The Department of Insurance estimates HB 5233 will cost the state about $19 million over the next two years as it institutes a new health benefit mandate requiring insurance companies (fully insured) to cover 3D mammograms.

HB 5233, which passed both chambers of the General Assembly and awaits the Governor's signature, drives up the cost to buy health insurance for smaller employers and individuals by adding more services to health plans sold in those markets.

GAP_Healthcare_2016Further, it's likely this mandate will be included in the state employee benefit plan—which drives up costs for the state.

The Department of Insurance concluded this is a "new" mandate and therefore taxpayers will also have to foot the bill for certain individuals that use the state’s healthcare exchange.

These costs were not included in any budget put forward this legislative session.

While the intent of this mandate, and others, are certainly well intentioned, continuing to mandate more expensive coverage simply means plans will be even more unaffordable.

If individuals cannot afford to purchase health insurance, it won't matter what benefits the plans cover.

Insurance Fund Increase Defeated

The Department of Insurance is funded through the "Insurance Fund," with insurers receiving an annual bill dividing the total amount of the fund between them.

The fund totals about $81 million and also pays for the state's vaccination program as well as various Department of Public health programs.

Earlier iterations of the state budget transferred between $3-$7 million worth of DPH items into the Insurance Fund.

None of these transfers were included in the budget ultimately passed by the legislature.

This is a big deal for employers as the increased costs of the fund are passed on by insurance companies in the form of higher premiums.

Mandates That Died

A number of proposed new health benefit mandates that would have driven up the cost of health insurance for smaller employers and individuals did not pass this session.

Many of these items also impacted the state budget due to adoption by the state employee health plan or because they were "new" mandates and the state would have to pick up the tab (SB 36, SB 37, SB 370, SB 374, HB 5230).

SB 433: Network Requirements

This Department of Insurance bill made various changes to network requirements—meaning how many and which doctors/facilities insurance companies must include in their listing of physicians, facilities, and other medical professionals for health plans.

CBIA had no concerns with the language but monitored its development, considering its potential impact on health plan design.

Utilizing narrow networks may create an opportunity to positively impact costs.

This bill was adopted by the legislature and is awaiting action by the Governor.


For more information, contact CBIA’s Jennifer Herz (860.970.4404) | @CBIAjherz