Fill and Sign the Carer Payment Andor Carer Allowance Medical Report for a Form

Table of Contents Public Act 05-10 (Senate Bill 963) An Act Concerning Civil Unions.................................................................................................................................7 Public Act 05-15 (House Bill 6868) An Act Concerning Filing Deadlines for Managed Care Ombudsman Report ............................................................8 Public Act 05-20 (House Bill 6618) An Act Concerning Federal Requirements for Medicare Supplement Plans................................................................3 Public Act 05-25 (House Bill 6807) An Act Concerning Fees for Requests for Agent Appointments .................................................................................8 Public Act 05-29 (House Bill 6863) An Act Concerning Minor and Technical Changes to the Insurance Statutes..............................................................9 Public Act 05-57 (House Bill 6622) AAC Protecting Seniors in Annuity Transactions........................................................................................................4 Public Act 05-61 (House Bill 6806) An Act Concerning Insurance Producer Compensation...............................................................................................4 Public Act 05-63 (House Bill 6866) An Act Concerning Life Insurance Offered to State Employees..................................................................................9 Public Act 05-65 (House Bill 6917) An Act Concerning Interlocal Risk Management Agencies.........................................................................................9 Public Act 05-69 (Senate Bill 30) An Act Concerning Health Insurance Coverage for Breast Cancer Screening...........................................................10 Public Act 05-94 (Senate Bill 1002) An Act Concerning Appeals of Health Insurance Determinations made to the Insurance Commissioner ..................5 Public Act 05-97 (Senate Bill 1297) An Act Concerning Managed Care Grievance Procedures ........................................................................................11 Public Act 05-100 (Senate Bill 1351) An Act Concerning Retaliatory Laws Against Connecticut Domiciled Insurers .......................................................11 Public Act 05-102 (Senate Bill 1205) An Act Concerning Appeals of Denials or Determinations by Managed Care Organization and Renaming the Office of the Managed Care Ombudsman...........................................................................................12 Public Act 05-103 (Senate Bill 1299) An Act Concerning Extended Reporting Period Coverage under Medical Malpractice Insurance Policies ..............12 Public Act 05-140 (Senate Bill 999) An Act Concerning Changes to the Insurance Statutes................................................................................................5 Public Act 05-162 (Senate Bill 31) An Act Concerning Notice of Late Fees under Personal Risk Insurance Policies and the Commissioners’ 2001 Standard Ordinary Mortality Table ..................................................................................13 Public Act 05-193 (Senate Bill 1251) An Act Concerning Owner-controlled Insurance Programs on State and Municipal Construction Projects................................................................................................................................14 Public Act 05-196 (Senate Bill 508) An Act Concerning Health Insurance Coverage for Infertility Treatment .................................................................15 1 Public Act 05-199 (Senate Bill 1336) An Act Concerning Revisions to Statutes Governing the Second Injury Fund ..........................................................17 Public Act 05-233 (House Bill 5292) An Act Concerning the Requirement that Prescriptions be Filled by Mail Order ......................................................19 Public Act 05-237 (HB 6619) An Act Concerning Discount Health Plans..................................................................................................................6 Public Act 05-238 (House Bill 6655) An Act Concerning Groups Covered under the State Employee Health Plan and Association Group Plans............................................................................................................................................19 Public Act 05-253 (Senate Bill 1034) An Act Establishing a Comprehensive Health Insurance Consumer Education Program..........................................21 Public Act 05-261 (Senate Bill 1350) An Act Concerning the Interest Earned on Lawyers’ Clients’ Funds Accounts Program..........................................22 Public Act 05-266 (House Bill 6805) An Act Concerning the Renewal of Insurance Producer Licenses...............................................................................7 Public Act 05-270 (House Bill 6865) An Act Redefining Health Insurance Under Health Reinsurance Association Plans .................................................22 Public Act 05-271 (House Bill 6915) An Act Concerning Portability Under Health Care Plans Issued through the Health Reinsurance Association...........................................................................................................................23 Public Act 05-272 (House Bill 6713) An Act Concerning Revisions to the Department of Public Health Statutes..............................................................33 Public Act 05-275 (Senate Bill 1052) An Act Concerning Medical Malpractice ..................................................................................................................24 Public Act 05-280 (House Bill 7000) An Act Concerning Social Services and Public Health Budget Implementation Provisions......................................34 Public Act 05-282 (Senate Bill 1102) An Act Concerning Enforcement of Mandatory Insurance Requirements for Motor Vehicles..................................32 2 Acts Proposed by the Insurance Department Public Act 05-20 (House Bill 6618) An Act Concerning Federal Requirements for Medicare Supplement Plans (Signed by the Governor 05/09/05) This act revises Medicare supplement policy requirements to reflect federal law changes that take effect January 1, 2006. It prohibits an insurer from considering a person’s age, gender, claim history, or medical condition when deciding to accept or reject an application for coverage under a Medicare supplement policy. But, the act permits an insurer to consider a person’s claims history and medical condition when deciding to issue plans H, I, and J to an applicant before January 1, 2006. By eliminating authority for insurers to consider claims history and medical condition when establishing rates for plans H, I, and J, the act requires insurers to community rate all Medicare supplement plans, since plans A through G must already be community rated by law. (Community rating is the process of developing a uniform rate for all enrollees. ) The act permits, instead of requires, the insurance commissioner to adopt regulations governing Medicare supplement plans. It replaces a reference to 10 plans with 12 plans, “A” through “L” to accommodate new plans K and L. The act also makes a minor change regarding loss ratio premium refunds and several technical changes. The act applies to insurers, HMOs, hospital and medical service corporations, fraternal benefit societies, and other entities that issue Medicare supplement plans. EFFECTIVE DATE: July 1, 2005 LOSS RATIO PREMIUM REFUND DONATIONS This act requires that insurers donate all loss ratio premium refunds held in an interest-bearing account by law to the University of Connecticut Health Center, instead of splitting them between the Health Center and Uncas-on-Thames Hospital, which is defunct. BACKGROUND Medicare Supplement Policies A Medicare supplement policy (also referred to as “Medigap”) is a health insurance policy that covers some of the health care costs that Medicare does not cover. Currently, there