Connecticut Seal

General Assembly

File No. 17

    February Session, 2012

Substitute Senate Bill No. 97

Senate, March 8, 2012

The Committee on Insurance and Real Estate reported through SEN. CRISCO of the 17th Dist., Chairperson of the Committee on the part of the Senate, that the substitute bill ought to pass.

This act shall take effect as follows and shall amend the following sections:

Section 1

January 1, 2013


Sec. 2

January 1, 2013



Joint Favorable Subst.


Agency Affected


FY 13 $

FY 14 $

State Comptroller - Fringe Benefits

GF & TF - Cost

Less than $5,000

Less than $10,000



FY 13 $

FY 14 $

Various Municipalities










1 FY 13 reflects a partial year of expenses and assumes the state plan adopts the mandate effective January 1, 2013. If the state were to adopt the mandate at the beginning of the next plan year, July 1, 2014, there would be no cost in FY 13.

2 Source: State of Connecticut Health Benefit Plan: Plan Document.

3 The potential cost assumes the average ultrasound screening is approximately $220. (Source: University of Connecticut. Review and Evaluation of Certain Health Benefit Mandates in Connecticut, 2012, p. 198)

4 It is estimated the removal of cost sharing requirements for breast ultrasound screenings increase premiums (medical and administrative costs) by $0.24 per member per month (PMPM) 2013 and $0.26 PMPM in 2014 . The impact to a plan would depend on the number of lives covered. (Source: Id. p. 133.)

5 Grandfathered plans include most group insurance plans and some individual health plans created or purchased on or before March 23, 2010. Pursuant to the PPACA, all health plans, including those with grandfathered status are required to provide the following as of September 23, 2010: 1) No lifetime limits on coverage, 2) No rescissions of coverage when individual gets sick or has previously made an unintentional error on an application, and 3) Extension of parents' coverage to young adults until age 26. (

6 According to the PPACA, compared to the plans' policies as of March 23, 2010, grandfathered plans who make any of the following changes within a certain margin may lose their grandfathered status: 1) Significantly cut or reduce benefits, 2) Raise co-insurance charges, 3) Significantly raise co-payment charges, 4) Significantly raise deductibles, 5) Significantly lower employer contributions, and 5) Add or tighten annual limits on what insurer pays. (

7 EHB requires coverage in 10 categories. In addition, Section 2711 of the Public Service Act prohibits annual dollar limits or lifetime maximums on EHBs.

8 The state may choose one of the three largest plans by enrollment in one of the following categories to serve as the benchmark plan: 1) small group, 2) state employee health plans, 3) federal employee health plans, or 4) the largest HMO plan offered in the state's commercial market. If the state does not select one of the aforementioned options, the default plan will be the small group plan with the largest enrollment in the state. (Source: Dept. of Health and Human Services. Essential Health Benefits: HHS Informational Bulletin Fact Sheet (December 16, 2011)).

9 As of December 2011, Connecticut had 32 mandated health benefits in law. Maryland has the most, with 35 and Indiana has the least with 6. (Source: The Blue Cross/Blue Shield Association. State Legislative Healthcare and Insurance Issues 2011. Prepared by: Susan S. Laudicina, Joan M. Gardner, Kim Holland. As reported by NCSL, Accessed 3/2/12. )

10 Source: Dept. of Health and Human Services. Frequently Asked Questions on Essential Health Benefits Bulletin (February 21, 2012).