Substitute Bill No. 5041 establishes a Connecticut Option program aimed at providing affordable health care through a standardized health benefit plan. The bill requires the Secretary of the Office of Policy and Management to conduct a feasibility study, analyzing program design, necessary regulatory changes, staffing needs, and impacts on the state insurance market, with interim and final reports due by January 15, 2027, and January 31, 2028, respectively. Additionally, the bill introduces new mandates for health benefit plans to offer lower cost-sharing options for generic drugs and biosimilars, effective January 1, 2027, and prohibits more restrictive formulary exception processes for these medications compared to their reference products.

The bill also enhances healthcare coverage under the Covered Connecticut program by providing premium and cost-sharing subsidies to specific groups, including certain family members of beneficiaries and low-income adults aged nineteen to sixty-four, with coverage expansions starting July 1, 2021, and July 1, 2022. It introduces provisions for dental and nonemergency medical transportation services, effective January 1, 2027, while removing previous requirements for these services to be provided before July 1, 2022. The bill further modifies the roles of the Office of Health Strategy, replacing it with the Department of Social Services, and ensures that benefits under the Covered Connecticut program are not considered taxable income. Overall, the bill aims to improve healthcare access and affordability while supporting small businesses in providing health benefits to their employees.

Statutes affected:
Governor's Bill:
HS Joint Favorable:
File No. 404:
FIN Joint Favorable: