OFFICE OF FISCAL ANALYSIS

Legislative Office Building, Room 5200

Hartford, CT 06106 (860) 240-0200

http://www.cga.ct.gov/ofa

sSB-586

AN ACT EXPANDING MANDATED HEALTH BENEFITS FOR WOMEN, CHILDREN AND ADOLESCENTS.

As Amended by Senate "A" (LCO 8258), Senate "B" (LCO 8326)

House Calendar No.: 619

Senate Calendar No.: 147


OFA Fiscal Note

State Impact: None

Municipal Impact:

Municipalities

Effect

FY 18 $

FY 19 $

Various Municipalities

Potential Cost

See Below

See Below

Explanation

The bill is not anticipated to result in a cost to the state employee and retiree health plan or fully-insured, non-grandfathered municipal plans to comply with the coverage provisions in sections 1 through 8 of the bill. These plans provide coverage for the services specified in the bill pursuant to state or federal law.

The bill may result in a cost to certain fully-insured grandfathered plans which do not currently provide coverage for those services required by the federal Affordable Care Act but not currently mandated by state law, such as breast feeding supplies. The coverage requirements will result in increased premium costs when municipalities enter into new health insurance contracts after January 1, 2018.

Pursuant to federal law, self-insured health plans are exempt from state health mandates.

Lastly, the bill's special enrollment period established for individual plans within CGS 38a-481 does not result in a cost to the state or municipalities, as the provisions pertain to individual health insurance plans. In addition, the bill expressly prohibits state and municipal employees and their dependents, who are insured in the state health plan, those sponsored by the Comptroller, or municipal health plans, from any statutorily established special enrollment period related to pregnancy.

The bill makes other conforming changes which do not result in a fiscal impact.

Senate “A”: (1) eliminated the prohibition on step therapy and prior authorization for contraceptives from the underlying bill, and (2) permits cost sharing for out of network services which reduced the cost of the underlying bill and resulted in the impact described above.

Senate “B” established a special enrollment period for uninsured individuals who become pregnant in individual health insurance policies. The amendment expressly prohibited the application of any pregnancy related special enrollment period from applying to individuals enrolled in the state plan, a plan procured by the Comptroller, or a municipal plan, which did not result in a fiscal impact.

The Out Years

The annualized potential fiscal impact identified above will continue in the future and will be reflected in future health premiums.

The preceding Fiscal Impact statement is prepared for the benefit of the members of the General Assembly, solely for the purposes of information, summarization and explanation and does not represent the intent of the General Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of informational sources, including the analyst's professional knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.