are 10 standard Medicare supplement policies called plans “A” through “J. ” Plan A covers only basic benefits. Plans B through J offer additional benefits, with Plan J offering the most. States retain regulatory authority over policies that meet minimum standards set forth in federal law and by the National Association of Insurance Commissioners. Medicare Modernization Act of 2003 The federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P. L. 108-173) (MMA) establishes Medicare Part D, which provides prescription drug coverage for seniors. As of January 1, 2006, no new Medicare supplement plans will be sold with prescription drug coverage. If a person enrolls in a Medicare supplement policy that currently covers prescription drugs (i. e. , plans H, I, or J) by December 31, 2005, he can keep that policy with the drug coverage if he does not enroll in Medicare’s Prescription Drug Benefit (Medicare Part D). If he chooses to enroll in a Medicare prescription drug benefit plan, he can keep the supplement policy but the drug coverage will be removed from it. MMA also creates two new Medicare supplement plans, K and L, which include reduced first dollar coverage. One will cover 50% of the cost-sharing required under Medicare Parts A and B and limit out-ofpocket expenses to $4,000, subject to an annual inflationary adjustment. The other will cover 75% of the 3 cost-sharing and limit out-of-pocket expenses to $2,000. Loss Ratio Loss ratio is the ratio between insurance losses sustained and premiums earned in a given period. By law, a Medicare supplement premium rate filing must include a guarantee that actual loss ratios will meet or exceed a specified anticipated loss ratio. If the target is not met, an insurer is required to refund premium to Connecticut policyholders as necessary to bring the actual loss ratio up to the guaranteed level. Refunds under two dollars must be aggregated by the insurer and deposited in an interest-bearing account. At each calendar year end, the insurer must donate the account balance as specified by law. Public Act 05-57 (House Bill 6622) An Act Concerning Protecting Seniors in Annuity Transactions (Signed by the Governor 06/02/05) This act requires the insurance commissioner to adopt regulations to establish (1) standards for selling or exchanging annuities to a senior consumer and (2) procedures for making annuity sales or exchange recommendations to a senior consumer. A "senior consumer" is an individual age 65 or older. In the case of a purchase by more than one person, the purchaser is considered a senior consumer if one of the people is age 65 or older. By law, “annuities” are agreements to make periodic payments where all or some of the payments depend on a person’s continued life or a specified number of years. It does not include payments under a life insurance policy. EFFECTIVE DATE: Upon passage Public Act 05-61 (House Bill 6806) An Act Concerning Insurance Producer Compensation (includes Ins. Dept. lang.) (Signed by the Governor 06/02/05) This act expands what constitutes a misrepresentation of an insurance policy. Existing law makes a misrepresentation to induce the lapse, forfeiture, exchange, conversion, or surrender of an insurance policy an unfair and deceptive insurance practice. This act makes a misrepresentation to induce the purchase of insurance an unfair and deceptive insurance practice. It also includes an intentional premium rate misquote as a misrepresentation. This act prohibits an insurance producer or his affiliate who receives compensation directly from a customer for an insurance sale from also receiving compensation from an insurer or other third party for the sale unless, before he delivers the insurance policy to the customer, the producer (1) obtains the customer’s acknowledgement that he or his affiliate will receive compensation from the insurer or other third party and (2) discloses the compensation amount. If the amount is unknown, he must give a reasonable estimate, if possible, and describe how the compensation is calculated. The customer’s acknowledgement must be in writing, but if the transaction occurs over the telephone or electronically and written consent cannot reasonably be obtained, the producer can document the acknowledgement himself. The act does not apply to a producer (1) whose only compensation is from an insurer (e. g. , he is the insurer’s employee) or (2) who does not receive compensation from the customer and informs the customer before policy delivery that (a) he will receive compensation from the insurer or (b) he represents the insurer and can service the customer on the insurer’s behalf. It also does not apply to (1) the placement of insurance in surplus lines or residual markets, (2) a person who is a licensed producer but only acts as an intermediary between the insurer and the customer’s producer, or (3) a reinsurance intermediary. 4 Compensation from a customer excludes commissions that are deductible from the customer’s premium payment and fees agreed to in writing for certain administrative services authorized by current regulation. Compensation from the insurer means payments, commissions, fees, awards, overrides, bonuses, contingent commissions, loans, stock options, gifts, prizes, or other valuable consideration, whether agreed to in writing or not. EFFECTIVE DATE: October 1, 2005 BACKGROUND Unfair and Deceptive Insurance Practice When the insurance commissioner determines, after a hearing, that a person has committed an unfair and deceptive insurance practice, she may order fines, restitution, license suspension or revocation, or any combination of these. Fines are up to $1,000 per violation, not to exceed $10,000 in total. If the person knowingly commits the violation, fines are up to $5,000 per violation, not to exceed $50,000 in total in any six-month period. Public Act 05-94 (Senate Bill 1002) An Act Concerning Appeals of Health Insurance Determinations made to the Insurance Commissioner (Signed by the Governor 06/07/05) This act requires a health insurer to (1) have a grievance process for enrollees to appeal the insurer's actions or inactions and (2) notify enrollees of the process at enrollment annually and when it denies a service, admission, or hospital stay extension. It also expands the external appeal law to permit a plan enrollee to appeal a health insurer's denial to the insurance commissioner after exhausting the insurer's process. By law, an enrollee can appeal a managed care organization or utilization review company decision to the commissioner. The act requires utilization review company that, after an appeal, upholds a decision to not authorize an admission, service, procedure, or hospital stay extension to provide in writing to the individual (1) the main reason for the decision, (2) notice that he has exhausted all internal appeal opportunities, and (3) an external appeal application and procedures. The act requires each managed care organization (MCO) and health insurer that, after appeal, upholds a claim denial based on medical necessity to provide the enrollee in writing (1) notice that he exhausted all internal appeal opportunities and (2) an external appeal application and procedures. By law, an MCO must provide the commissioner, enrollee, or provider certain information regarding a plan under which an appeal is made within five business days of receiving a written request. The act eliminates all of the information that must be sent if the appeal relates to a self-insured governmental health plan, except for verification that it is self-insured. EFFECTIVE DATE: July 1, 2005 Public Act 05-140 (Senate Bill 999) An Act Concerning Changes to the Insurance Statutes (Signed by the Governor 06/24/05) This act makes several changes to Connecticut's insurance statutes. The act removes from the list of unfair and deceptive insurance practices nonpayment of mandatory fees to 5 the insurance commissioner. This means that a person’s or insurance company’s failure to pay any of the required fees will no longer be subject to the unfair practice penalties, which include fines and license suspension or revocation. The act does not affect any other penalty allowed by law for not paying fees or paying them late. The act eliminates the requirement that an insurer provide people covered under an automobile insurance policy written notice of the availability of full glass repair or replacement coverage. By law, each automobile insurance policy must include such coverage at the insured’s request. The act also makes changes in the Connecticut Insurance Guaranty Association statutes. The act specifies that the association is not responsible for a claim that arises out of a policy issued by an insurer that was not licensed to transact insurance in Connecticut either when the policy was issued or when the insured event occurred. It also redefines “insolvent insurer” for purposes of the guaranty association. Under prior law, an insolvent insurer included the legal successor of the insolvent insurer in the event of a merger. Under the act, an insolvent insurer instead includes the legal successor of an insurer (because of a merger) that was licensed to transact insurance in Connecticut either when the policy was issued or when the insured event occurred, as long as an insurance regulator with jurisdiction approved the merger. By law, a court of competent jurisdiction must make the determination that the insurer is insolvent. The act also broadens the definition of an “insolvent insurer” to include an insurer (1) that inherits the policy obligations of an insurer (because of a corporate division) licensed to transact insurance in Connecticut when the policy was issued or when the insured event occurred, if the corporate division is approved and (2) determined to be insolvent by a court of competent jurisdiction. The corporate division must be approved in a jurisdiction that allows it by an insurance regulator having jurisdiction over it. EFFECTIVE DATE: October 1, 2005, except for the changes to the guaranty association statutes, which are effective upon passage and applicable to insolvencies occurring on or after that date. BACKGROUND Connecticut Insurance Guaranty Association Connecticut has a property and casualty insurance guaranty association fund. All insurance companies licensed to issue property and casualty coverage—with the exceptions prescribed by law— must belong to the association. If an insurance company defaults, the guaranty association pays valid claims of policyholders and other claimants, up to the dollar limits of the policy subject to ceilings fixed by state law. Policyholders also may receive partial refunds of premiums. Payment of claims by the guaranty association is coordinated with the Connecticut Insurance Department. Guaranty association payments are triggered by an order of the insurance commissioner or a court of competent jurisdiction declaring a life or health insurance company to be “impaired” or by an order of a court of competent jurisdiction declaring a property and casualty company to be insolvent. Public Act 05-237 (House Bill 6619) An Act Concerning Discount Health Plans (Signed by the Governor 07/11/05) This act establishes a regulatory framework for medical discount plans and organizations that offer such plans. It establishes requirements for (1) incorporation and licensure, (2) net worth, (3) provider agreements, (4) advertising and plan material content, and (5) consumer disclosures. It also establishes fines and penalties for violations and authorizes the commissioner to adopt implementing regulations. 6 EFFECTIVE DATE: January 1, 2006, except for the prohibition on marketing, advertising, or selling plans that do not meet the mandatory plan provisions and related fines, which are effective July 1, 2005. Public Act 05-266 (House Bill 6805) An Act Concerning the Renewal of Insurance Producer Licenses (Signed by the Governor 07/13/05) This act (1) makes an insurance producer license renewable every two years on the licensee's birthday instead of on February 1 in even-numbered years; (2) permits the insurance commissioner to establish a process to transition producers to the new license renewal schedule and establishes a $ 40 transitional license fee; (3) increases license renewal fees to $ 40 per year or any portion thereof instead of $ 40 every two years; (4) requires the commissioner to notify a producer at least 30 days before his license expires; (5) adds license renewal fee payment to the renewal requirements; (6) authorizes the commissioner to implement a more efficient license renewal process that supercedes the mandated requirements upon implementation; and (7) permits the commissioner to adopt regulations to establish a license renewal schedule. EFFECTIVE DATE: October 1, 2005, except for the license renewal fee change, which is effective January 1, 2006. Other Acts of Interest Public Act 05-10 (Senate Bill 963) An Act Concerning Civil Unions (Signed by the Governor 04/20/05) This act authorizes same sex couples to enter into civil unions, granting them the same legal benefits, protections, and responsibilities as married couples. It incorporates civil unions by reference in most statutes that use or define terms indicating a spousal relationship. It establishes eligibility, application, and licensing criteria; specifies who can perform civil union ceremonies; and sets forth record-keeping requirements. The act (1) restricts civil unions to couples over age 18, (2) exempts people authorized to perform civil union ceremonies from liability for failing or refusing to do so, and (3) requires town clerks to give civil union license applicants copies of the relevant laws. Otherwise, the act's substantive provisions and penalties are identical to current marriage statutes. The act also defines "marriage" as the union of one man and one woman. It establishes circumstances under which the state will recognize civil unions performed in other countries. EFFECTIVE DATE: October 1, 2005 BENEFITS, PROTECTIONS, AND RESPONSIBILITIES The act specifies that the rights it extends to civil union partners may derive under statute, administrative regulations or court rules, policy, common law, or any other source of civil law. Generally, these fall into the following categories: 1. family law, including marriage, divorce, and support; 2. title, tenure, descent and distribution, intestate succession, wills, survivorships, or other incidents of the acquisition, ownership, or transfer (during life or at death) of real or personal property; 3. state and municipal taxation; 4. probate courts and procedure; 5. pensions and group insurance for employees in plans not regulated exclusively by federal law; 6. family leave benefits; 7. financial disclosure and conflict-of-interest rules; 8. protection against discrimination based on marital status; 7 9. emergency and non-emergency medical care and treatment, hospital visitation and notification, and authority to act in matters affecting family members; 10. state public assistance benefits; 11. workers’ compensation; 12. crime victims’ rights; 13. marital privileges in court proceedings; and 14. vital records and absentee voting procedures. Excluded Laws The act does not incorporate civil unions by reference in the chapter of the General Statutes relating to marriage procedures and formalities. But it includes new provisions setting out the same procedures and formalities for applicants and parties to civil unions. Civil unions are also specifically excluded under the act from the statute that states that “the current public policy of the state is now limited to a marriage between a man and a woman” (CGS § 45a-727a(4)). ELIGIBILITY CRITERIA To be eligible to form a civil union, the act requires that each party be of the same sex, not a party to another civil union or a marriage, and no more closely related to one another than first cousin. Unions between people more closely related are void. People under age 18 can enter into civil unions only if a court has declared them emancipated (legal adults). By law, partners 16 or 17 years of age may marry if their parents consent, and those under age 15 may do so with a probate judge’s consent. Under the act, as well as existing marriage law, people under conservatorships must obtain their conservator’s written permission. A conservator’s refusal to permit the ceremony to proceed must be based on clear and convincing proof of recent behavior that would cause or create a risk of harm. Public Act 05-15 (House Bill 6868) An Act Concerning Filing Deadlines for Managed Care Ombudsman Report (Signed by the Governor 05/09/05) This act requires the managed care ombudsman to file his annual report by March 1 instead of January 1. It also requires the Office of Managed Care Ombudsman’s advisory committee to file its annual evaluation of the office by April 1 instead of February 1. Reports are filed with the governor and the General Assembly’s Public Health and Insurance and Real Estate committees. EFFECTIVE DATE: October 1, 2005 Public Act 05-25 (House Bill 6807) An Act Concerning Fees for Requests for Agent Appointments (Signed by the Governor 05/09/05) This act exempts a non-Connecticut domiciled (non-domestic) insurance company from the $ 25 per "request for agent appointment" filing fee if the state or country where the company is domiciled does not require a fee when a Connecticut insurance company requests an agent appointment in that state or country. EFFECTIVE DATE: October 1, 2005 BACKGROUND Agent Appointments and Fees Before a licensed insurance producer may act as an agent on behalf of a Connecticut insurance company, (1) the company must request an agent appointment from the Insurance Department and (2) the department 8 must issue the appointment. In addition to the request for agent appointment fee, state law requires (1) a $40 fee per appointment issued or continued for an agent of a domestic insurance company and (2) a $20 fee per appointment issued or continued for an agent of a non-domestic insurance company. The latter fee is waived if the other state or country does not require a fee for an appointment issued to an agent of a Connecticut insurance company. Public Act 05-29 (House Bill 6863) An Act Concerning Minor and Technical Changes to the Insurance Statutes (Signed by the Governor 05/09/05) This act expands the type of information a managed care organization (MCO) must provide when responding to the insurance commissioner’s, an enrollee’s, or a provider’s request for information about an enrollee’s appeal under a self-insured government health care contract. By law, an MCO must provide instructions on how to access an electronically available fully insured policy under which an appeal is brought. The act requires an MCO to send similar instructions on how to access an electronically available self-insured government contract under which an appeal is brought. Information must be provided within five days of the request. (PA 05-94 amends this act by eliminating the requirement that an MCO provide any information related to a self-insured government health care contract, except verification of its selfinsured status.) The act also makes technical and conforming changes in the insurance statutes. EFFECTIVE DATE: October 1, 2005 PA 05-63 (House Bill 6866) An Act Concerning Life Insurance Offered to State Employees (Signed by the Governor 06/02/05) This act makes a state employee or legislator ineligible for a state-issued group life insurance policy as both a retiree and an active employee or legislator. The act permits him to keep any policy obtained through the state in accordance with the policy terms if the policy was in effect on June 30, 2005. Thus, for example, if a person retires from state service, maintains a life insurance policy that took effect before July 1, 2005, and is later rehired as an active employee, he is not eligible for another policy but can keep his existing one. By law the comptroller, with the attorney general’s and insurance commissioner’s approval, can revise the group life insurance plan for state employees. Employees are eligible for coverage after six months of continuous service. Legislators are eligible six months after taking office. EFFECTIVE DATE: July 1, 2005 Public Act 05-65 (House Bill 6917) An Act Concerning Interlocal Risk Management Agencies (Signed by the Governor 06/02/05) Connecticut law permits two or more municipalities to form an interlocal risk management agency to pool risks and jointly purchase insurance for (1) public liability, automobile, and property; (2) workers’ compensation, and (3) excess risk. Prior law required each pool to maintain a contingency fund of a specified amount. This act allows an interlocal risk management pool organized between July 1, 1995 and July 1, 2005 that established a contingency fund as required before July 1, 2005 to forgo the contingency requirements until July 1, 2010. Beginning July 1, 2010, the act requires a workers’ compensation or excess risk pool that chose not to 9 maintain a contingency fund to maintain at least $100,000 for contingencies for each fiscal year it operates, but the pool does not have to have more than $500,000 total. Beginning July 1, 2010, the act requires a public liability, automobile, and property risk pool that opted not to maintain a contingency fund to maintain one at a minimum of: (1) as of June 30, 2011, $100,000 plus 1% of total member contributions for the preceding year; (2) as of June 30, 2012, $200,000 plus 2% of total member contributions for the preceding year; (3) as of June 30, 2013, $300,000 plus 3% of total member contributions for the preceding year; (4) as of June 30, 2014, $400,000 plus 4% of total member contributions for the preceding year; and (5) as of June 30, 2015, $500,000 plus 5% of total member contributions for the preceding year. As of July 1, 2015, the act reinstates prior law for all pools. Thus, a workers’ compensation or excess risk pool must maintain at least $100,000 for contingencies for each fiscal year it operates, but the pool does not need to have more than $500,000 total. A public liability, automobile, and property risk pool must maintain at least $500,000 for contingencies for its first fiscal year of operation and increase it by 5% of total member contributions for each subsequent year until the contributions-to-fund ratio is no more than three to one. The act also requires each pool operating under the requirements of this act to submit reports to the insurance commissioner, as she requires. EFFECTIVE DATE: July 1, 2005 BACKGROUND Contingency Fund A contingency fund is unassigned money held above and beyond other pool liability reserves. Members advance the funds to the pool. An advance is repaid only when a repayment does not reduce the fund below its required minimum. Public Act 05-69 (Senate Bill 30) An Act Concerning Health Insurance Coverage for Breast Cancer Screening (Signed by the Governor 06/02/05) This act requires certain health insurance policies to cover physician-recommended comprehensive ultrasound screening of an entire breast or breasts for a woman classified as a category 2, 3, 4, or 5 on the American College of Radiology's Breast Imaging Reporting and Database System (BI-RADS), subject to any policy provisions applicable to other covered services. The act applies to individual and group health insurance policies that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; and (4) hospital or medical services, including those provided by HMOs. The act also applies to individual policies that cover (1) accidents only and (2) limited benefits. EFFECTIVE DATE: October 1, 2005 BACKGROUND Ultrasound A breast ultrasound sends high-frequency sound waves through the breast. A computer detects the sound wave echoes to create an image that is displayed on a viewing screen. BI-RADS Categories The American College of Radiology collaborated with the National Cancer Institute, the Center for Disease Control and Prevention, the American Medical Association, and others to develop BI-RADS. BI-RADS is a breast mammogram assessment tool. There are six BI-RADS categories, 0 through 5, each with a specific finding and recommendation, as shown below. The radiologist includes a BI-RADS category in the 10 