reglab/statecodes huggingface dataset:
Connecticut Administrative Code › Title 38a - Insurance Department › 192 - High Deductible Health Plans for Health Care Centers › Section 38a-192-1 - Definitions

Current through July 10, 2024
As used in Sections 38a-192-1 to
				38a-192-3
				inclusive:
(1) "Annual" means any 12
			 month period as determined by the contract;
(2) "Commissioner" means the Insurance
			 Commissioner;
(3) "Copay" means a
			 flat fee that an enrollee or member is required to pay each time a specified
			 service is rendered;
(4)
			 "Deductible" means the amount of covered expenses which must be accumulated
			 annually before benefits become payable as additional covered expenses
			 incurred;
(5) "Enrollee" means
			 "enrollee" as defined in section
			 38a-175(14)
			 of the Connecticut General Statutes;
(6) "Health Care Center" means "health care
			 center" as defined in section
			 38a-175(9)
			 of the Connecticut General Statutes;
(7) "High Deductible Plan" means a contract
			 for health care services that has an annual deductible for individuals of not
			 less than $1,500 for in-network services and an annual deductible for families
			 of not less than $3,000;
(8)
			 "Member" means "member" as defined in section
			 38a-175(14)
			 of the Connecticut General Statutes; and
(9) "Provider" means "provider" as defined in
			 section
			 38a-175(19)
			 of the Connecticut General Statutes.
Connecticut Administrative Code › Title 38a - Insurance Department › 192 - High Deductible Health Plans for Health Care Centers › Section 38a-192-2 - Method of providing access to health care

Current through July 10, 2024
(a) In addition
			 to the methods set forth in section
			 38a-177
			 of the Connecticut General Statutes and subject to section
			 38a-183
			 of the Connecticut General Statutes, a health care center may provide access to
			 health care through the use of a high deductible plan.
(b) Only expenses for health care services
			 that are generally covered by the nondeductible portion of the contract may be
			 applied against the deductible. This restriction includes limitations on
			 particular providers, including in-network and out-of-network providers, if
			 any, as set forth in the contract.
(c) Deductibles shall not be limited to
			 single benefit services only.
(d)
			 The expense for health care services applied against the deductible shall be
			 the actual amount paid to the provider by the member, enrollee or their
			 designee on behalf of the member or enrollee, excluding any amounts in excess
			 of the negotiated allowable expense and any copay amounts paid by the member,
			 enrollee or their designee on behalf of the member or enrollee.
(e) If a high deductible health plan is
			 intended to be federally tax qualified, there shall be disclosure on the face
			 page of the policy in quarter inch type or contrasting color that states: "This
			 policy is intended to be federally tax qualified. Approval by the Insurance
			 Department does not guarantee tax qualification and members and enrollees are
			 encouraged to seek the counsel of a tax advisor".
Connecticut Administrative Code › Title 38a - Insurance Department › 193 - Risk-Based Capital Requirements For Health Care Centers › Section 38a-193-1 - Definitions

Current through July 10, 2024
As used in sections 38a-193-1 to
				38a-193-13,
				inclusive, of the Regulations of Connecticut State Agencies:
(1) "Adjusted RBC report" means an RBC report
			 which has been adjusted by the commissioner in accordance with section
			 38a-193-2(d)
			 of the Regulations of Connecticut State Agencies;
(2) "Commissioner" means the Insurance
			 Commissioner of the State of Connecticut;
(3) "Corrective order" means an order issued
			 by the commissioner specifying corrective actions which the commissioner has
			 determined are required;
(4)
			 "Domestic health care center" means a health care center domiciled in this
			 state that is licensed to do health care center business in this state under
			 section
			 38a-41
			 of the Connecticut General Statutes;
(5) "Foreign health care center" means a
			 health care center that is licensed to do health care center business in this
			 state under section
			 38a-41
			 of the Connecticut General Statutes but is not domiciled in this
			 state;
(6) "Health care center"
			 means a "health care center" as defined in section
			 38a-175
			 of the Connecticut General Statutes, and includes both a domestic health care
			 center and a foreign health care center. This definition does not include an
			 organization that is licensed as an insurance company under section
			 38a-41
			 of the Connecticut General Statutes and that is otherwise subject to the
			 financial requirements of section
			 38a-72
			 of the Connecticut General Statutes;
(7) "NAIC" means the National Association of
			 Insurance Commissioners;
(8) "RBC"
			 means risk-based capital;
(9) "RBC
			 instructions" means the RBC report including risk-based capital instructions
			 adopted by the NAIC, as these RBC instructions may be amended by the NAIC from
			 time to time in accordance with the procedures adopted by the NAIC;
(10) "RBC level" means a health care center's
			 Company Action Level RBC, Regulatory Action Level RBC, Authorized Control Level
			 RBC, or Mandatory Control Level RBC where:
(A)
			 "Company Action Level RBC" means, with respect to any health care center, the
			 product of 2.0 and its Authorized Control Level RBC;
(B) "Regulatory Action Level RBC" means the
			 product of 1.5 and its Authorized Control Level RBC;
(C) "Authorized Control Level RBC" means the
			 number determined under the risk-based capital formula in accordance with the
			 RBC Instructions; and
(D)
			 "Mandatory Control Level RBC" means the product of .70 and the Authorized
			 Control Level RBC;
Connecticut Administrative Code › Title 38a - Insurance Department › 193 - Risk-Based Capital Requirements For Health Care Centers › Section 38a-193-2 - RBC reports

