reglab/housing_qa huggingface dataset:
CT Gen Stat § 38a-469 (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-469 - Definitions.

 As used in this title, unless the context otherwise requires or a different meaning is specifically prescribed, “health insurance” policy means insurance providing benefits due to illness or injury, resulting in loss of life, loss of earnings, or expenses incurred, and includes the following types of coverage: (1) Basic hospital expense coverage; (2) basic medical-surgical expense coverage; (3) hospital confinement indemnity coverage; (4) major medical expense coverage; (5) disability income protection coverage; (6) accident only coverage; (7) long-term care coverage; (8) specified accident coverage; (9) Medicare supplement coverage; (10) limited benefit health coverage; (11) hospital or medical service plan contract; (12) hospital and medical coverage provided to subscribers of a health care center; (13) specified disease coverage; (14) TriCare supplement coverage; (15) travel health coverage; (16) single service ancillary health coverage, including, but not limited to, dental, vision or prescription drug coverage; and (17) short-term care coverage.(P.A. 90-243, S. 68; P.A. 96-227, S. 9; P.A. 08-147, S. 5; Sept. Sp. Sess. P.A. 09-7, S. 171; P.A. 16-63, S. 1.)History: P.A. 96-227 added “specified disease coverage” as a type of “health insurance” policy; (Revisor's note: In 2005 the words “title 38a” were replaced editorially by the Revisors with “this title”); P.A. 08-147 added Subdiv. (14) to include TriCare supplement coverage in definition of “health insurance” policy; Sept. Sp. Sess. P.A. 09-7 added Subdiv. (15) re travel health coverage and Subdiv. (16) re single service ancillary health coverage as types of health insurance policies; P.A. 16-63 added Subdiv. (17) re short-term care coverage and made a technical change.
CT Gen Stat § 38a-472a (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-472a - Medical provider indemnification agreements prohibited.

 No contract between a managed care company, other organization or insurer authorized to do business in this state and a medical provider practicing in this state for the provision of services may require that the medical provider indemnify the managed care company, other organization or insurer for any expenses and liabilities including, without limitation, judgments, settlements, attorneys' fees, court costs and any associated charges incurred in connection with any claim or action brought against a managed care company, other organization or insurer on the basis of its determination of medical necessity or appropriateness of health care services if the information provided by such medical provider used in making the determination was accurate and appropriate at the time it was given. As used in this section and section 38a-472b, “medical provider” means any person licensed pursuant to chapters 370 to 373, inclusive, or chapter 375, 378, 379, 380 or 383.(P.A. 95-199, S. 3; P.A. 15-118, S. 44; P.A. 19-98, S. 7.)History: P.A. 15-118 made a technical change; P.A. 19-98 redefined “medical provider” by adding reference to Ch. 378.
CT Gen Stat § 38a-472b (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-472b - Medical provider indemnification contracts. Professional actions and related liability.

 Notwithstanding the provisions of section 38a-472a, every medical provider participating in a contract pursuant to said section shall be responsible for his professional actions and related liability.(P.A. 95-199, S. 4.)
CT Gen Stat § 38a-472c (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-472c - Dental policies. Estimate of reimbursement. Material adjustments to fee schedules for in-network providers. Notice.

 (a) For any policy delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for inpatient or outpatient dental services only, the person who issues the policy shall provide the insured or a licensed dentist acting on behalf of the insured, upon request, an estimate of reimbursement under the policy with respect to specific dental procedure codes ordered or recommended for the insured by a licensed dentist, except that the actual reimbursement may be adjusted based on factors such as the insured's eligibility, plan design, utilization of benefits and the actual claim submitted.(b) No person that issues a policy described in subsection (a) of this section that uses a provider network for such policy shall materially adjust the fee schedule for in-network providers more than once annually.(c) Each person that makes a material adjustment described in subsection (b) of this section shall issue a notice to each in-network provider at least ninety days before the effective date of such adjustment. Each such notice shall be sent by mail, electronic mail or facsimile, and disclose:(1) The percentage effect that such adjustment will have on such provider's fees; or(2) A measure, other than the measure described in subdivision (1) of this subsection, that will enable such provider to understand how such adjustment will affect such provider's fees for the twenty covered procedures that such provider most frequently performed, and for which such provider sought reimbursement, during the twelve months immediately preceding the date of such notice.(P.A. 04-125, S. 1; P.A. 11-19, S. 7; P.A. 19-155, S. 3.)History: P.A. 11-9 made a technical change; P.A. 19-155 designated existing provisions re policy that provides coverage for inpatient or outpatient dental services only as Subsec. (a) and added Subsecs. (b) and (c) re material adjustments to fee schedules for in-network providers, effective January 1, 2020.
CT Gen Stat § 38a-472d (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-472d - Public education outreach program re health insurance availability and eligibility requirements.

