SB 479 Released in Connecticut…

CT Raised Bill No 479 STOP LOSSBrooks Goodison at Diversified Group Benefits just advised that SB 479 was just released in Connecticut. This is not good for the self-funded industry and we are strongly opposed.

Sec. 5. (NEW) (Effective October 1, 2014) (a) (1) On and after January 1, 2015, no insurance company shall deliver, issue for delivery or renew a stop loss insurance policy in this state for health care or medical benefits that: (A) Has an annual attachment point for claims incurred per individual covered that is less than forty-five thousand dollars; (B) for qualified employers that are small employers, as defined in Section 1304 of the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, has an annual aggregate attachment point that is less than forty-five thousand dollars or five thousand dollars multiplied by the number of enrolled employees, whichever is greater; (C) for qualified employers that are large employers, as defined in Section
1304 of the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, has an annual aggregate attachment point that is less than one hundred twenty per cent of expected claims; or (D) provides direct coverage for the health care or medical expenses of an enrollee.

(2) As used in this section, (A) “attachment point” means the claims amount incurred by the insured, above which the insurance company that issued the stop loss insurance policy will incur liability for payment, and (B) “expected claims” means the claims amount that, in the absence of a stop loss insurance policy or other insurance coverage, is projected to be incurred by the insured under its health insurance policy or medical benefits plan.

(b) If an insurance company delivers, issues for delivery or renews an employer’s stop loss insurance policy in this state for health care or medical benefits that is not prohibited under subsection (a) of this section, such insurance company shall determine at least annually the number of such employer’s employees.

(c) Not later than March fifteenth annually, each insurance company that delivers, issues for delivery or renews an employer’s stop loss insurance policy in this state for health care or medical benefits that is not prohibited under subsection (a) of this section shall submit to the Insurance Commissioner a written certification by an actuary who is a member in good standing of the American Academy of Actuaries. Such certification shall include, but is not limited to, (1) a summary of the records of and actuarial assumptions and methods used by such company and reviewed by such actuary to establish attachment points and other applicable determinations related to the stop loss insurance policy, (2) a statement that the premiums charged by such company for each such stop loss insurance policy are reasonable in connection with the risks borne by such company, and (3) a statement that such company is in compliance with the provisions of this section. Each such company shall retain a copy of such certification at its principal place of business.

(d) The Insurance Commissioner may adopt regulations in accordance with the provisions of chapter 54 to implement the provisions of this section.

See Copy of Raised Bill…