Bill Text: CT HB06511 | 2011 | General Assembly | Introduced

---

Bill Title: An Act Concerning Small Group Health Insurance Rate Reviews.

Spectrum: Committee Bill

Status: (Introduced - Dead) 2011-03-04 - Public Hearing 03/08 [HB06511 Detail]

Download: Connecticut-2011-HB06511-Introduced.html

---

General Assembly		Raised Bill No. 6511
January Session, 2011		LCO No. 3880
		*03880_______INS*
Referred to Committee on Insurance and Real Estate
Introduced by:
(INS)

AN ACT CONCERNING SMALL GROUP HEALTH INSURANCE RATE REVIEWS.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Subsection (a) of section 38a-513 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2011):

(a) (1) No group health insurance policy, as defined by the commissioner, or certificate shall be issued or delivered in this state unless a copy of the form for such policy or certificate has been submitted to and approved by the commissioner under the regulations adopted pursuant to this section, and on and after January 1, 2012, no group health insurance policy or certificate for a small employer, as defined in section 38a-564, shall be issued or delivered in this state unless the classification of risks and the premium rates for such policy have been filed with and approved by the commissioner. The commissioner shall adopt regulations, in accordance with chapter 54, concerning the provisions, submission and approval of such policies and certificates and establishing a procedure for reviewing such policies and certificates. If the commissioner issues an order disapproving the use of such form, the provisions of section 38a-19 shall apply to such order.

(2) No rate filed under the provisions of subdivision (1) of this subsection shall be effective unless approved by the commissioner. The commissioner shall adopt regulations, in accordance with chapter 54, to prescribe standards to ensure that such rates shall not be excessive, inadequate or unfairly discriminatory. The commissioner may disapprove such rate within thirty days after it has been filed if it fails to comply with such standards.

Sec. 2. Subsections (a) and (b) of section 38a-568 of the general statutes are repealed and the following is substituted in lieu thereof (Effective October 1, 2011):

(a) (1) Subject to approval by the commissioner, the board shall establish the form and level of coverages to be made available by small employer carriers in accordance with the provisions of subsection (b) of this section. Such coverages, which shall be designated as small employer health care plans, shall be limited to: (A) A basic hospital plan, (B) a basic surgical plan, (C) major medical plans which can be written in conjunction with basic hospital plans or basic surgical plans, (D) comprehensive plans, and (E) plans with benefit and cost-sharing levels which are consistent with the basic method of operation and the benefit plans of health care centers, including any restrictions imposed by federal law. The board shall submit such plans to the commissioner for the commissioner's approval not later than ninety days after the appointment of the board pursuant to section 38a-569. The board shall take into consideration the levels of health insurance provided in Connecticut and such medical and economic factors as may be deemed appropriate and shall establish benefit levels, deductibles, coinsurance factors, exclusions and limitations determined to be generally reflective of health insurance provided to small employers. Such plans may include cost containment features including, but not limited to: (i) Preferred provider provisions; (ii) utilization review of health care services, including review of medical necessity of hospital and physician services; (iii) case management benefit alternatives; and (iv) other managed care provisions.

(2) After the commissioner's approval of the form and level of coverages of small employer health care plans submitted by the board pursuant to subdivision (1) of this subsection, and in lieu of the procedure for the submission and approval of policies and certificates established by section 38a-513, as amended by this act, any small employer carrier may certify to the commissioner, in the form and manner prescribed by the commissioner, that the small employer health care plans filed by the carrier are in substantial compliance with the provisions in the corresponding approved board plan. Upon receipt by the department of such certification, the carrier may use such certified plans until such time as the commissioner, after notice and hearing, disapproves their continued use.

(b) Not later than ninety days after the commissioner's approval of the form and level of coverages of small employer health care plans submitted by the board, each small employer carrier, including, but not limited to, each health care center, shall, as a condition of transacting such insurance in this state, offer those small employer health care plans that correspond to the insurance products being currently offered by the carrier to small employers. Each small employer that elects to be covered under such plan and agrees to make the required premium payments and to satisfy the other provisions of the plan shall be issued such a plan by the small employer carrier.

This act shall take effect as follows and shall amend the following sections:
Section 1	October 1, 2011	38a-513(a)
Sec. 2	October 1, 2011	38a-568(a) and (b)

Statement of Purpose:

To require insurers writing small group health insurance policies in the state to file premium rates with, and obtain approval from, the Insurance Department prior to such rates becoming effective.

[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.]