 (a) Not later than January 1, 2006, the Insurance Commissioner, in consultation with the Commissioner of Social Services and the Healthcare Advocate, shall develop a comprehensive public education outreach program to educate health insurance consumers about the availability and general eligibility requirements of various health insurance options in this state. The program shall maximize public information concerning health insurance options in this state and shall provide for the dissemination of such information on the Insurance Department's Internet web site.(b) The information on the department's Internet web site shall reference the availability and general eligibility requirements of (1) programs administered by the Department of Social Services, including, but not limited to, the Medicaid program and HUSKY A and B, (2) health insurance coverage provided by the Comptroller under subsection (i) of section 5-259, and (3) other health insurance coverage offered through local, state or federal agencies or through entities licensed in this state. The commissioner shall update the information on the web site at least quarterly.(P.A. 05-253, S. 1; P.A. 11-44, S. 137; P.A. 15-69, S. 39; 15-247, S. 35.)History: P.A. 11-44 amended Subsec. (b)(1) by deleting “the state-administered general assistance program” and making technical changes, effective July 1, 2011; P.A. 15-69 amended Subsec. (b)(1) to replace “the HUSKY Plan, Part A and Part B” with “HUSKY A and B”, effective June 19, 2015; P.A. 15-247 amended Subsec. (b) by deleting former Subdiv. (3) re health insurance coverage available under comprehensive health care plans and redesignating existing Subdiv. (4) as Subdiv. (3), effective July 10, 2015.
CT Gen Stat § 38a-472e (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-472e - Health insurer. Requirements re offer to contract with a school-based health center.

 Each health insurer licensed to do business in this state shall, at the request of any school-based health center or group of school-based health centers, offer to contract with such center or centers to provide reimbursement for covered health care services to persons who are insured by such licensed insurer. Such offer shall be made on terms and conditions similar to contracts offered to other providers of health care services.(P.A. 10-118, S. 1.)History: P.A. 10-118 effective June 7, 2010.
CT Gen Stat § 38a-472g (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-472g - Restrictions applicable to prior authorization or precertification.

 (a)(1) No insurer, health care center, fraternal benefit society, hospital service corporation or medical service corporation or other entity, delivering, issuing for delivery, renewing, amending or continuing an individual or group health insurance policy in this state providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 or utilization review company performing utilization review for such insurer, center, society, corporation or entity, that issues prior authorization for or precertifies, on or after January 1, 2012, an admission, service, procedure or extension of stay shall reverse or rescind such prior authorization or precertification or refuse to pay for such admission, service, procedure or extension of stay if:(A) Such insurer, center, society, corporation, entity or company failed to notify the insured's or enrollee's health care provider at least three business days prior to the scheduled date of such admission, service, procedure or extension of stay that such prior authorization or precertification has been reversed or rescinded on the basis of medical necessity, fraud or lack of coverage; and(B) Such admission, service, procedure or extension of stay has taken place in reliance on such prior authorization or precertification.(2) The provisions of this subsection shall apply regardless of whether such prior authorization or precertification is required or is requested by an insured's or enrollee's health care provider. Unless reversed or rescinded as set forth in subparagraph (A) of subdivision (1) of this subsection, such prior authorization or precertification shall be effective for not less than sixty days from the date of issuance.(b) Nothing in subsection (a) of this section shall be construed to authorize benefits or services in excess of those that are provided for in the insured's or enrollee's policy or contract.(c) Nothing in subsection (a) of this section shall affect the provisions of subsection (b) of section 38a-479b.(P.A. 11-58, S. 18; P.A. 17-15, S. 37.)History: P.A. 11-58 effective January 1, 2012; P.A. 17-15 made technical changes in Subsec. (a).
CT Gen Stat § 38a-472i (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-472i - Payment amount of professional services component of covered colonoscopy or endoscopic services.

