Conn. Gen. Stat. § 38a-564

Current with legislation from the 2024 Regular and Special Sessions.

Section 38a-564 - Definitions

As used in this section and sections 38a-566, 38a-567, 38a-569 and 38a-574:

(1) "Pool" means the Connecticut Small Employer Health Reinsurance Pool, established under section 38a-569.

(2) "Board" means the board of directors of the pool.

(3) "Employee" means an individual employed by an employer. "Employee" does not include (A) an individual and such individual's spouse with respect to an incorporated or unincorporated trade or business that is wholly owned by such individual, by such individual's spouse or by such individual and such individual's spouse, or (B) a partner in a partnership and such partner's spouse with respect to such partnership.

(4)

(A) "Small employer" means

(i) prior to January 1, 2016, an employer that employed an average of at least one but not more than fifty employees on business days during the preceding calendar year and employs at least one employee on the first day of the group health insurance plan year,

(ii) on and after January 1, 2016, and prior to January 1, 2025, an employer that employed an average of at least one but not more than one hundred employees on business days during the preceding calendar year and employs at least one employee on the first day of the group health insurance plan year, except the commissioner may postpone said January 1, 2016, date to be consistent with any such postponement made by the Secretary of the United States Department of Health and Human Services under the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, and

(iii) on and after January 1, 2025, an employer that employed an average of at least one but not more than fifty employees on business days during the preceding calendar year and employs at least one employee on the first day of the group health insurance plan year. "Small employer" does not include a sole proprietorship that employs only the sole proprietor or the spouse of such sole proprietor.

(B)

(i) For purposes of subparagraph (A) of this subdivision, the number of employees shall be determined by adding (I) the number of full-time employees for each month who work a normal work week of thirty hours or more, and (II) the number of full-time equivalent employees, calculated for each month by dividing by one hundred twenty the aggregate number of hours worked for such month by employees who work a normal work week of less than thirty hours, and averaging such total for the calendar year.

(ii) If an employer was not in existence throughout the preceding calendar year, the number of employees shall be based on the average number of employees that such employer reasonably expects to employ in the current calendar year.

(C) All persons treated as a single employer under Section 414 of the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as amended from time to time, shall be considered a single employer for purposes of this subdivision.

(5) "Insurer" means any insurance company, hospital service corporation, medical service corporation or health care center, authorized to transact health insurance business in this state.

(6) "Insurance arrangement" means any multiple employer welfare arrangement, as defined in Section 3 of the Employee Retirement Income Security Act of 1974, as amended from time to time, except for any such arrangement that is fully insured within the meaning of Section 514(b)(6) of said act, as amended from time to time.

(7) "Health insurance plan" means any hospital and medical expense incurred policy, hospital or medical service plan contract and health care center subscriber contract. "Health insurance plan" does not include (A) accident only, credit, dental, vision, Medicare supplement, long-term care or disability insurance, hospital indemnity coverage, coverage issued as a supplement to liability insurance, insurance arising out of a workers' compensation or similar law, automobile medical-payments insurance, or insurance under which beneficiaries are payable without regard to fault and which is statutorily required to be contained in any liability insurance policy or equivalent self-insurance, or (B) policies of specified disease or limited benefit health insurance, provided the carrier offering such policies files on or before March first of each year a certification with the commissioner that contains the following:

(i) A statement from the carrier certifying that such policies are being offered and marketed as supplemental health insurance and not as a substitute for hospital or medical expense insurance;

(ii) a summary description of each such policy including the average annual premium rates, or range of premium rates in cases where premiums vary by age, gender or other factors, charged for such policies in the state; and

(iii) in the case of a policy that is described in this subparagraph and that is offered for the first time in this state on or after October 1, 1993, the carrier files with the commissioner the information and statement required in this subparagraph at least thirty days prior to the date such policy is issued or delivered in this state.

(8) "Plan of operation" means the plan of operation of the pool, including articles, bylaws and operating rules, adopted by the board pursuant to section 38a-569.

(9) "Dependent" means the spouse or child of an eligible employee, subject to applicable terms of the health insurance plan covering such employee. "Dependent" includes any dependent who is covered under the small employer's health insurance plan pursuant to workers' compensation, continuation of benefits pursuant to section 38a-512a or other applicable laws.

(10) "Commissioner" means the Insurance Commissioner.

(11) "Member" means each insurer and insurance arrangement participating in the pool.

(12) "Small employer carrier" means any insurer or insurance arrangement that offers or maintains group health insurance plans covering eligible employees of one or more small employers.

(13) "Health care center" has the same meaning as provided in section 38a-175.

(14) "Case characteristics" means demographic or other objective characteristics of a small employer, including age and geographic location. "Case characteristics" does not include claims experience, health status or duration of coverage since issue.

Conn. Gen. Stat. § 38a-564

(P.A. 90-134, S. 12, 28; P.A. 91-201 , S. 4 , 8 ; P.A. 92-125 , S. 1 , 5 ; P.A. 93-137 , S. 1 , 6 ; 93-239 , S. 9 ; 93-345 , S. 6 ; P.A. 94-214 , S. 2 , 4 ; P.A. 95-79 , S. 144 , 189 ; P.A. 96-271 , S. 213 , 254 ; P.A. 99-124 , S. 1 , 4 ; P.A. 00-114 , S. 1 , 2 ; 00-218 , S. 1 ; P.A. 01-30 , S. 2 , 4 ; June 30 Sp. Sess. P.A. 03-3, S. 32; P.A. 04-163 , S. 1 ; P.A. 05-238 , S. 3 ; P.A. 07-185 , S. 18 , 19 ; P.A. 08-110 , S. 3 ; P.A. 10-4 , S. 1 ; 10-5 , S. 34 ; 10-13 , S. 4 ; P.A. 11-19 , S. 14 ; 11-58 , S. 46 ; P.A. 14-122 , S. 52 ; P.A. 15-118 , S. 22 ; 15-247 , S. 17 ; P.A. 17-15 , S. 72 .)

Amended by P.A. 24-0138,S. 11 of the Connecticut Acts of the 2024 Regular Session, eff. 10/1/2024.

Amended by P.A. 17-0015, S. 72 of the Connecticut Acts of the 2017 Regular Session, eff. 10/1/2017.

Amended by P.A. 15-0118, S. 22 of the Connecticut Acts of the 2015 Regular Session, eff. 10/1/2015.

Amended by P.A. 14-0122, S. 52 of the Connecticut Acts of the 2014 Regular Session, eff. 10/1/2014.

Amended by P.A. 11-0058, S. 46 of the the 2011 Regular Session, eff. 7/1/2011.

Amended by P.A. 11-0019, S. 14 of the the 2011 Regular Session, eff. 10/1/2011.

Amended by P.A. 10-0013, S. 4 of the February 2010 Regular Session, eff. 5/5/2010.

Amended by P.A. 10-0005, S. 34 of the February 2010 Regular Session, eff. 5/5/2010.

Amended by P.A. 10-0004, S. 1 of the February 2010 Regular Session, eff. 1/1/2011.