Connecticut HB 5375: AN ACT CONCERNING THE RECOMMENDATIONS OF THE INSURANCE AND REAL ESTATE COMMITTEE WORKING GROUPS.

Bill Text

Substitute House Bill No. 5375 
 
Public Act No. 26-47 
 
 
AN   ACT   CONCERNING   THE   RECOMMENDATIONS   OF   THE 
INSURANCE    AND    REAL    ESTATE    COMMITTEE    WORKING 
GROUPS. 
Be  it  enacted  by  the  Senate  and  House  of  Representatives  in  General 
Assembly convened: 
 
Section  1.  (Effective  from  passage)  (a)  The  Insurance  Commissioner 
shall, within available appropriations: 
(1)  Study  the  feasibility  of  (A)  allowing  more  than  one  nonprofit 
entity  to  pool  such  nonprofit  entities'  liability  insurance  policies,  (B) 
establishing a captive insurance company, risk management agency or 
a program to insure the risk of such pool, and (C) establishing any other 
insurance program that may address the needs of nonprofit entities that 
contract with the state. 
(2)   Develop   a   proposed   plan   to   establish   a   captive   insurance 
company,  risk  management  agency  or  a  program  to  insure  the  risk  of 
nonprofit  entities  who  pool  such  liability  insurance  policies.  Such 
proposed plan shall assess the appropriate structure of such company, 
agency  or  program  to  ensure  its  financial  and  operational  viability, 
including, but not limited to, (A) a process for collecting relevant data 
from  nonprofit  entities  participating  in  such  pool,  (B)  an  actuarial 
analysis  of  any  risks  to  be  underwritten  by  such  company,  agency  or 

Substitute House Bill No. 5375 
 
Public Act No. 26-47 2 of 4 
 
program,  (C)  a  plan  design,  and  (D)  any  other  factors  as  deemed 
appropriate by the commissioner. 
(3) Develop a financial analysis of such company, agency or program 
described in subdivision (2) of this subsection, that includes, but is not 
limited to, (A) an estimate of the initial investment required to ensure 
such  company,  agency  or  program  (i)  meets  any  applicable  statutory 
operating  ratios  set  forth  in  title  38a  of  the  general  statutes,  and  (ii)  is 
fully operational as a licensed insurer or reinsurer in this state, and (B) 
estimates of future premium costs for nonprofit entities participating in 
such pool. 
(b) Not  later  than  November  1,  2026,  the  Insurance  Commissioner 
shall submit a report, in accordance with the provisions of section 11-4a 
of the general statutes, to the joint standing committees of the General 
Assembly having  cognizance of matters relating to insurance, finance, 
revenue and bonding, appropriations and the budgets of state agencies 
and human services on the findings of such study, proposed plan and 
financial analysis, including any recommendations for legislative action 
required  for  the  establishment  of  such  company,  agency  or  program, 
and an assessment of any such funding needed for implementation of, 
and future investment in, any such company, agency or program. 
Sec. 2. (NEW) (Effective January 1, 2028) (a) As used in this section: 
(1) "Health benefit plan" has the same meaning as provided in section 
38a-1080 of the general statutes. 
(2) "Health carrier" has the same meaning as provided in section 38a-
1080 of the general statutes. 
(3)  "Pharmacist"  has  the  same  meaning  as  provided  in  section  38a-
479aaa of the general statutes. 
(4) "Pharmacy benefits manager" has the same meaning as provided 

Substitute House Bill No. 5375 
 
Public Act No. 26-47 3 of 4 
 
in section 38a-479aaa of the general statutes. 
(5) "Covered clinical service" means any service or procedure that (A) 
is within the scope of the pharmacist's license under chapter 400j of the 
general  statutes,  and  (B)  is  a  covered  service  under  the  terms  of  the 
health  benefit  plan  when performed  by any other  licensed  health  care 
provider. 
(b)  Each  health  carrier,  or  third-party  administrator  or  pharmacy 
benefits manager, as applicable, that provides, administers or manages 
benefits  under  a  health  benefit  plan  in  this  state  shall  ensure  that 
reimbursement   processes   and   provider   networks   are inclusive   of 
pharmacists for the purpose of reimbursing covered clinical services. 
(c) No health carrier, third-party administrator or pharmacy benefits 
manager  shall  deny  reimbursement  for  a  clinical  service  solely  on  the 
basis that such clinical service: 
(1) Is provided by a pharmacist in accordance with such pharmacist's 
scope  of  practice  and  license  pursuant  to  chapter  400j  of  the  general 
statutes; and 
(2) Would otherwise be eligible for reimbursement if provided by a 
physician, physician assistant or advanced practice registered nurse. 
(d) Nothing in this section shall be construed to: 
(1) Require coverage of any service not otherwise covered under the 
health benefit plan; or 
(2)  Prevent  a  health  carrier,  third-party  administrator  or  pharmacy 
benefits     manager     from     establishing     reasonable     participation, 
credentialing or contracting standards. 
(e)   The   Insurance   C