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 Section 38a-1 of the general statutes is repealed and the 1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