Current through July 10, 2024
(a) Every domestic
			 health care center shall, on or prior to each March 1 (the "filing date"),
			 prepare and submit to the commissioner a report of its RBC levels as of the end
			 of the calendar year just ended, in a form and containing such information as
			 is required by the RBC instructions. In addition, a domestic health care center
			 shall file its RBC report:
(1) With the NAIC
			 in accordance with the RBC instructions; and
(2) With the insurance commissioner of any
			 other state in which the domestic health care center is authorized to do health
			 care center business, if such insurance commissioner requests, in writing, that
			 such domestic health care center submit such RBC report to such insurance
			 commissioner, in which case the health care center shall file its RBC report
			 not later than the later of:
(A) Fifteen (15)
			 days after such domestic health care center received such request; or
(B) The filing date.
Connecticut Administrative Code › Title 38a - Insurance Department › 193 - Risk-Based Capital Requirements For Health Care Centers › Section 38a-193-3 - Company action level event

Current through July 10, 2024
(a) As used in
			 sections
			 38a-193-1 to
			 38a-198-13, inclusive, of the Regulations of Connecticut State Agencies,
			 "Company Action Level Event" means any of the following events:
(1) The filing of an RBC report by a health
			 care center that indicates that the health care center's total adjusted capital
			 is greater than or equal to its Regulatory Action Level RBC but less than its
			 Company Action Level RBC;
(2) If a
			 health care center has total adjusted capital which is greater than or equal to
			 its Company Action Level RBC but less than the product of its Authorized
			 Control Level RBC and 3.0 and triggers the trend test determined in accordance
			 with the trend test calculation included in the Health RBC
			 instructions;
(3) notification by
			 the commissioner to the health care center of an adjusted RBC report that
			 indicates an event in subdivision (1) of this subsection, provided the health
			 care center does not challenge the adjusted RBC report under section
			 38a-193-7 of the
			 Regulations of Connecticut State Agencies; or
(4) if, pursuant to section
			 38a-193-7 of the
			 Regulations of Connecticut State Agencies, a health care center challenges an
			 adjusted RBC report that indicates the event in subdivision (1) of this
			 subsection, the notification by the commissioner to the health care center that
			 the commissioner has, after a hearing, rejected the health care center's
			 challenge.
Connecticut Administrative Code › Title 38a - Insurance Department › 193 - Risk-Based Capital Requirements For Health Care Centers › Section 38a-193-5 - Authorized control level event

Current through July 10, 2024
(a) As used in
			 Sections
			 38a-193-1 to
			 38a-193-13,
			 inclusive, of the Regulations of Connecticut State Agencies, "Authorized
			 Control Level Event" means any of the following events:
(1) The filing of a RBC report by the health
			 care center that indicates that the health care center's total adjusted capital
			 is greater than or equal to its Mandatory Control Level RBC but less than its
			 Authorized Control Level RBC;
(2)
			 the notification by the commissioner to the health care center of an adjusted
			 RBC report that indicates the event in subdivision (1) of this subsection,
			 provided the health care center does not challenge the adjusted RBC report
			 under section
			 38a-193-7 of the
			 Regulations of Connecticut State Agencies;
(3) if, pursuant to section
			 38a-193-7 of the
			 Regulations of Connecticut State Agencies, the health care center challenges an
			 adjusted RBC report that indicates the event in subdivision (1) of this
			 subsection, notification by the commissioner to the health care center that the
			 commissioner has, after a hearing, rejected the health care center's
			 challenge;
(4) the failure of the
			 health care center to respond, in a manner satisfactory to the commissioner, to
			 a corrective order (provided the health care center has not challenged the
			 corrective order under section
			 38a-193-7 of the
			 Regulations of Connecticut State Agencies); or
(5) if the health care center has challenged
			 a corrective order under section
			 38a-193-7 of the
			 Regulations of Connecticut State Agencies and the commissioner has, after a
			 hearing, rejected the challenge or modified the corrective order, the failure
			 of the health care center to respond, in a manner satisfactory to the
			 commissioner, to the corrective order subsequent to rejection or modification
			 by the commissioner.
Connecticut Administrative Code › Title 38a - Insurance Department › 193 - Risk-Based Capital Requirements For Health Care Centers › Section 38a-193-6 - Mandatory control level event

Current through July 10, 2024
(a) As used in
			 Sections
			 38a-193-1 to
			 38a-193-13,
			 inclusive, of the Regulations of Connecticut State Agencies, "Mandatory Control
			 Level Event" means any of the following events:
(1) The filing of a RBC report which
			 indicates that the health care center's total adjusted capital is less than its
			 Mandatory Control Level RBC;
(2)
			 notification by the commissioner to the health care center of an adjusted RBC
			 report that indicates the event in subdivision (1) of this subsection, provided
			 the health care center does not challenge the adjusted RBC report under section
			 38a-193-7 of the
			 Regulations of Connecticut State Agencies; or
(3) if, pursuant to section
			 38a-193-7 of the
			 Regulations of Connecticut State Agencies, the health care center challenges an
			 adjusted RBC report that indicates the event in subdivision (1) of this
			 subsection, notification by the commissioner to the health care center that the
			 commissioner has, after a hearing, rejected the health care center's
			 challenge.
Connecticut Administrative Code › Title 38a - Insurance Department › 193 - Risk-Based Capital Requirements For Health Care Centers › Section 38a-193-7 - Hearings

