1083	information from enrollment and eligibility files. 915
1084	1084	(2) (A) "Reporting entity" means: 916
1085	1085	(i) An insurer, as described in section 38a-1, as amended by this act, 917
1086	1086	licensed to do health insurance business in this state; 918
1087	1087	(ii) A health care center, as defined in section 38a-175; 919
1088	1088	(iii) An insurer or health care center that provides coverage under 920
1089	1089	Part C or Part D of Title XVIII of the Social Security Act, as amended 921
1090	1090	from time to time, to residents of this state; 922
1091	1091	(iv) A third-party administrator, as defined in section 38a-720; 923
1092	1092	(v) A pharmacy benefits manager, as defined in section 38a-479aaa; 924
1093	1093	(vi) A hospital service corporation, as defined in section 38a-199; 925
1094	1094	(vii) A nonprofit medical service corporation, as defined in section 926
1095	1095	38a-214; 927 Raised Bill No. 5247
1096	1096
1097	1097
1098	1098
1099	1099	LCO No. 1731 31 of 32
1100	1100
1101	1101	(viii) A fraternal benefit society, as described in section 38a-595, that 928
1102	1102	transacts health insurance business in this state; 929
1103	1103	(ix) A dental plan organization, as defined in section 38a-577; 930
1104	1104	(x) A preferred provider network, as defined in section 38a-479aa; 931
1105	1105	[and] 932
1106	1106	(xi) Any other person that administers health care claims and 933
1107	1107	payments pursuant to a contract or agreement or is required by statute 934
1108	1108	to administer such claims and payments; and 935
1109	1109	(xii) A multiple employer welfare arrangement trust, as defined in 936
1110	1110	section 2 of this act. 937
1111	1111	(B) "Reporting entity" does not include an employee welfare benefit 938
1112	1112	plan, as defined in the federal Employee Retirement Income Security 939
1113	1113	Act of 1974, as amended from time to time, that is also a trust established 940
1114	1114	pursuant to collective bargaining subject to the federal Labor 941
1115	1115	Management Relations Act. 942
1116	1116	(3) "Medicaid data" means the Medicaid provider registry, health 943
1117	1117	claims data and Medicaid recipient data maintained by the Department 944
1118	1118	of Social Services. 945
1119	1119	(4) "CHIP data" means the provider registry, health claims data and 946
1120	1120	recipient data maintained by the Department of Social Services to 947
1121	1121	administer the Children's Health Insurance Program. 948
1122	1122	This act shall take effect as follows and shall amend the following
1123	1123	sections:
1124	1124
1125	1125	Section 1 October 1, 2024 38a-1
1126	1126	Sec. 2 October 1, 2024 New section
1127	1127	Sec. 3 October 1, 2024 New section
1128	1128	Sec. 4 April 1, 2025 38a-567
1129	1129	Sec. 5 October 1, 2024 38a-9(a)
1130	1130	Sec. 6 October 1, 2024 38a-14
1131	1131	Sec. 7 October 1, 2024 38a-15 Raised Bill No. 5247
1132	1132
1133	1133
1134	1134
1135	1135	LCO No. 1731 32 of 32
1136	1136
1137	1137	Sec. 8 October 1, 2024 19a-755a(a)
1138	1138
1139	1139	Statement of Purpose:
1140	1140	To authorize employee health benefit consortiums in this state.
1141	1141	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
1142	1142	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
1143	1143	underlined.]
1144	1144