mammogram report he prepares for the referring doctor. Public Act 05-97 (Senate Bill 1297) An Act Concerning Managed Care Grievance Procedures (Signed by the Governor 06/07/05) By law, a managed care organization (MCO) must maintain a specified grievance process for enrollees to appeal the MCO’s actions or inactions. This act makes violating the grievance requirements an unfair and deceptive insurance practice, subject to a fine up to $1,000 for each violation, to a maximum of $10,000. If a person knew or should have known his action was a violation, the penalty is (1) a fine up to $5,000 for each violation, to a maximum of $50,000 in any six-month period; (2) license suspension or revocation; and (3) restitution of any amounts obtained through the violation. By law, a grievance must be resolved within 60 days after it is initiated, unless the enrollee requests an extension. The act permits a person acting on the enrollee’s behalf also to request an extension. It requires an MCO to pay a $25 fine for each time it does not provide notice of the grievance resolution within the required timeframe. The fines are payable to the insurance commissioner for deposit into the Insurance Fund and must be allocated to the managed care ombudsman’s office (which PA 05-102 renames the Office of the Healthcare Advocate). The act requires the MCO to notify the enrollee and his provider of the grievance process when it denies a service, admission, or stay extension the provider ordered. Prior law required it to notify just the enrollee of the grievance process when it denied any service, admission, or stay extension, regardless of who requested it. The notice must explain (1) the process for submitting a grievance; (2) that the enrollee or a person acting on his behalf, including his provider, can submit a grievance; and (3) the insurer’s timeframe to resolve a grievance. A grievance can be submitted orally, electronically, or in writing. EFFECTIVE DATE: October 1, 2005 BACKGROUND Related Act PA 05-94 extends the grievance procedure requirements to health insurers, requires a final denial notice to include instructions on how to appeal to the insurance commissioner, and limits the information an MCO must provide about a self-insured government plan that is the subject of an appeal. Public Act 05-100 (Senate Bill 1351) An Act Concerning Retaliatory Laws Against Connecticut Domiciled Insurers (Signed by the Governor 06/07/05) When another state or foreign country imposes taxes; fees; fines; deposit requirements; or other obligations, restrictions, or prohibitions against Connecticut insurance companies doing business there that exceed those Connecticut imposes on their insurance companies operating here, Connecticut law imposes an equivalent retaliatory charge or restriction on the other jurisdiction’s companies doing business in Connecticut. This act invokes Connecticut’s retaliatory law when another jurisdiction retaliates against Connecticut insurers because Connecticut imposes certain types of taxes, fees, or charges on that jurisdiction’s insurers. These taxes, fees, or charges include real and personal property taxes based on property value; personal income taxes; premium taxes on special health care plans for previously uninsured small employers; agents’ license fees; and special purpose assessments, including assessments for workers’ compensation and the Insurance Guaranty Association Fund. EFFECTIVE DATE: October 1, 2005 11 Public Act 05-102 (Senate Bill 1205) An Act Concerning Appeals of Denials or Determinations by Managed Care Organization and Renaming the Office of the Managed Care Ombudsman (Signed by the Governor 06/07/05) The law allows an enrollee, or health care provider acting on an enrollee’s behalf with his consent, who has exhausted the internal mechanisms provided by a managed care organization (MCO) or utilization review (UR) company, to appeal a claim denial based on medical necessity to the insurance commissioner up to 30 days after receiving written notice of the denial. It also allows appeals of determinations not to certify an admission, service, procedure, or extension of stay. The act allows the insurance commissioner to issue an order specifying how an MCO or UR company must make determinations about procedural or diagnostic coding if she receives three or more appeals of denials or determinations by the same MCO or UR company about the same procedural or diagnostic coding. The commissioner can issue the order on her own motion. The act also changes the name of the Office of Managed Care Ombudsman to the Office of Healthcare Advocate and makes a number of technical changes to accomplish this throughout the statutes. The duties and responsibilities of the office remain the same. EFFECTIVE DATE: October 1, 2005 Public Act 05-103 (Senate Bill 1299) An Act Concerning Extended Reporting Period Coverage under Medical Malpractice Insurance Policies (Signed by the Governor 06/07/05) This act requires that under certain circumstances, professional liability insurance policies issued on a claims-made basis provide coverage for prior acts and unlimited extended reporting period coverage without additional charge to insureds. The requirement applies if, while an insured is covered under the policy, (1) the insurer stops offering the policy in Connecticut for any reason and the insured is over the age of 55 and has been insured by the insurer for the seven consecutive years immediately preceding the discontinuance or (2) the insured dies, becomes permanently disabled and unable to carry out his or her practice, or retires permanently from practice. (The act overrides current regulations relating to physicians, advanced practice registered nurses, or physician assistants who retire—(see BACKGROUND-Related Regulation). The act applies to policies delivered, issued for delivery, or renewed in Connecticut on or after October 1, 2005, to a physician or surgeon, advanced practice registered nurse, physician assistant or hospital. The act makes prior acts coverage and unlimited extended reporting period coverage enforceable against an insurer that stops offering such policies in Connecticut for any reason before the insured's death, disability, or retirement, if the insured is covered under the policy on the date the insurer stops offering the policy. The act requires the insurer to provide such coverage upon death, disability, or retirement in the same manner as if the insurer continued offering it in Connecticut. EFFECTIVE DATE: October 1, 2005 BACKGROUND Claims Made Policy By law, “claims-made policy” means an insurance policy or an endorsement to an insurance policy that covers liability for injury or damage that the insured is legally obligated to pay (including injury or damage occurring before the effective date of the policy, but after the retroactive date, if any), arising out of incidents, acts, or omissions, as long as the claim is first made during the policy period or any extended reporting period (Conn. Agencies Reg. § 38a-327-1). (It is not clear if this definition will apply to the act. ) 12 Related Laws The law requires that every professional liability insurance policy issued on a claims-made basis contain (1) a provision for the purchase of coverage for prior acts and (2) a contractual right of the insured to purchase at any time during the policy period (or within 30 days after it) equivalent coverage for all claims occurring during an insured policy period regardless of when made (CGS § 38a-394). Anyone required by law to have a medical malpractice insurance policy who has a claims-made policy may not lose the right to unlimited additional extended reporting period coverage after he permanently retires from practice because he provides free professional services at a tax-exempt clinic (CGS § 20-11b). Related Regulation Under an Insurance Department regulation, which applies to all claims-made policies for professional liability, unlimited additional extended reporting period coverage must be provided without additional cost to the insured if, while covered by a claims-made professional