Current through July 10, 2024
The health care center shall have the right to a departmental
				hearing, on a record, at which the health care center may challenge any
				determination or action by the commissioner upon:
(1) Notification to a health care center by
			 the commissioner of an adjusted RBC report;
(2) notification to a health care center by
			 the commissioner that the health care center's RBC plan or revised RBC plan is
			 unsatisfactory; and Notification constitutes a Regulatory Action Level Event
			 with respect to the health care center;
(3) notification to a health care center by
			 the commissioner that the health care center has failed to adhere to its RBC
			 plan or revised RBC plan and that the failure has a substantial adverse effect
			 on the ability of the health care center to eliminate the Company Action Level
			 Event with respect to the health care center in accordance with its RBC plan or
			 revised RBC plan; or
(4)
			 notification to a health care center by the commissioner of a corrective order
			 with respect to the health care center.
Connecticut Administrative Code › Title 38a - Insurance Department › 193 - Risk-Based Capital Requirements For Health Care Centers › Section 38a-193-9 - Supplemental provisions; exemption

Current through July 10, 2024
(a) The provisions
			 of sections
			 38a-193-1 to
			 38a-193-13,
			 inclusive, of the Regulations of Connecticut State Agencies are supplemental to
			 any other provisions of the laws and regulations of this state, and shall not
			 preclude or limit any other powers or duties of the commissioner under such
			 laws, including, but not limited to, Chapter 704c of the Connecticut General
			 Statutes and sections
			 38a-8-101 to
			 38a-8-104,
			 inclusive, of the Regulations of Connecticut State Agencies.
(b) The commissioner may exempt from the
			 application of sections
			 38a-193-1 to
			 38a-193-13,
			 inclusive, of the Regulations of Connecticut State Agencies a domestic health
			 care center that:
(1) assumes no reinsurance
			 in excess of five percent (5%) of direct premium written; and
(2) writes direct annual premiums for
			 comprehensive medical business of $2,000,000 or less.
Connecticut Administrative Code › Title 38a - Insurance Department › 193 - Risk-Based Capital Requirements For Health Care Centers › Section 38a-193-9a - Foreign Health Care Centers

Current through July 10, 2024
(a)
(1) A foreign health care center shall, upon
			 the written request of the commissioner, submit to the commissioner an RBC
			 report for the calendar year just ended, on or prior to the later of:
(A) The date on which the foreign health care
			 center would be required to submit an RBC report under sections
			 38a-193-1 to
			 38a-193-13,
			 inclusive, of the Regulations of Connecticut State Agencies if such foreign
			 health care center were a domestic health care center; or
(B) Fifteen (15) days after the foreign
			 health care center received such request.
Connecticut Administrative Code › Title 38a - Insurance Department › 193 - Risk-Based Capital Requirements For Health Care Centers › Section 38a-193-11 - Notices

Current through July 10, 2024
All notices by the commissioner to a health care center that
				may result in regulatory action under sections
				38a-193-1 to
				38a-193-13,
				inclusive, of the Regulations of Connecticut State Agencies shall be effective
				upon dispatch if transmitted by registered or certified mail, or in the case of
				any other transmission shall be effective upon the health care center's receipt
				of notice.
Connecticut Administrative Code › Title 38a - Insurance Department › 193 - Risk-Based Capital Requirements For Health Care Centers › Section 38a-193-13 - Severability

Current through July 10, 2024
If any provision of sections
				38a-193-1 to
				38a-193-13, inclusive, of the Regulations of Connecticut State Agencies or its
				application to any person or circumstance, is held invalid by a court of
				competent jurisdiction, that determination shall not affect the provisions or
				applications of sections
				38a-193-1 to
				38a-193-13, inclusive, of the Regulations of Connecticut State Agencies that
				can be given effect without the invalid provision or application, and to that
				end the provisions of sections
				38a-193-1 to
				38a-193-13, inclusive, of the Regulations of Connecticut State Agencies are
				severable.
Connecticut Administrative Code › Title 38a - Insurance Department › 199 - Standards for Approval of Clinics › Section 38a-199-1 - Clinic defined

Current through July 10, 2024
For the purposes of sections
				38a-199-2
				to
				38a-199-6,
				inclusive, of these regulations a clinic is an organization which provides
				out-patient medical or dental care for diagnosis, treatment and care of persons
				with chronic or acute conditions.
Connecticut Administrative Code › Title 38a - Insurance Department › 199 - Standards for Approval of Clinics › Section 38a-199-2 - Building and equipment requirements

