reglab/housing_qa huggingface dataset:
CT Gen Stat § 38a-518o (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-518o - Mandatory coverage for bone marrow testing.

 (a) Subject to the provisions of subsection (b) of this section, each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state shall provide coverage for expenses arising from human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B and DR antigens for utilization in bone marrow transplantation.(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for such testing in excess of twenty per cent of the cost for such testing per year. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-520.(c) Such policy shall:(1) Require that such testing be performed in a facility (A) accredited by the American Society for Histocompatibility and Immunogenetics, or its successor, and (B) certified under the Clinical Laboratory Improvement Act of 1967, 42 USC Section 263a, as amended from time to time; and(2) Limit coverage to individuals who, at the time of such testing, complete and sign an informed consent form that also authorizes the results of the test to be used for participation in the National Marrow Donor Program.(d) Such policy may limit such coverage to a lifetime maximum benefit of one testing.(P.A. 11-88, S. 2; P.A. 18-68, S. 18; July Sp. Sess. P.A. 20-4, S. 29.)History: P.A. 11-88 effective January 1, 2012; P.A. 18-68 made a technical change in Subsec. (b); July Sp. Sess. P.A. 20-4 amended Subsec. (b) by substituting “high deductible health plan” for “high deductible plan”.See Sec. 38a-492o for similar provisions re individual policies.
CT Gen Stat § 38a-518p (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-518p - Mandating coverage for medically monitored inpatient detoxification.

 Each insurance company, hospital service corporation, medical service corporation, health care center, fraternal benefit society or other entity that delivers, issues for delivery, renews, amends or continues in this state a group health insurance policy providing coverage of the type specified in subdivision (1), (2), (4), (11) or (12) of section 38a-469 that provides coverage to an insured or enrollee who has been diagnosed with a substance use disorder, as described in section 17a-458, shall cover medically necessary, medically monitored inpatient detoxification services and medically necessary, medically managed intensive inpatient detoxification services provided to the insured or enrollee. For purposes of this section, “medically monitored inpatient detoxification” and “medically managed intensive inpatient detoxification” have the same meanings as described in the most recent edition of the American Society of Addiction Medicine Treatment Criteria for Addictive, Substance-Related and Co-Occurring Conditions.(P.A. 17-131, S. 9.)History: P.A. 17-131 effective January 1, 2018.
CT Gen Stat § 38a-518q (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-518q - Mandatory coverage for essential health benefits.

 (a) For the purposes of this section:(1) “Employee” has the same meaning as specified in section 38a-564.(2) “Essential health benefits” means health care services and benefits that fall within the following categories:(A) Ambulatory patient services;(B) Emergency services;(C) Hospitalization;(D) Maternity and newborn health care;(E) Mental health and substance use disorder services, including, but not limited to, behavioral health treatment;(F) Prescription drugs;(G) Rehabilitative and habilitative services and devices;(H) Laboratory services;(I) Preventive and wellness services and chronic disease management; and(J) Pediatric services, including, but not limited to, oral and vision care.(3) (A) “Small employer” means an employer that employed an average of at least one but not more than fifty employees on business days during the preceding calendar year and employs at least one employee on the first day of the group health insurance policy year. “Small employer” does not include a sole proprietorship that employs only the sole proprietor or the spouse of such sole proprietor.(B) (i) For the purposes of subparagraph (A) of this subdivision, the number of employees shall be determined by adding (I) the number of full-time employees for each month who work a normal work week of thirty hours or more, and (II) the number of full-time equivalent employees, calculated for each month by dividing by one hundred twenty the aggregate number of hours worked for such month by employees who work a normal work week of less than thirty hours, and averaging such total for the calendar year.(ii) If an employer was not in existence throughout the preceding calendar year, the number of employees shall be based on the average number of employees that such employer reasonably expects to employ in the current calendar year.(b) Each group health insurance policy providing, through a small employer, coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state on or after January 1, 2019, shall provide coverage for essential health benefits.(c) No provision of the general statutes concerning a requirement of the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, shall be construed to supersede any provision of this section that provides greater protection to an insured, except to the extent this section prevents the application of a requirement of the Affordable Care Act.(d) The Insurance Commissioner may adopt regulations, in accordance with chapter 54, to carry out the purposes of this section, including, but not limited to, regulations specifying the health care services and benefits that fall within each category set forth in subdivision (2) of subsection (a) of this section.(P.A. 18-10, S. 2.)History: P.A. 18-10 effective January 1, 2019.See Sec. 38a-492q for similar provisions re individual policies.
CT Gen Stat § 38a-518r (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-518r - Mandatory coverage for certain immunizations.