liability policy, the insured dies or becomes permanently disabled and unable to carry out his practice. It also applies if the insured retires permanently from practice: 1. at or over age 65 having been insured with the same insurer on a claims-made basis for at least the five consecutive years immediately preceding retirement, or 2. at or over age 62 having and has been insured with the same insurer on a claims-made basis for at least the 10 consecutive years immediately preceding retirement (Conn. Agencies Reg. § 38a-327-3(e)). Regarding professional liability insurance, “additional extended reporting period coverage” means coverage for the period specified in the policy during which claims first made after termination of coverage, for injury or damage that occurs on or after the retroactive date, if any, but before the policy term expires is considered made during the policy term (Conn. Agencies Reg. § 38a-327-1(f)(2)). If a policy has no aggregate liability limit, the insurer must offer additional extended reporting period coverage without an aggregate liability limit. If a policy contains an aggregate liability limit, the insurer must offer additional extended reporting period coverage with a limit at least equal to that specified in the policy (Conn. Agencies Reg. § 38a-327-3(f)). Public Act 05-162 (Senate Bill 31) An Act Concerning Notice of Late Fees under Personal Risk Insurance Policies and the Commissioners’ 2001 Standard Ordinary Mortality Table (Signed by the Governor 07/01/05) This act requires personal risk insurers that charge a fee when an insured pays his premiums late to conspicuously display the fee amount and applicability on the bill sent to the policyholder. By law, "personal risk insurance" includes homeowners, tenants, private passenger automobile, mobile home, and other property and casualty insurance for personal, family, or household needs, but excludes workers' compensation. The act also revises the law that regulates the calculation of life insurance minimum reserves, nonforfeiture benefits, and premiums by allowing an insurer to use the 2001 Commissioners' Standard Ordinary (CSO) Mortality Table, instead of older versions, for policies issued after December 31, 2003. For policies issued before April 1, 2005, the act prohibits insurers from using the 2001 table to increase an insured's already agreed-upon premiums. (Apparently an insurer can use the 2001 table to effect a premium reduction for policies issued before April 1, 2005. ) An insurer must give the insurance commissioner written notice of its decision to use the 2001 table before January 1, 2009. Beginning on January 1, 2009, the act requires insurers to use the 2001 table. EFFECTIVE DATE: January 1, 2006, except for the provisions regarding life insurance mortality tables, which are effective upon passage. 13 BACKGROUND Reserve Valuation By law, insurers must apply a standard accounting methodology to calculate the value of its future policy obligations. This valuation is the basis for setting minimum reserves (i. e. , the amount of money an insurer must have on hand to pay claims and other obligations). The calculation includes certain interest rates and the use of mortality tables. In general, as life expectancy increases, a smaller reserve amount is needed because the expected future earned interest increases. Thus, if the 2001 table reflects longer life spans than the older tables currently in use and an insurer calculates reserves based upon it, the insurer may need to keep less in reserve. Nonforfeiture Benefits By law, a life insurance policy guarantees a certain minimum benefit (either a lump sum cash payment or the paid-up insurance amount) to a policyholder who stops paying his premiums. Nonforfeiture benefit calculations also use interest rates and mortality tables. Increased life expectancy may result in lower premiums since an insurer will have longer to invest premiums collected before having to pay out on the policy. 2001 CSO Mortality Table The "2001 CSO Mortality Table" is a table of mortality rates for women and men. The American Academy of Actuaries CSO Task Force developed the 2001 table based on the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force's Valuation Basic Mortality Table. The National Association of Insurance Commissioners adopted the 2001 table in December 2002. Retroactive Application of a Law The act permits an insurer, after December 1, 2004 and at its election, to use the 2001 mortality table for any one or more life insurance policies issued after December 31, 2003 and before April 1, 2005 for reserve and nonforfeiture valuations, except to increase premiums. It permits an insurer to use the 2001 table after December 31, 2004 for policies issued on and after April 1, 2005 for valuation, including to increase premiums. This constitutes a retroactive application of the new provisions. General statutory construction applies new laws prospectively and considers retroactive application as unfair (Sutherland Statutory Construction). Despite this default rule, courts have upheld retroactive legislation that is determined to be reasonable. Courts weigh retroactivity carefully, looking at (1) the nature and identity of the parties; (2) their rights and reliance on the existing law; (3) the impact on completed transactions; and (4) constitutional concerns, such as due process. Public Act 05-193 (Senate Bill 1251) An Act Concerning Owner-controlled Insurance Programs on State and Municipal Construction Projects (Signed by the Governor 07/01/05) This act prohibits contracts to build, alter, or repair public buildings or works from allowing or requiring the state or a municipality to maintain an owner-controlled insurance program (“OCIP”), with two exceptions: (1) any “UConn 2000” infrastructure improvement project or (2) municipal projects totaling at least $100 million that are under the supervision of one construction manager or located within a municipality’s boundaries if under the supervision of two or more construction managers. The act requires each principal or contractor to disclose in its project plans or specifications when soliciting bids that the project will be covered by an OCIP. It also establishes certain requirements for an OCIP contract or insurance policy, which must provide that: 1. coverage for work performed and materials furnished continue from the date work is completed to the date all causes of action are barred under any applicable statute of limitations; 2. the principal and all covered contractors receive notice of a change in coverage, coverage cancellation, or a refusal to renew coverage; 14 3. the effective date of a change in coverage is at least 30 days after the principal and contractors receive notice of it; and 4. the effective date of a cancellation or non-renewal of coverage is at least 60 days after the principal and contractors receive notice of it. Under the act, an OCIP is an insurance procurement program where a principal provides and consolidates insurance coverage for one or more contractors or one or more construction projects. The act also limits the bonding requirement for contracts exceeding $50,000 to the state and municipalities, instead of the state and any of its political subdivisions. EFFECTIVE DATE: Upon passage BACKGROUND Owner-Controlled Insurance Program (OCIP) In an OCIP, the construction project owner purchases insurance for other participants in the project and administers the project’s loss-prevention program. The coverage can include general liability, builder’s risk, workers’ compensation, design errors and omissions, excess, umbrella, and other special coverage. The owner requires the other project participants to reduce their bid prices by eliminating their usual insurance costs in exchange for the owner-provided coverage. An OCIP administrator runs the program, acts as the owner’s agent, and is usually selected by the insurance broker. When an owner implements an OCIP, the contractor and subcontractors must participate. Public Act 05-196 (Senate Bill 508) An Act Concerning Health Insurance Coverage for