Current through July 10, 2024
(a) A clinic
			 building shall be of sound construction and shall provide adequate space and
			 equipment for patient interviews, physical examinations and treatment of
			 patients and for service and other areas in accordance with the requirements of
			 the state department of health.
(b)
			 Clinic buildings and equipment shall meet the requirements of the state fire
			 safety code. Annual application for approval shall be accompanied by a
			 certificate of inspection by the local fire marshal.
(c) Areas in which explosive gases or
			 radioactive materials are used shall provide for adequate protection of
			 patients and personnel.
(d) The
			 clinic buildings and equipment shall be maintained in a good state of repair
			 and shall be kept clean at all times.
Connecticut Administrative Code › Title 38a - Insurance Department › 199 - Standards for Approval of Clinics › Section 38a-199-3 - Governing board. Administrator. Personnel

Current through July 10, 2024
(a) A clinic
			 shall be managed by a governing board whose duties shall include, as a minimum:
(1) Adoption of bylaws, rules and
			 regulations, including medical or dental staff bylaws or both;
(2) annual appointment of the medical or
			 dental staff with annual designation of a medical or dental director;
(3) appointment of a clinic
			 administrator qualified on the basis of training and experience approved by the
			 commissioner of health.
Connecticut Administrative Code › Title 38a - Insurance Department › 199 - Standards for Approval of Clinics › Section 38a-199-4 - Professional staff

Current through July 10, 2024
(a) There shall be
			 an organized professional staff of not fewer than three members of the major
			 profession or professions providing care in the clinic and, in a rehabilitation
			 clinic, a staff including a medical director and physical therapist and one
			 other major profession providing care in the clinic.
(b) The professional staff shall adopt
			 written rules or regulations governing its own activities, subject to approval
			 of the governing board of the clinic. As a minimum these shall include:
(1) Methods of control of privileges granted
			 to members of the medical or dental staff and the responsibilities of the
			 medical or dental director;
(2)
			 method of professional supervision of clinical work;
(3) provision for regular staff meetings;
(4) preparation of adequate case
			 records;
(5) procedure for
			 recommending appointments to the staff and for hearing complaints regarding the
			 conduct of members, referring the same, with recommendations, to the governing
			 board.
Connecticut Administrative Code › Title 38a - Insurance Department › 199 - Standards for Approval of Clinics › Section 38a-199-5 - Records

Current through July 10, 2024
(a) There shall be a medical or dental
			 records department with adequate space and equipment and qualified
			 personnel.
(b) A medical or dental
			 record shall be started for each patient at the time of admission, including
			 proper identifying data. Medical and dental records shall include sufficient
			 information to justify the diagnosis and warrant the treatment given. Each
			 entry shall be signed by the person responsible for it.
(c) Medical and dental records shall be filed
			 in an accessible manner in the clinic, with proper provision for their
			 confidentiality, and shall be kept for a minimum of five years after discharge
			 of the patient.
Connecticut Administrative Code › Title 38a - Insurance Department › 199 - Standards for Approval of Clinics › Reserve Requirements for Hospital Service Corporation › Section 38a-199-7 - Authority

Current through July 10, 2024
The following regulations are adopted pursuant to Section
				  38a-199
				  of the General Statutes of Connecticut as amended by Section 1 of Public Act
				  74-5 and, as applicable, Public Act 74-7.
Connecticut Administrative Code › Title 38a - Insurance Department › 199 - Standards for Approval of Clinics › Reserve Requirements for Hospital Service Corporation › Section 38a-199-8 - Definitions

Current through July 10, 2024
As used in Reg. Sec.
				  38a-199-7 to Reg. Sec.
				  38a-199-13:
				  "Ascertained Experience" means the loss and expense ratio for the most recent
				  twelve-month period of operation, or such other period as the commissioner may
				  deem appropriate.
"Commissioner" means the insurance commissioner.
"Contingency Reserves" and "Reserve for Contingencies" means
				  the unassigned funds held over and above the Policy Contract Liability Reserves
				  as defined in these regulations and all other liabilities.
"Policy Contract Liability Reserves" means the reserves held
				  for present claims or claims in process plus the reserves held for future or
				  deferred benefits and for unearned premiums.
All technical words and phrases and such as have acquired a
				  peculiar and appropriate meaning in the law and in the field of insurance shall
				  be construed and understood accordingly.
Connecticut Administrative Code › Title 38a - Insurance Department › 199 - Standards for Approval of Clinics › Reserve Requirements for Hospital Service Corporation › Section 38a-199-9 - Policy contract liability reserves

Current through July 10, 2024
Each hospital service corporation shall maintain Policy
				  Contract Liability Reserves at a level consistent with the following
				  requirements:
Minimum.
An amount sufficient to pay and adjust
				  all present claims and claims in process when and as such claims become due,
				  plus an amount sufficient to pay and adjust all future claims or deferred
				  benefits as and when such benefits become due and to cover unearned premiums.
				  The standards of payment and adjustment of claims when and as such become due
				  shall be in accordance with the standards required of insurance companies under
				  the provisions of Section
				  38a-17
				  of the General Statutes of Connecticut, as it may from time to time be
				  amended.
Maximum.
An amount not to exceed the minimum as
				  hereinbefore defined plus amounts computed and as approved by the commissioner
				  to compensate for inflationary trends, projected increased costs for the future
				  or deferred benefits, interest charges which may become due on settlement of
				  disputed claims, and changing claim frequency in respect to future or deferred
				  benefits.
Connecticut Administrative Code › Title 38a - Insurance Department › 199 - Standards for Approval of Clinics › Reserve Requirements for Hospital Service Corporation › Section 38a-199-10 - Congingency reserves

