§ 38a-183 — (Formerly Sec. 33-179k). Approval of rates to be paid by subscribers and agreements. Capital Reserve Fund. Prescription drug rebates.

Connecticut § 38a-183

• Jurisdiction: Connecticut
• Title 38a: Insurance
• Ch. 698a: Health Care and Related Service Groups

Text

(a)(1) A health care center governed by sections 38a-175 to 38a-194, inclusive, shall not enter into any agreement with subscribers unless and until it has filed with the commissioner a full schedule of the amounts to be paid by the subscribers and has obtained the commissioner's approval thereof. Such filing shall include the information and data required under section 38a-479qqq if the contract or policy is subject to said section, and an actuarial memorandum that includes, but is not limited to, pricing assumptions and claims experience, and premium rates and loss ratios from the inception of the contract or policy. The commissioner may refuse such approval if the commissioner finds such amounts to be excessive, inadequate or discriminatory. As used in this subsection, “loss ratio” means the ratio of incurred claims to earned premiums by the number of years of policy duration for all combined durations. (2) Premium rates and special enrollment periods offered to individuals shall be consistent with the requirements set forth in section 38a-481 . (3) Premium rates offered to small employers, as defined in section 38a-564 , shall be consistent with the requirements set forth in section 38a-567 . (4) No such health care center shall enter into any agreement with subscribers unless and until it has filed with the commissioner a copy of such agreement or agreements, including all riders and endorsements thereon, and until the commissioner's approval thereof has been obtained. The commissioner shall, within a reasonable time after the filing of any request for an approval of the amounts to be paid, any agreement or any form, notify the health care center of the commissioner's approval or disapproval thereof. (b) A health care center may establish rates of payment by any method permitted by the Federal Health Maintenance Organization Act and the regulations adopted thereunder from time to time unless otherwise determined by the commissioner by regulation. (c) Each such health care center may include as a component of its rate a sum up to ten per cent of such rate to be used for the objects and purposes set forth in section 38a-184 . An amount not exceeding ten per cent of the annual net premium income of such center may be set aside annually as a capital reserve fund and may be accumulated from year to year by such health care center, to be expended for the objects and purposes as set forth and in accordance with said section. (d) Each such health care center shall, if such health care center intends to account for rebates, as defined in section 38a-479ooo in the manner specified in section 38a-479rrr , account for such rebates in calculating premium rates offered on or after January 1, 2021, if such health care center is subject to section 38a-479rrr .

Legislative History

(1971, P.A. 445, S. 11; P.A. 77-614, S. 163, 610; P.A. 80-482, S. 228, 348; P.A. 82-415, S. 7, 18; P.A. 90-68, S. 7, 16; P.A. 15-247, S. 1; P.A. 17-198, S. 22; P.A. 18-41, S. 7; 18-43, S. 3; P.A. 19-196, S. 2.) History: P.A. 77-614 made insurance department a division within the department of business regulation with commissioner as its head, effective January 1, 1979; P.A. 80-482 restored insurance division as independent department with commissioner as its head and abolished department of business regulation; P.A. 82-415 substituted references to health care centers for references to corporations, added Subsec. (c), requiring health care centers to prove to the insurance commissioner that members are protected from liability for uncovered expenditures; P.A. 90-68 made various technical corrections, inserted a new Subsec. (b) allowing health care centers to establish rates of payment which are permitted by the Federal Health Maintenance Organization Act provided the commissioner has not made such a determination by regulation, deleted former Subsec. (c) which required health care centers to prove to the commissioner that members are protected from liability for uncovered expenditures and redesignated former Subsec. (b) as Subsec. (c); Sec. 33-179k transferred to Sec. 38a-183 in 1991; P.A. 15-247 amended Subsec. (a) by designating existing provisions re filing and approval of amounts to be paid by subscribers as Subdiv. (1) and amending same to add provision re information to be included with such filing, add definition of “loss ratio” and make a technical change, adding Subdivs. (2) and (3) re rates offered to individuals and small employers, respectively, and designating existing provisions re filing and approval of agreement with subscribers as Subdiv. (4) and making technical changes therein, effective July 10, 2015; P.A. 17-198 amended Subsec. (a)(1) by replacing reference to Sec. 38a-192 with reference to Sec. 38a-194, effective July 1, 2017; P.A. 18-41 amended Subsec. (a)(1) by adding provisions re inclusion of information and data required under Sec. 38a-479qqq and added Subsec. (d) re accounting for rebates in manner specified in Sec. 38a-479rrr, effective January 1, 2020; P.A. 18-43 added “and special enrollment periods” in Subsec. (a)(2), effective January 1, 2019; P.A. 19-196 added “and special enrollment periods” in Subsec. (a)(2), effective January 1, 2020.