OLR Bill Analysis
AN ACT CONCERNING THE CONSUMER REPORT CARD.
This bill requires:
1. the insurance commissioner to include in the annual health insurance consumer report card the “medical loss ratio” of each insurer and HMO the report discusses,
2. the insurance department to prominently display a link to the report card on its website, and
3. each health insurer or HMO to disclose its “medical loss ratio” in writing to a person when he or she applies for coverage.
The bill defines “medical loss ratio” as the ratio of incurred claims to earned premiums for the prior calendar year for managed care plans issued in Connecticut. It limits “claims” to medical expenses for services and supplies provided to enrollees, excluding expenses for stop loss coverage, reinsurance, enrollee educational programs, and other cost containment programs or features.
It applies this definition to the laws requiring a managed care organization (MCO) to give certain information, including medical loss ratio, to the commissioner and plan enrollees (see COMMENT). The law defines an MCO as an insurer, HMO, hospital or medical service corporation, or other organization delivering, issuing, renewing, or amending individual or group health managed care plans in Connecticut.
The bill also names the report card the “Consumer Report Card on Health Insurance Carriers in Connecticut” and makes technical changes. The report card is a comparison guide of all HMOs and the 15 largest insurers that offer managed care plans in Connecticut.
EFFECTIVE DATE: October 1, 2009
COMMENT
Potential Conflict with Existing Law
The laws requiring an MCO to give certain information to the commissioner and plan enrollees require it to disclose its “medical loss ratio,” which they describe as the “percentage of the total premium revenues spent on medical care compared to administrative costs and plan marketing” (CGS §§ 38a-478(a)(4) and 38a-478g(b)(9)). The definition the bill provides appears to conflict. Thus, it is unclear which definition an MCO should follow.
COMMITTEE ACTION
Insurance and Real Estate Committee
Joint Favorable
Yea |
13 |
Nay |
6 |
(03/10/2009) |