Current through July 10, 2024
Each hospital service corporation shall maintain Contingency
				  Reserves at a minimum level computed on the following basis:
The amount required by insurance companies licensed to
				  transact accident and health insurance, under Section
				  38a-72
				  of the General Statutes as it may from time to time be amended, plus the
				  greater of (1) an amount equal to the average monthly cost of claims and
				  expense for the preceding twelve months or (2) an amount which bears a
				  reasonable relation to the liabilities of such corporation.
If a corporation's reserve falls below an amount equal to
				  Section
				  38a-72
				  plus the net loss in the previous two years, the corporation shall act to
				  restore the reserve to at least that amount.
Permissible additions to minimum.
Subject to the
				  approval of the commissioner, in addition to such minimum Contingency Reserves,
				  further Contingency Reserves may be accumulated by the subject corporation
				  based upon the following factors:
(1)
				Stability, solvency, and interest of the corporation and the interests of the
				policyholders and other affected persons, including such specific objectives as
				rate stability, inflationary trends, deviations from the forecast of changing
				claim frequency, market fluctuations, and the possibility of epidemics and
				catastrophes;
(2) Present or
				projected public service pilot projects which are undertaken for the purpose of
				providing more and better care in the manner most economical to the
				subscribers;
(3) Costs of
				consolidations, acquisitions, or mergers as provided by law;
(4) Capital expenditures reasonably related
				to the general purposes of the corporation;
(5) Proposed increases in benefits without
				fully compensating rate increases;
(6) Projected profit or loss forecasts
				together with any other factors reasonably tending to justify the maintenance,
				increase, or decrease of any such Contingency Reserve.
Maximum.
No hospital service corporation subject
				  to these regulations shall maintain Contengency Reserves in amounts greater
				  than the minimum as hereinabove defined, plus the permissible additions to the
				  minimum prescribed above and provided the approval of the commissioner has been
				  obtained prior to the reserving of the permissible additions.
Maximum limit.
The maximum Contingency Reserves
				  which may be maintianed by any hospital service corporation subject to these
				  regulations shall in no event be greater than an amount equal to 50 percent of
				  the preceding twelve months cost of claims and expense of such
				  corporation.
Connecticut Administrative Code › Title 38a - Insurance Department › 199 - Standards for Approval of Clinics › Reserve Requirements for Hospital Service Corporation › Section 38a-199-11 - Changes in contingency reserve levels

Current through July 10, 2024
The commissioner may, after a hearing called at the request
				  of any interested person admitted as a party for the purpose of any such
				  hearing or on his own motion, order the maintenance, increase, or decrease of
				  any such Contingency Reserve, whether in connection with a rate change or
				  otherwise, consistent with these regulations and other requirements, and may
				  require such hospital service corporation to adjust its rates or benefits or
				  both to accomplish any adjustment in such reserve.
Connecticut Administrative Code › Title 38a - Insurance Department › 199 - Standards for Approval of Clinics › Reserve Requirements for Hospital Service Corporation › Section 38a-199-12 - Standards

Current through July 10, 2024
In permitting and approving adjustments in accordance with
				  these regulations, the commissioner may consider the Ascertained Experience of
				  the hospital service corporation and may use as a basis such reasonable periods
				  of time as he may deem appropriate. The commissioner in determining the
				  computations shall consider the interest of the subscribers and the solvency of
				  the hospital service corporation.
Connecticut Administrative Code › Title 38a - Insurance Department › 214 - Reserve Requirements for Medical Service Corporations › Section 38a-214-2 - Definitions

Current through July 10, 2024
As used in Reg. Sec.
				38a-214-1 to Reg. Sec.
				38a-214-7:
"Ascertained Experienced" means the loss and expense ratio for
				the most recent twelve-month period of operation, or such other period as the
				commissioner may deem appropriate.
"Commissioner" means the insurance commissioner.
"Contingency Reserves" and "Reserve for Contingencies" means
				the unassigned funds held over and above the Policy Contract Liability Reserves
				as defined in these regulations and all other liabilities.
"Policy Contract Liability Reserves" means the reserves held
				for present claims or claims in process plus the reserves held for future or
				deferred benefits and for unearned premiums.
All technical words and phrases and such as have acquired a
				peculiar and appropriate meaning in the law and in the field of insurance shall
				be construed and understood accordingly.
Connecticut Administrative Code › Title 38a - Insurance Department › 214 - Reserve Requirements for Medical Service Corporations › Section 38a-214-3 - Policy contract liability reserves