 (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for prescription drugs shall provide coverage for (1) immunizations recommended by the American Academy of Pediatrics, American Academy of Family Physicians and the American College of Obstetricians and Gynecologists, and (2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved.(b) No policy described in subsection (a) of this section shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under said subsection. The provisions of this subsection shall apply to a high deductible health plan, as that term is used in subsection (f) of section 38a-520, to the maximum extent permitted by federal law, except if such plan is used to establish a medical savings account or an Archer MSA pursuant to Section 220 of the Internal Revenue Code of 1986 or any subsequent corresponding internal revenue code of the United States, as amended from time to time, or a health savings account pursuant to Section 223 of said Internal Revenue Code, as amended from time to time, the provisions of this subsection shall apply to such plan to the maximum extent that (1) is permitted by federal law, and (2) does not disqualify such account for the deduction allowed under said Section 220 or 223, as applicable. Nothing in this section shall preclude a policy that provides the coverage required under subsection (a) of this section and uses a provider network from imposing cost-sharing requirements for any benefit or service required under said subsection (a) that is delivered by an out-of-network provider.(P.A. 18-10, S. 6; July Sp. Sess. P.A. 20-4, S. 30.)History: P.A. 18-10 effective January 1, 2019; July Sp. Sess. P.A. 20-4 amended Subsec. (b) by substituting “high deductible health plan” for “high deductible plan” and reference to Sec. 38a-520(f) for reference to Sec. 38a-493(f), adding reference to medical savings account and Archer MSA, and making technical and conforming changes.See Sec. 38a-492r for similar provisions re individual policies.
CT Gen Stat § 38a-518s (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-518s - Mandatory coverage for certain preventive care and screenings for individuals who are twenty-one years of age or younger.

 (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for preventive care and screenings for individuals twenty-one years of age or younger in accordance with the most recent edition of the American Academy of Pediatrics' “Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents” or any subsequent corresponding publication.(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall apply to a high deductible health plan, as that term is used in subsection (f) of section 38a-520, to the maximum extent permitted by federal law, except if such plan is used to establish a medical savings account or an Archer MSA pursuant to Section 220 of the Internal Revenue Code of 1986 or any subsequent corresponding internal revenue code of the United States, as amended from time to time, or a health savings account pursuant to Section 223 of said Internal Revenue Code, as amended from time to time, the provisions of this subsection shall apply to such plan to the maximum extent that (1) is permitted by federal law, and (2) does not disqualify such account for the deduction allowed under said Section 220 or 223, as applicable. Nothing in this section shall preclude a policy that provides the coverage required under subsection (a) of this section and uses a provider network from imposing cost-sharing requirements for any benefit or service required under said subsection (a) that is delivered by an out-of-network provider.(P.A. 18-10, S. 8; July Sp. Sess. P.A. 20-4, S. 31.)History: P.A. 18-10 effective January 1, 2019; July Sp. Sess. P.A. 20-4 amended Subsec. (b) by substituting “high deductible health plan” for “high deductible plan” and reference to Sec. 38a-520(f) for reference to Sec. 38a-493(f), adding reference to medical savings account and Archer MSA, and making technical and conforming changes.See Sec. 38a-492s for similar provisions re individual policies.
CT Gen Stat § 38a-518t (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-518t - Mandatory coverage for prosthetic devices.

