Legislative Office Building, Room 5200

Hartford, CT 06106 (860) 240-0200




LCO No.: 7240

File Copy No.: 242

Senate Calendar No.: 147

OFA Fiscal Note

State Impact:

Agency Affected


FY 18 $

FY 19 $

State Comptroller - Fringe Benefits (State Employee and Retiree Health)

GF&TF - Cost

See Below

See Below

Note: GF&TF=General Fund & Transportation Fund

Municipal Impact:



FY 18 $

FY 19 $

Various Municipalities


See Below

See Below


The amendment will result in a cost to the state employee and retiree health plan1 and municipalities for including pregnancy as a qualifying event for special enrollment. If adopted by the state plan, cost to the plan will depend on the (1) number of pregnant individuals who enroll under the special enrollment terms established in the amendment who otherwise would not be covered by the plan until they were eligible to enroll under the current plan terms, (2) when the individual enrolls, and (3) the plan the individual enrolls in, including the level of coverage (i.e. employee only coverage, etc.). As of FY 17, the annual state share of premiums (medical and pharmacy) for active employees range from $6,444 to $21,516.2 A recent study reported the average hospital cost of a birth ranged from approximately $3,300 to $37,000 for a vaginal delivery and $8,300 to $71,000 for a caesarean section. This does not include the cost of routine or follow-up care.3

The amendment makes other changes to conform to federal law which are not anticipated to result in a fiscal impact to the state or municipalities.

Municipal Impact

As previously stated, the amendment will increase costs to certain fully insured, municipal plans that do not currently include pregnancy as a qualifying event for special enrollment. The coverage requirements will result in increased premium costs when municipalities enter into new health insurance contracts after January 1, 2018. In addition, many municipal health plans are recognized as “grandfathered” health plans under the ACA.4 It is unclear what effect the adoption of certain health mandates will have on the grandfathered status of certain municipal plans under ACA. Pursuant to federal law, self-insured health plans are exempt from state health mandates.

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.

1 The state employee and retiree health plan is a self-insured health plan. Pursuant to federal law, self-insured health plans are exempt from state health mandates. However, the state has traditionally adopted all state health mandates.

2 The range is based on employee only to family coverage. This excludes the Anthem Preferred Plan which is closed to new members and the Anthem Out of Area Plan.

3 Source: Analysis of Variation in Charges and Prices Paid for Vaginal and Caesarean Section Births: A Cross-Sectional Study, Hsia, R., Alcosa Antwi, Y., & Wever, E. (2013) BMJ, Vol. 4, Issue 1.

4 Grandfathered plans include most group insurance plans and some individual health plans created or purchased on or before March 23, 2010.