A key legislative committee in Connecticut has announced a public hearing on a new bipartisan legislation aimed at providing small business employees with more affordable and high-quality healthcare options. The Insurance and Real Estate Committee will be discussing HB 5247 at its upcoming meeting on February 27th at the Legislative Office Building.
The proposed bill would allow small employers to join together through a trade association domiciled in Connecticut to offer self-funded health benefit plans, known as multiple employer welfare arrangements (MEWAs), for their employees. By pooling their resources and becoming “one employer,” small businesses can gain access to the same benefits enjoyed by large employers, unions, municipalities, and the state of Connecticut.
This legislation, which is similar to a previous bill championed by a coalition of bipartisan lawmakers led by Rep. Kerry Wood, has already received bipartisan support in the committee. Although it was approved with a 9-3 vote, it unfortunately did not make it to a vote in the House during the last session.
The need for such legislation is evident as the fully-insured health insurance market has been steadily declining in membership over the years. Currently, the total enrollment stands at less than 80,000 lives, a significant drop from over 230,000 lives just five years ago. In addition, carrier competition is dwindling, with two major carriers pulling out of the market in recent years.
Lawmakers from both parties believe that HB 5247 is a sensible solution that will finally provide small employers with the opportunity to obtain high-quality healthcare at a lower cost for their employees. This approach has already been successful in Virginia, where a similar bill was passed in 2022. The state’s WiseChoice Healthcare Alliance, initiated by the Virginia Chamber of Commerce, is expected to enroll over 100,000 members by next year.
To ensure eligibility and regulatory oversight, the associations must meet certain requirements, including being industry trade groups domiciled in the state and having a minimum of 500 employees and 25 employer-members. Employers must be active members of the association and have at least two employees. MEWAs will be subject to rigorous financial and market examinations by the Connecticut Insurance Department, just like licensed insurance companies.
Consumer protections are a key focus of the proposed legislation. MEWAs will be required to cover all 10 federal essential health benefits and over 60 state coverage mandates, offering the same level of benefits as fully-insured plans. The plans offered by MEWAs must also meet certain actuarial value requirements, ensuring that they provide comprehensive coverage. Discrimination based on pre-existing conditions or health status will be strictly prohibited.
In addition to providing more affordable options, MEWAs will also adopt value-based insurance design and value-based contracting, which are currently being utilized by larger employers and the state. This will enable small businesses to benefit from initiatives such as wellness programs, alternative payment models, and patient-centered medical homes.
To protect small employers from unexpected and significant claims, the trust formed by the MEWAs must purchase stop-loss insurance and maintain an aggregate stop-loss policy. The pricing and renewal methodology of these plans will be reviewed by the Connecticut Insurance Department, following the same standards as fully-insured large group policies.
With this new legislation, small businesses in Connecticut will have the opportunity to provide their employees with affordable and comprehensive healthcare coverage, leveling the playing field and giving them access to the same benefits enjoyed by larger entities. By joining together through trade associations, small employers can finally offer their employees high-quality healthcare options without breaking the bank.
Une section FAQ basée sur les principaux sujets et informations présentés dans l’article :
Q : Quelle est la proposition de législation en discussion à Connecticut concernant les petites entreprises ?
R : La proposition de loi HB 5247 vise à permettre aux petites entreprises de se regrouper à travers des associations professionnelles domiciliées à Connecticut afin d’offrir des régimes de soins de santé autofinancés, appelés régimes d’avantages sociaux pour employeurs multiples (MEWA), à leurs employés.
Q : Comment les petites entreprises peuvent-elles bénéficier de cette législation ?
R : En regroupant leurs ressources et en devenant “un employeur”, les petites entreprises peuvent accéder aux mêmes avantages proposés par les grandes entreprises, syndicats, municipalités et l’État de Connecticut.
Q : Pourquoi cette législation est-elle nécessaire ?
R : Le marché de l’assurance santé à adhésion totale a vu le nombre d’adhérents diminuer régulièrement au fil des années. En outre, la concurrence entre les assureurs diminue également.
Q : Quels sont les avantages de la législation HB 5247 pour les petites entreprises ?
R : Cette législation permettrait aux petites entreprises de proposer des soins de santé de haute qualité à un coût réduit pour leurs employés. Ce modèle a déjà été mis en place avec succès en Virginie.
Q : Quels sont les critères d’éligibilité pour les associations professionnelles ?
R : Les associations doivent être des groupes professionnels domiciliés dans l’état et avoir un minimum de 500 employés et 25 membres-employeurs. Les employeurs doivent être membres actifs de l’association et avoir au moins deux employés. Les MEWAs seront également soumis à des examens financiers et de marché rigoureux par le département de l’assurance de Connecticut.
Q : Quels sont les avantages offerts par les MEWAs ?
R : Les MEWAs devront couvrir les 10 prestations de santé essentielles fédérales et plus de 60 mandats de couverture de l’état. Ils devront également respecter certaines exigences de valeur actuarielle garantissant une couverture complète. La discrimination basée sur les antécédents médicaux ou l’état de santé sera strictement interdite.
Q : Comment les petites entreprises seront-elles protégées contre les demandes de remboursement importantes ?
R : Le fonds formé par les MEWAs devra souscrire une assurance de réassurance et maintenir une police de réassurance globale. Les tarifs et la méthodologie de renouvellement de ces régimes seront examinés par le département de l’assurance de Connecticut.
Q : Quels sont les avantages supplémentaires offerts par les MEWAs ?
R : Les MEWAs adopteront également des modèles d’assurance axée sur la valeur et des contrats axés sur la valeur, ce qui permettra aux petites entreprises de bénéficier d’initiatives telles que les programmes de bien-être, les modèles de paiement alternatifs et les centres médicaux axés sur le patient.
Liens suggérés vers le domaine principal :
– Département de l’assurance de Connecticut