 (a) As used in this section, “prosthetic device” means an artificial limb device to replace, in whole or in part, an arm or a leg, including a device that contains a microprocessor if such microprocessor-equipped device is determined by the insured's or enrollee's health care provider to be medically necessary. “Prosthetic device” does not include a device that is designed exclusively for athletic purposes.(b) (1) Each group health insurance policy providing coverage of the types specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for prosthetic devices that is at least equivalent to that provided under Medicare. Such coverage may be limited to a prosthetic device that is determined by the insured's or enrollee's health care provider to be the most appropriate to meet the medical needs of the insured or enrollee. Such prosthetic device shall not be considered durable medical equipment under such policy.(2) Such policy shall provide coverage for the medically necessary repair or replacement of a prosthetic device, as determined by the insured's or enrollee's health care provider, unless such repair or replacement is necessitated by misuse or loss.(3) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for a prosthetic device that is more restrictive than that imposed on substantially all other benefits provided under such policy, except that a high deductible health plan, as that term is used in subsection (f) of section 38a-520, shall not be subject to the deductible limits set forth in this subdivision or under Medicare pursuant to subdivision (1) of this subsection.(c) A group health insurance policy may require prior authorization for prosthetic devices, provided such authorization is required in the same manner and to the same extent as is required for other covered benefits under such policy.(P.A. 18-69, S. 2; July Sp. Sess. P.A. 20-4, S. 32.)History: P.A. 18-69 effective January 1, 2019; July Sp. Sess. P.A. 20-4 amended Subsec. (b)(3) by substituting “high deductible health plan” for “high deductible plan”.See Sec. 38a-492t for similar provisions re individual policies.
CT Gen Stat § 38a-519. (Formerly Sec. 38-174j) (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-519. (Formerly Sec. 38-174j) - Offset proviso prohibited in certain policies. Required disclosures for group long-term disability policies.

 (a) No group health insurance policy that provides disability income protection coverage, delivered, issued for delivery, renewed, amended or continued in this state, and no application, rider or endorsement used in connection therewith shall contain an offset proviso. For the purposes of this subsection, “offset proviso” means any provision of an insurance policy that allows the insurer to reduce its liability for loss or expense from sickness or from bodily injury of the insured by reason of any cost of living increase in other disability benefits that occur after the date a claim commences under such policy.(b) For each group long-term disability income protection coverage policy delivered, issued for delivery, renewed, amended or continued in this state that contains an offset, the insurer shall disclose to a policyholder in a separate document and in a conspicuous manner in not less than fourteen-point boldface type: (1) That the policy contains an offset; (2) that such offset will function to limit payments to an insured under the policy, taking into account Social Security disability benefits and other benefits the insured may receive; (3) for what other categories of benefits the policy will offset; (4) the percentage of income the policy covers and the maximum dollar limit of the policy, if applicable; and (5) at least one example showing how such offset will operate. Such disclosure shall include a statement that, if an eligible individual wants a policy that does not contain an offset, the individual may contact an insurance agent or company for an individual policy.(c) The policyholder shall provide to each eligible individual the information and the statement required to be disclosed under subsection (b) of this section.(P.A. 75-622, S. 1, 3; P.A. 80-416; P.A. 90-243, S. 103; P.A. 10-65, S. 1; P.A. 11-19, S. 12.)History: P.A. 80-416 prohibited offset provisos in policies in effect on January 1, 1976, and in applications, riders or endorsements after January 1, 1981; P.A. 90-243 made technical corrections for statutory consistency and deleted the references to “contract”; Sec. 38-174j transferred to Sec. 38a-519 in 1991; P.A. 10-65 designated existing provisions as Subsec. (a) and amended same to redefine “offset proviso” and make technical changes and added Subsecs. (b) and (c) re disclosure requirements, effective January 1, 2011; P.A. 11-19 made technical changes in Subsecs. (a) and (b).
CT Gen Stat § 38a-521 (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-521 - Home health care by recognized nonmedical systems.

 Notwithstanding the provisions of section 38a-520, no insurer, health care center or issuer of any service plan contract for hospital or medical expense delivered, issued for delivery or renewed in this state shall be prohibited from providing, at its own discretion, coverage for home health care to persons employing a recognized nonmedical system of health care and treatment.(P.A. 90-243, S. 105.)
CT Gen Stat § 38a-524 (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-524 - Coverage for occupational therapy.

