Sec. 38a-565. Special health care plans.
Sec. 38a-565. Special health care plans. (a)(1) In order to facilitate the provision
of lower cost health insurance coverage for uninsured small employers, the board shall
establish, subject to the approval of the commissioner, special health care plans for
use by the Health Reinsurance Association. The board shall submit such plans to the
commissioner for the commissioner's approval. The board shall take into consideration
the levels of health care plans provided in Connecticut and such medical and economic
factors as may be deemed appropriate and shall establish benefit levels, deductibles,
coinsurance factors, maximum copayment obligations and exclusions and limitations
which the board considers appropriate for uninsured small employers, provided the level
of reimbursement shall be based on the reimbursement rate. Such plans may include
cost containment features such as, but not limited to: (A) Preferred provider provisions;
(B) utilization review of health care services, including review of medical necessity of
hospital and physician services; (C) case management benefit alternatives; and (D) other
managed care provisions.
(2) After the commissioner's approval of special health care plans submitted by
the board pursuant to subdivision (1) of this subsection, and in lieu of the procedure
established by section 38a-481, the Health Reinsurance Association may certify to the
commissioner, in the form and manner prescribed by the commissioner, that the special
health care plans filed by said association are in substantial compliance with the provisions in the corresponding approved board plan. Upon receipt by the department of
such certification, said association may offer such certified plans until such time as the
commissioner, after notice and hearing, disapproves their continued use.
(b) (1) Not later than ninety days after approval by the commissioner of the special
health care plans submitted by the board, the Health Reinsurance Association shall offer
small employers such plans. Except as provided in subdivision (2) of this subsection,
every small employer that elects to be covered under a special health care 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 Health Reinsurance Association.
(2) No small employer shall be eligible to purchase a special health care plan unless
such employer had maintained no health insurance coverage for its employees at any
time during the one-year period ending on the date of application for such policy. No
small employer shall purchase a special health care plan for more than three years.
(c) Insurers may issue individual special health care plans subject to the laws applicable to individual health insurance in this state, provided such policies shall be identical
to the individual special health care plans made available by the Health Reinsurance
Association pursuant to section 38a-571.
(P.A. 90-134, S. 13, 28; P.A. 91-201, S. 6, 8; P.A. 93-137, S. 2, 6; 93-239, S. 6; P.A. 07-185, S. 20; P.A. 08-33, S. 1.)
History: P.A. 91-201 added Subsec. (b)(6) setting conditions under which small employer carriers are not required to
offer small employer coverage; P.A. 93-137 amended Subsec. (b) to require small employer carriers who do not offer
special health care plans to refer small employers to the Health Reinsurance Association and reduced the period during
which an employer must have not carried coverage for its employees from two years to one year to purchase special health
care plans, effective June 11, 1993; P.A. 93-239 corrected an internal reference in Subsec. (a)(2); P.A. 07-185 deleted
former Subsec. (b)(3) re sale of special health care plans with initial effective date of January 1, 1995, or later and redesignated existing Subsec. (b)(4) to (6) as Subsec. (b)(3) to (5), effective July 1, 2007; P.A. 08-33 made technical changes,
amended Subsecs. (a) and (b) to delete references to special health care plans from small employer carriers and health care
centers and, in Subsec. (b), deleted former Subdivs. (3) to (5) re special health care plans offered by small employer carriers
and health care centers, effective May 7, 2008.