AN ACT CONCERNING THE CONSUMER REPORT CARD.

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,” as reported in the most recent consumer report card, 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 also 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. Current law requires an MCO to disclose to the commissioner and enrollees its “medical loss ratio,” which it describes as the “percentage of the total premium revenue spent on medical care compared to administrative costs and plan marketing. ” The bill also changes the date by which an MCO must annually report to the insurance commissioner from May 1 to January 1.

The bill names the report card the “Consumer Report Card on Health Insurance Carriers in Connecticut. ” The report card is a comparison guide of all HMOs and the 15 largest insurers that offer managed care plans in Connecticut. The bill changes, from March 15 to October 15, the date by which the insurance commissioner, after consultation with the public health commissioner, must annually develop and distribute the report card.

*Senate Amendment “B” changes (1) the definition of “medical loss ratio” in the laws requiring an MCO to give certain information to the commissioner and plan enrollees and (2) the deadlines for distribution of the report card and for MCOs to submit information.

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.

Yea

Nay

(03/10/2009)