Current through July 10, 2024
Each medical service corporation shall maintain Policy Contract
				Liability Reserves at a level consistent with the following
				requirements:
Minimum.
An amount sufficient to pay and adjust
				all present claims and claims in process when and as such claims become due,
				plus an amount sufficient to pay and adjust all future claims or deferred
				benefits as and when such benefits become due and to cover unearned premiums.
				The standards of payment and adjustment of claims when and as such become due
				shall be in accordance with the standards required of insurance companies under
				the provisions of Section
				38a-17
				of the General Statutes of Connecticut, as it may from time to time be
				amended.
Maximum.
An amount not to exceed the minimum as
				hereinbefore defined plus amounts computed and as approved by the commissioner
				to compensate for inflationary trends, projected increased costs for the future
				or deferred benefits, interest charges which may become due on settlement of
				disputed claims, and changing claim frequency in respect to future or deferred
				benefits.
Connecticut Administrative Code › Title 38a - Insurance Department › 214 - Reserve Requirements for Medical Service Corporations › Section 38a-214-4 - Contingency reserves

Current through July 10, 2024
Each medical service corporation shall maintain Contingency
				Reserves at a minimum level computed on the following basis:
The amount required by insurance companies licensed to transact
				accident and health insurance, under Section 38-93 of the General Statutes as
				it may from time to time be amended, plus the greater of (1) an amount equal to
				the average monthly cost of claims and expense for the preceding twelve months
				or (2) an amount which bears a reasonble relation to the liabilities of such
				corporation.
If a corporation's reserve falls below an amount equal to
				Section
				38a-72
				plus the net loss in the previous two years, the corporation shall act to
				restore the reserve to at least that amount.
Permissible additions to minimum.
Subject to the
				approval of the commissioner, in addition to such minimum Contingency Reserves,
				further Contingency Reserves may be accumulated by the subject corporation
				based upon the following factors:
(1)
			 Stability, solvency, and interest of the corporation and the interests of the
			 policyholders and other affected persons, including such specific objectives as
			 rate stability, inflationary trends, deviations from the forecast of changing
			 claim frequency, market fluctuations, and the possibility of epidemics and
			 catastrophes;
(2) Present or
			 projected public service pilot projects which are undertaken for the purpose of
			 providing more and better care in the manner most economical to the
			 subscribers;
(3) Costs of
			 consolidations, acquisitions, or mergers as provided by law;
(4) Capital expenditures reasonably related
			 to the general purposes of the corporation;
(5) Proposed increases in benefits without
			 fully compensating rate increases;
(6) Projected profit or loss forecasts
			 together with any other factors reasonably tending to justify the maintenance,
			 increase, or decrease of any such Contingency Reserve.
Maximum.
No medical service corporation nor any
				merged corporation subject to these regulations shall maintain Contingency
				Reserves in amounts greater than the minimum as hereinabove defined, plus the
				permissible additions to the minimum prescribed above and provided the approval
				of the commissioner had been obtained prior to the reserving of the permissible
				additions.
Maximum limit.
The maximum Contingency Reserves
				which may be maintained by any medical service corporation subject to these
				regulations shall in no event be greater than an amount equal to 50 percent of
				the preceding twelve months cost of claims and expense of such
				corporation.
Connecticut Administrative Code › Title 38a - Insurance Department › 214 - Reserve Requirements for Medical Service Corporations › Section 38a-214-5 - Changes in contingency reserve levels

Current through July 10, 2024
The commissioner may, after a hearing called at the request of
				any interested person admitted as a party for the purpose of any such hearing
				or on his own motion, order the maintenance, increase, or decrease of any such
				Contingency Reserve, whether in connection with a rate change or otherwise,
				consistent with these regulations and other requirements, and may require such
				medical service or merged corporation to adjust its rates or benefits or both
				to accomplish any adjustment in such reserve.
Connecticut Administrative Code › Title 38a - Insurance Department › 214 - Reserve Requirements for Medical Service Corporations › Section 38a-214-6 - Standards

Current through July 10, 2024
In permitting and approving adjustments in accordance with
				these regulations, the commissioner may consider the Ascertained Experience of
				the medical service corporation and may use as a basis such reasonable periods
				of time as he may deem appropriate. The commissioner in determining the
				computations shall consider the interest of the subscribers and the solvency of
				the medical service corporation.
Connecticut Administrative Code › Title 38a - Insurance Department › 272 - Reporting Requirements for Licensees Seeking to do Business With Certain Unauthorized Multiple Employer Welfare Arrangements › Section 38a-272-1 - Authority

Current through July 10, 2024
Sections 38a-272-1 to
				38a-272-10,
				inclusive, are adopted pursuant to the authority of Section
				38a-8
				of the General Statutes as necessary to implement Sections
				38a-271
				to
				38a-278,
				inclusive,
				38a-703,
				and
				38a-815
				of the General Statutes.
Connecticut Administrative Code › Title 38a - Insurance Department › 272 - Reporting Requirements for Licensees Seeking to do Business With Certain Unauthorized Multiple Employer Welfare Arrangements › Section 38a-272-2 - Purpose