 (a) For the purposes of this section:(1) “Occupational therapy” means services provided by a licensed occupational therapist in accordance with a plan of care established and approved in writing by a physician licensed in accordance with the provisions of chapter 370 or an advanced practice registered nurse licensed in accordance with the provisions of chapter 378, who has certified that the prescribed care and treatment are not available from sources other than a licensed occupational therapist and which are provided in private practice or in a licensed health care facility. Such plan shall be reviewed and certified at least every two months by such physician or advanced practice registered nurse.(2) “Health care facility” means an institution which provides occupational therapy, including, but not limited to, an outpatient clinic, a rehabilitative agency and a skilled or intermediate nursing facility.(3) “Rehabilitative agency” means an agency which provides an integrated multitreatment program designed to upgrade the function of persons with physical disabilities by bringing together, as a team, specialized personnel from various allied health fields.(4) “Partial hospitalization” means a formal program of care provided in a hospital or facility for periods of less than twenty-four hours a day.(b) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for expenses incurred for physical therapy shall provide coverage for occupational therapy provided in private practice or in a health care facility or in a partial hospitalization program on an exchange basis.(P.A. 90-243, S. 108; P.A. 11-19, S. 46; P.A. 16-39, S. 67; P.A. 17-202, S. 92.)History: P.A. 11-19 inserted “amended or continued” and made technical changes in Subsec. (b), effective January 1, 2012; P.A. 16-39 amended Subsec. (a)(1) by adding references to advanced practice registered nurse; P.A. 17-202 amended Subsec. (a)(3) by replacing “handicapped disabled individuals” with “persons with physical disabilities”.See Sec. 38a-496 for similar provisions re individual policies.
CT Gen Stat § 38a-525 (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-525 - Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider.

 (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for medically necessary ambulance services for persons covered by the policy. The hospital policy shall be primary if a person is covered under more than one policy. The policy shall, as a minimum requirement, cover such services whenever any person covered by the contract is transported when medically necessary by ambulance to a hospital. Such benefits shall be subject to any policy provision which applies to other services covered by such policies. Notwithstanding any other provision of this section, such policies shall not be required to provide benefits in excess of the maximum allowable rate established by the Department of Public Health in accordance with section 19a-177.(b) (1) Each such group health insurance policy shall provide that any payment by such company, corporation or center for emergency ambulance services under coverage required by this section shall be paid directly to the ambulance provider rendering such service if such provider has complied with the provisions of this subsection and has not received payment for such service from any other source.(2) Any ambulance provider submitting a bill for direct payment pursuant to this section shall stamp the following statement on the face of each bill: “NOTICE: This bill subject to mandatory assignment pursuant to Connecticut general statutes”.(3) This subsection shall not apply to any transaction between an ambulance provider and an insurance company, hospital service corporation, medical service corporation, health care center or other entity if the parties have entered into a contract providing for direct payment.(P.A. 90-243, S. 109; P.A. 02-124, S. 2; P.A. 12-145, S. 59; P.A. 15-118, S. 15.)History: P.A. 02-124 amended Subsec. (a) to rewrite provisions re policies renewed or amended in this state, substitute “October 1, 2002” for “March 1, 1984”, substitute “medically necessary” for “emergency” re covered ambulance services, delete requirement that person be admitted to hospital as an inpatient in order to obtain coverage, and substitute the maximum allowable rate established by the Department of Public Health for $500 re the maximum required coverage, deleted language in Subsec. (b)(1) re policies delivered, issued for delivery, etc., and amended Subsec. (b)(3) to add “health care center or other entity”; P.A. 12-145 amended Subsec. (a) to add “or continued” re policy and delete “on or after October 1, 2002”, effective January 1, 2013; P.A. 15-118 made a technical change in Subsec. (b)(3).See Sec. 38a-498 for similar provisions re individual policies.
CT Gen Stat § 38a-525a (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-525a - Prior authorization prohibited for certain 9-1-1 emergency calls.

 No group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 38a-469, delivered, issued for delivery or renewed in this state, on or after October 1, 1996, shall direct or require an enrollee to obtain approval from the insurer or health care center prior to calling a 9-1-1 local prehospital emergency medical service system whenever such enrollee is confronted with a life or limb threatening emergency. For purposes of this section, a “life or limb threatening emergency” means any event which the enrollee believes threatens his life or limb in such a manner that a need for immediate medical care is created to prevent death or serious impairment of health.(P.A. 96-67, S. 2.)History: (Revisor's note: In codifying public act 96-67, an incorrect reference to “of subsection (a)” appearing before the reference to “section 38a-469” was deleted editorially by the Revisors).See Sec. 38a-498a for similar provisions re individual policies.