Infertility Treatment (Signed by the Governor 07/01/05) This act requires individual and group health insurance policies to cover the medically necessary costs of diagnosing and treating infertility. It specifies permissible coverage limitations and requirements. It also permits religious employers and individuals to exclude infertility coverage if it is contrary to their religious tenets. Prior law required insurers and HMOs to offer infertility coverage to group plan sponsors, who could have rejected or accepted it. The act requires a clinical practice that performs insurance-covered in-vitro fertilization (IVF), gamete intra-fallopian transfer (GIFT), or zygote intra-fallopian transfer (ZIFT) procedures to report certain information to the Department of Public Health (DPH) by February 1 following any year it performs the procedures. The act applies to policies delivered, issued, amended, renewed, or continued on and after October 1, 2005 that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; and (4) hospital or medical services, including HMOs. EFFECTIVE DATE: October 1, 2005 INFERTILITY COVERAGE The act requires health insurance policies to cover medically necessary expenses incurred for the diagnosis and treatment of infertility, including ovulation induction, intrauterine insemination, IVF, uterine embryo lavage, embryo transfer, GIFT, ZIFT, and low tubal ovum transfer. It defines “infertility” as the inability of a presumably healthy person to conceive or produce conception or sustain a successful pregnancy during a one-year period. COVERAGE LIMITATIONS AND REQUIREMENTS A policy can: 1. limit coverage to people under age 40; 2. place a lifetime ovulation induction coverage limit of four cycles; 15 3. place a lifetime intrauterine insemination coverage limit of three cycles; 4. place a lifetime IVF, GIFT, ZIFT, or low tubal ovum transfer limit of two cycles and two embryo implantations per cycle, where each fertilization and transfer procedure counts toward the maximum as one cycle; 5. require covered services to be performed at facilities conforming to standards and guidelines developed by the American Society for Reproductive Medicine or the Society of Reproductive Endocrinology and Infertility; 6. limit coverage to people who have been covered by the policy for at least 12 months; 7. require a person seeking infertility coverage to disclose to the insurer on a form developed by the insurance commissioner any previous infertility treatment or procedures for which a different health insurance policy provided coverage; and 8. limit IVF, GIFT, ZIFT, and low tubal ovum transfers to people who have used less expensive and medically viable treatments or procedures covered under the policy but remain infertile. But, coverage for IVF, GIFT, ZIFT, and low tubal ovum transfers cannot be denied if a person forgoes a less expensive treatment option because her doctor determines it is unlikely to be successful. RELIGIOUS EXEMPTION An insurer, medical or service corporation, or HMO can issue a religious employer a health insurance policy that excludes infertility diagnosis and treatment coverage contrary to the employer's bona fide religious tenets. If a person states in writing that infertility diagnosis and treatment is contrary to his religious or moral beliefs, an insurer, medical or service corporation, or HMO can issue him a policy or rider that excludes the coverage. An entity that issues a policy excluding the infertility coverage because of the religious exemption must give written notice of the exclusion to each insured or prospective insured. The notice must appear in the policy, application, and sales brochure and be in at least 10-point type. Under the act, a “religious employer” is a “qualified church-controlled organization,” as defined in federal law, or a church-affiliated organization. Federal law defines “qualified church-controlled organization” as a church-controlled tax-exempt organization, other than one that (1) offers goods, services, or facilities for sale to the general public, other than those sold at a nominal charge that is substantially less than the actual cost, and (2) normally receives more than 25% of its support from either (a) government sources or (b) receipts from admissions, merchandise sales, services performed, or facilities furnished (26 USC § 3121). REPORTABLE INFORMATION A clinical practice that performs insurance-covered IVF, GIFT, and ZIFT procedures must report to DPH by February 1 the (1) number of procedures performed the previous year; (2) number of multiple births or conceptions per pregnancy with a breakdown of births or conceptions per pregnancy; and (3) rates of complications. It must also report, per patient on average and by the number of attempts required, the (1) number of procedures attempted before a successful implantation, (2) number of embryos implanted, and (3) pregnancy rate. The practice must report the information on a form DPH develops. BACKGROUND Infertility Procedures Ovulation induction uses medication to stimulate development of one or more mature follicles (where eggs develop) in a woman’s ovaries. IVF uses a drug to stimulate a woman’s egg production. Once mature, the eggs are removed to a culture dish and fertilized with sperm. After fertilization, embryos are placed in the woman’s uterus. In GIFT, egg and sperm are placed in a woman’s fallopian tubes where fertilization can occur naturally. ZIFT involves placing embryos in a woman’s fallopian tubes. Low tubal ovum transfer involves transferring eggs past a blocked or damaged section of the fallopian tube to an area closer to the uterus. Uterine embryo lavage is a procedure by which the uterus is flushed to recover a preimplantation embryo from a donor and then transferring it to the woman who is to bear the child. 16 Public Act 05-199 (Senate Bill 1336) An Act Concerning Revision to Statutes Governing the Second Injury Fund (Signed by the Governor 07/01/05) This act makes changes in the laws governing the Second Injury Fund, a state-run workers' compensation fund that the state treasurer administers. It exempts the fund from liability in certain cases and reduces the fund's potential liability by prohibiting retroactive claims older than two years from the date on which the employer or its insurer paid benefits. It changes the method of assessing employers for fund liabilities and authorizes: 1. the treasurer to audit employers and insurers regarding requested information and any fund payment due, 2. penalties of 15% for insurers and employers who fail to pay their fund assessment or surcharge and 6% annual interest on unpaid assessments and surcharges, and 3. workers' compensation commissioners and the treasurer to enter into settlements with claimants either before or after an award against an employer. The act defines employer paid losses and prohibits credits against paid losses with some exceptions. For insured employers, the act imposes collection and payment responsibilities on their insurance carriers. EFFECTIVE DATE: July 1, 2006 PROVISIONS REDUCING LIABILITY The act reduces the fund's liability by (1) exempting the fund from being considered an employer or insurer when liability is given to an employee's previous employers, (2) prohibiting claims on the fund older than two years from the date on which the employer or its insurer paid benefits, (3) exempting it from claims brought due to an insolvent insurer, and (4) exempting it from claims by the Insurance Guarantee Association. Reimbursement in Previous Employer Claims (§ 1) By law, a person's last employer is initially responsible for his workers' compensation claim. But a workers' compensation commissioner can order an earlier employer or his insurer to reimburse the last employer or his insurer, if the commissioner determines that the earlier employer is partially liable for the claim. Under the act, the fund is not an employer or insurer, and thus is exempt from liability. Under the act, any amount the Second Injury Fund is exempt from will be proportionally reallocated between the other insurers or former