Current through July 10, 2024
The Insurance Department has become aware that certain health
				benefit arrangements have been transacting unauthorized insurance in this state
				with the assistance and through the professional services of persons licensed
				by the Department. In many cases these arrangements claim that state insurance
				laws and regulations applicable to the entity are preempted by the federal
				Employee Retirement Income Security Act of 1974 ("ERISA"),
				29 U.S.C. §
									1001,
et seq.
Licensees
				apparently have believed that they can provide professional services to such
				arrangements under a claimed ERISA preemption. Often, such arrangements are
				singularly referred to as a multiple employer welfare arrangement
				("MEWA").
However, recent advisory opinions from the U.S. Department of
				Labor have made it clear that the ERISA preemption claims of many of these
				arrangements are false and that state insurance laws and regulations, including
				state laws related to the transaction of unauthorized insurance, are fully
				applicable to many arrangements that have claimed ERISA preemption.
The purpose of this regulation is to require licensed agents,
				brokers, and insurers to submit information to the Insurance Department prior
				to assisting in any way the transaction of insurance by certain types of
				multiple employer arrangements identified in this regulation. These reports
				will help the Department identify unauthorized insurance arrangements so that
				they can protect themselves from potential liability for assisting in the
				transaction of unauthorized insurance.
Connecticut Administrative Code › Title 38a - Insurance Department › 272 - Reporting Requirements for Licensees Seeking to do Business With Certain Unauthorized Multiple Employer Welfare Arrangements › Section 38a-272-3 - Definitions

Current through July 10, 2024
As used in Sections 38a-272-3 to
				38a-272-10
				inclusive:
(a) "Arrangement" means a
			 fund, trust, plan, program or other mechanism by which a person provides, or
			 attempts to provide, health care benefits to individuals.
(b) "Collectively bargained arrangement"
			 means an arrangement which provides or represents that it is providing health
			 care benefits or coverage under or pursuant to one or more collective
			 bargaining agreements. "Collectively bargained arrangement" does not include an
			 arrangement that is fully insured by a licensed insurer.
(c) "Commissioner" means the insurance
			 commissioner of this state.
(d)
			 "Employee leasing arrangement" means labor leasing, staff leasing, employee
			 leasing, contract labor, extended employee staffing or supply, or other
			 arrangements, under contract or otherwise, whereby one business or entity
			 leases or obtains all or a significant number of its workers from another
			 business or entity.
(e) "Employee
			 welfare benefit plan" means any plan, fund or program which was heretofore or
			 is hereafter established or maintained by an employer or by an employee
			 organization, or by both, to the extent that such plan, fund or program was
			 established or is maintained for the purpose of providing for its participants
			 or their beneficiaries, through the purchase of insurance or otherwise,
			 medical, surgical or hospital care benefits, or benefits in the event of
			 sickness, accident disability, death or unemployment.
(f) "Fully insured by a licensed insurer"
			 means that, for all of the health care benefits or coverage provided or offered
			 by or through an arrangement:
(1) A licensed
			 insurer is directly obligated by contract to provide all of the coverage to or
			 under the arrangement;
(2) The
			 licensed insurer assumes all of the risk for payment of all covered services or
			 benefits; and
(3) The liability of
			 the licensed insurer for payment of the covered services or benefits runs
			 directly to the individual employee, member or dependent receiving the health
			 care services.
Connecticut Administrative Code › Title 38a - Insurance Department › 272 - Reporting Requirements for Licensees Seeking to do Business With Certain Unauthorized Multiple Employer Welfare Arrangements › Section 38a-272-4 - Producers prohibited from assisting reportable MEWAs prior to filing

Current through July 10, 2024
(a) No producer may solicit, advertise, or
			 market in this state health benefits or coverage from, or accept an application
			 for, or place coverage for a person who resides in this state with, a
			 reportable MEWA unless the producer first files the information required under
			 Section
			 38a-272-9.
(b) No producer may solicit another producer
			 to enter into an arrangement to solicit, advertise or market services, health
			 benefits or coverage of a reportable MEWA unless the producer first files the
			 information required under Section
			 38a-272-9.
Connecticut Administrative Code › Title 38a - Insurance Department › 272 - Reporting Requirements for Licensees Seeking to do Business With Certain Unauthorized Multiple Employer Welfare Arrangements › Section 38a-272-5 - Producers prohibited from assisting employee leasing arrangements prior to filing

Current through July 10, 2024
(a) No producer may
			 solicit, advertise or market in this state the services, health benefits or
			 coverage of an employee leasing arrangement or a person or arrangement which
			 represents itself as an employee leasing arrangement unless the producer first
			 files the information required under Section
			 38a-272-9.
(b) No producer may solicit another producer
			 to enter into an arrangement to solicit, advertise or market the services,
			 health benefits or coverage of an employee leasing arrangement unless the
			 producer first files the information required under Section
			 38a-272-9.
Connecticut Administrative Code › Title 38a - Insurance Department › 272 - Reporting Requirements for Licensees Seeking to do Business With Certain Unauthorized Multiple Employer Welfare Arrangements › Section 38a-272-6 - Producers prohibited from assisting collectively bargained arrangements prior to filing

Current through July 10, 2024
(a) No producer may
			 solicit, advertise, or market in this state health benefits or coverage from,
			 or accept an application for, or place coverage for a person who resides in
			 this state with, a collectively bargained arrangement unless the producer first
			 files the information required under Section
			 38a-272-9.
(b) No producer may solicit another producer
			 to enter into an arrangement to solicit, advertise or market health benefits or
			 coverage of a collectively bargained arrangement unless the producer first
			 files the information required under Section
			 38a-272-9.
Connecticut Administrative Code › Title 38a - Insurance Department › 272 - Reporting Requirements for Licensees Seeking to do Business With Certain Unauthorized Multiple Employer Welfare Arrangements › Section 38a-272-7 - Licensed insurers prohibited from assisting reportable MEWAs prior to filing

Current through July 10, 2024
(a) No licensed
			 insurer may solicit or effect coverage of, underwrite for, collect charges or
			 premiums for, adjust or settle claims of a resident of this state for, or enter
			 into any agreement to perform any of those functions for a reportable MEWA that
			 provides coverage to residents of this state unless the insurer first files the
			 information required under Section
			 38a-272-9.
(b) A licensed insurer which issues or has
			 issued any insurance coverage to a reportable MEWA that covers residents of
			 this state, including, but not limited to, a specific aggregate stop-loss
			 coverage, shall file the information required under Section
			 38a-272-9
			 within thirty (30) days after the coverage is issued or within thirty (30) days
			 after the date the reportable MEWA first provides coverage to a resident of
			 this state, whichever is later.
Connecticut Administrative Code › Title 38a - Insurance Department › 272 - Reporting Requirements for Licensees Seeking to do Business With Certain Unauthorized Multiple Employer Welfare Arrangements › Section 38a-272-8 - Lack of knowledge not a defense

Current through July 10, 2024
(a) Lack of
			 knowledge or intent to deceive with respect to the organization or status of
			 insurance coverage of a reportable MEWA, employee leasing firm or collectively
			 bargained arrangement is not a defense to a violation of this
			 regulation.
(b) A filing under this
			 regulation is solely for the purpose of providing information to the
			 commissioner. This regulation and any filing made thereunder do not authorize
			 or license a reportable MEWA, employee leasing firm, collectively bargained
			 arrangement or any other arrangement to engage in business in this state if
			 otherwise prohibited by law.
Connecticut Administrative Code › Title 38a - Insurance Department › 272 - Reporting Requirements for Licensees Seeking to do Business With Certain Unauthorized Multiple Employer Welfare Arrangements › Section 38a-272-9 - Information required to be filed and kept current

Current through July 10, 2024
(a) A
			 producer or insurer required to file under Sections
			 38a-272-4
			 through
			 38a-272-7
			 shall file all of the following information on a form prescribed by the
			 Commissioner:
(1) A copy of the organizational
			 documents of the reportable MEWA, employee leasing firm or collectively
			 bargained arrangement, including the articles of incorporation and bylaws,
			 partnership agreement or trust instrument;
(2) A copy of each insurance or reinsurance
			 contract which purports to insure or guarantee all or any portion of benefits
			 or coverage offered by the reportable MEWA, employee leasing firm or
			 collectively bargained arrangement to any person who resides in this
			 state;
(3) Copies of the benefit
			 plan description and other materials intended to be distributed to potential
			 purchasers; and
(4) The names and
			 addresses of any person performing or expected to perform the functions of a
			 third party administrator for the reportable MEWA, employee leasing firm or
			 collectively bargained arrangement.
Connecticut Administrative Code › Title 38a - Insurance Department › 272 - Reporting Requirements for Licensees Seeking to do Business With Certain Unauthorized Multiple Employer Welfare Arrangements › Section 38a-272-10 - Liability for violation

Current through July 10, 2024
In addition to the penalties provided in Section
				38a-278
				of the Connecticut General Statutes that may be imposed by the Commissioner, in
				the event that an arrangement that is an unauthorized insurer fails to pay a
				claim or loss in this state within the provisions of its contract, any person
				who assisted or in any manner aided directly or indirectly in the procurement
				of such insurance contract shall be liable in accordance with Section
				38a-275
				of the Connecticut General Statutes to the insured for the full amount of the
				claim or loss in the manner provided by the provisions of such insurance
				contract.
Connecticut Administrative Code › Title 38a - Insurance Department › 288 - Insurance on Motor Vehicles Sold Under Installment Contracts or Pledged for a Loan › Section 38a-288-2 - Description of insurance to purchaser or borrower

Current through July 10, 2024
There shall be a complete disclosure of insurance obtained by a
				dealer, finance factor or lender from an insurance company or an authorized
				agent thereof, which shall be made in all cases to the ultimate purchaser of
				such insurance, as follows:
(a) In no
			 instance shall the insurance company issue a policy or policies unless a
			 statement setting forth a clear and concise description of the insurance
			 coverage has been furnished to the purchaser or borrower at the time of the
			 sale or loan transaction. The policy or policies, when issued and, within the
			 time limit prescribed by section 36a-773 of the Connecticut General Statutes
			 after execution of a retail installment sale contract, shall be sent to the
			 purchaser or borrower and shall indicate clearly the amount of the premium, the
			 kind or kinds of insurance and the scope of the coverage and shall contain all
			 of the terms, exceptions, restrictions and conditions of the contract or
			 contracts of insurance.
(b)
			 Policies not containing public liability or property damage coverage shall be
			 clearly stamped or printed to the effect that such coverage is not included in
			 the policy.