employers. Retroactive Benefit Claims (§§ 2-7) The act exempts the fund from any liability for retroactive benefit claims older than two years from the date on which the employer or its insurer paid benefits. It applies this liability limitation on workers' compensation death benefits, cost of living increases, benefits after a relapse, and cases of insolvent insurers. Insolvent Insurer Claims (§ 7) In situations where more than one employer is liable for compensation, the act exempts the fund from claims brought due to an insolvent insurer. Insurance Guarantee Association (§ 12) The act exempts the fund from claims by the Insurance Guarantee Association, another statutorily created entity that makes payments when an insurer goes bankrupt. EMPLOYER ASSESSMENT (§ 8) The act creates a new method for assessing employers and adds specifics to the definitions of "insured employer" and "self-insured employer. " Under the act, an insured employer means an employer who insures its workers' compensation risks with an insurance company the state authorized to issue workers' compensation policies in Connecticut. It requires that a self-insured employer be one that the workers' compensation chairman has approved to self-insure 17 under the Workers' Compensation Act. The act specifies that the treasurer must allocate the fund's assessments between self-insured employers and insured employers based on a percentage of paid losses (defined below) for each group for the preceding calendar year. The act prohibits credits taken against paid losses except: 1. voided checks for expenses paid under the workers' compensation act previously reported as a paid loss, 2. recoveries from third-party tortfeasors, and 3. reimbursement granted under the initial liability of last employer law and Second Injury Fund reimbursements. Starting with policies effective July 1, 2006 or later, the assessment for insured employers will be based on the Second Injury Fund Surcharge Base (SIFSB), which the act defines as a direct written premium prior to application of any deductible policy premium credits. It specifies that a direct written premium means a premium based on policies prior to application of any deductible policy premium credits. Currently, the assessment for insured employers is based on a standard premium (not defined in law), which may include deductible premium credits and is subject to accounting adjustments that can delay payment to the Second Injury Fund. The act makes conforming changes replacing standard premium with the SIFSB. By law and unchanged by the act, the fund assesses self-insured employers based on the employer's paid losses. The act defines the Second Injury Fund Surcharge for insurance companies, interlocal risk management agencies, and self-insurance groups as the rate set by the treasurer multiplied by the SIFSB. For purposes of collecting the fund surcharge from insured employers and paying the surcharge to the fund, the act deems insurance companies to be collection agents of the Second Injury Fund. The insured employer is liable for paying the surcharge, and the insurance company must collect the payment and submit it to the fund. The act allows, instead of requires, the treasurer to adopt regulations regarding assessing employers. PAID LOSSES The act defines employer paid losses as the total indemnity, medical, and any other expenses, prior to any credits or deductions, paid on or after January 1, 2006, by or on behalf of the employer to or on behalf of the injured employee. Paid losses include all legal expenses paid for benefits in accordance with workers' compensation law and any loss payments within deductible limits on workers' compensation insurance policies. AUDITS, HEARINGS, AND PENALTIES (§§ 8 & 10) The act gives the treasurer the authority to conduct periodic audits of any self-insured employer, group selfinsured employer, insured employer, or insurance company regarding any information or payment the treasurer requires. The employer and insurer must provide all necessary documents and information the treasurer requires. Audit periods cannot cover more than three years. But if the last audit was conducted less than three years earlier, the period of review must be from the date of the prior audit. If the audit determines repeated errors or underreporting by an employer or insurer, the fund may conduct an audit covering an additional twoyear period. If an audit indicates that an employer or insurer has not properly reported to the fund and, as a result, has underpaid its assessment, the treasurer can require the employer to pay the full amount of the assessment along with interest and penalty due not later than 30 days after the treasurer's notice. FINES AND INTEREST PAYMENTS (§ 10) The act establishes a fine at a rate of 15% of the unpaid assessment (or a minimum of $ 50) and an interest charge of 6% per year on any amounts owed as the result of an audit. Under current law, the treasurer can only charge interest at 15%, although in practice this is considered a fine. For self-insured employers, interest accrues 30 days after notice from the fund of the unpaid audit assessment. For insurance companies, the interest accrues from the date of the notice of audit errors or deficiencies as determined by 18 the postmark date. Any partial payments made to the fund must first be applied to any unpaid penalty, then to any unpaid interest, and the remainder, if any, to the unpaid assessment. Interest or penalties will be applied if the fund receives assessment reports or payments postmarked after the designated due date. INSURANCE CARRIER RESPONSIBILITIES (§ 8) For insured employers, the act makes their insurers responsible for correct billing, timely collection, and timely payments to the fund. For insured employers, the SIFSB must be reported to the fund in the quarter the policy is effective, regardless of when the billing is sent or when the payment is made. Insurers must also report all endorsements, retrospective adjustments, and audits in the quarter the policy is issued. These requirements also apply to group self-insured employers. STIPULATED AGREEMENTS AND SETTLEMENTS (§ 11) Under the act, a workers' compensation commissioner may approve stipulated agreements (claim settlements) for benefits between an injured workers and the treasurer before or after an award or finding is issued against an employer, if the commissioner determines it is in the best interest of the injured worker. Notice of the proposed settlement must be sent to the employer by certified mail, return receipt requested to the last address on file with the secretary of the state or local postal authority. The commissioner must hold a hearing on the proposed settlement at the request of the employer in accordance with the workers' compensation law. If the employer does not file a written objection to the proposed settlement with the Workers' Compensation Commission within 28 days after the date of the settlement notice to the employer, the employer is deemed to have consented to the settlement and may not later contest the settlement terms. The settlement and its payments will be made by the fund if the employer is unable or fails to make such payments. The act also provides that none of its provisions, or those existing in current law, precludes the treasurer from entering into an agreement with the employer for the reimbursement of expenses, costs, or benefits paid by the fund. The treasurer, the uninsured employer, the injured worker, or the injured worker's beneficiaries, or a liable third party may enter into a settlement agreement to finally or partially settle the rights and liabilities of any or all parties, subject to the approval of the commissioner. AWARDS AND UNINSURED EMPLOYERS (§ 11) Under the act, when a finding and award of compensation has been made against an uninsured employer who failed, neglected, refused, or is unable to pay it, the Second Injury Fund must pay the compensation and any type of benefit coming due as a consequence of the award. If there are further claims for any related, reasonable, an