 Each insurer, health care center, hospital service corporation, medical service corporation or fraternal benefit society that delivers, issues for delivery, renews, amends or continues an individual or group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 in this state, and contracts directly with a physician or physician group or physician organization to provide medical services under such policy shall, at such contracted physician's or physician's group's or physician's organization's request, establish a payment amount for the physician's professional services component of colonoscopy or endoscopic services covered under such policy, that is the same regardless of where the physician's professional services are performed. Such payment amount for the physician's professional services shall not be less than the amount that would otherwise be paid to such contracted physician or physician group or physician organization if the services are performed at a facility other than an outpatient surgical facility, as defined in section 19a-493b. Nothing in this section shall prohibit a contracted physician or physician group or physician organization from agreeing to a different payment methodology for colonoscopy or endoscopic services.(P.A. 11-225, S. 3.)See Secs. 38a-492k and 38a-518k for individual and group health insurance coverage for colorectal cancer screening.
CT Gen Stat § 38a-472j (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-472j - Restrictions applicable to cost-sharing for covered benefits. Regulations.

 (a) Notwithstanding any provision of the general statutes and to the maximum extent permitted by federal law, no individual or group health insurance policy delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2020, providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for a covered benefit in an amount that exceeds the lesser of:(1) The amount paid to the provider or vendor for the covered benefit, including all discounts, rebates and adjustments, by the insurer, health care center, fraternal benefit society, hospital service corporation, medical service corporation or other entity that delivered, issued for delivery, renewed, amended or continued such policy or an intermediary engaged by such insurer, center, society, corporation or entity;(2) An amount calculated on the basis of the amount charged for the covered benefit by the provider or vendor, less any discount for such covered benefit and any amount due to, or charged by, an entity if such entity is affiliated with, or owned or controlled by, the insurer, health care center, fraternal benefit society, hospital service corporation, medical service corporation or other entity that delivered, issued for delivery, renewed, amended or continued such policy; or(3) The amount that the insured would have paid to the provider or vendor for the covered benefit without regard to such policy. If the Insurance Commissioner adopts regulations pursuant to subsection (c) of this section, the commissioner may define such amount in such regulations.(b) Any violation of subsection (a) of this section shall be deemed an unfair method of competition and unfair and deceptive act or practice in the business of insurance under section 38a-816.(c) The Insurance Commissioner may adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of this section.(P.A. 19-117, S. 236.)History: P.A. 19-117 effective January 1, 2020.
CT Gen Stat § 38a-472k (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-472k - Disability income policies. Discretionary clauses prohibited. Regulations.

 No insurer, health care center, fraternal benefit society, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, amending or continuing an individual or group health insurance policy in this state on or after January 1, 2020, providing coverage of the type specified in subdivision (5) of section 38a-469 shall include in such policy a provision reserving discretion to such insurer, center, society, corporation or entity to interpret the terms of such policy, or provide standards for the interpretation or review of such policy, that are inconsistent with the laws of this state.(P.A. 19-117, S. 244.)History: P.A. 19-117 effective January 1, 2020.
CT Gen Stat § 38a-473 (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-473 - Medicare supplement expense factors. Age, gender, previous claim or medical history rating prohibited.

 (a) No insurance company, fraternal benefit society, hospital service corporation, medical service corporation, health care center or other entity that delivers or issues for delivery Medicare supplement insurance policies or certificates, written, delivered, continued or renewed in this state during the previous calendar year shall incorporate in its rates for Medicare supplement insurance calculated in accordance with sections 38a-495, 38a-495a and 38a-522, and any regulations adopted pursuant to said sections, factors for expenses that exceed one hundred fifty per cent of the average expense ratio for the entire written premium for all lines of health insurance of such company, society, corporation, center or other entity for the previous calendar year.(b) No insurance company, fraternal benefit society, hospital service corporation, medical service corporation, health care center or other entity that delivers or issues for delivery in this state any Medicare supplement policies or certificates shall incorporate in its rates or determinations to grant coverage for Medicare supplement insurance policies or certificates any factors or values based on the age, gender, previous claims history or the medical condition of any person covered by such policy or certificate.(P.A. 90-243, S. 179, 181; P.A. 91-406, S. 9, 29; P.A. 92-60, S. 20; P.A. 93-239, S. 4; 93-390, S. 3, 8; May 25 Sp. Sess. P.A. 94-1, S. 39, 130; P.A. 05-20, S. 1; P.A. 11-19, S. 27; P.A. 17-15, S. 38.)History: P.A. 91-406 corrected an internal reference; P.A. 92-60 made provisions applicable to any Medicare supplement policy continued or renewed during the previous calendar year, made provisions applicable to all lines of health insurance and made technical corrections for statutory consistency; P.A. 93-239 made technical corrections for statutory consistency and accuracy; P.A. 93-390 made technical changes for statutory consistency by adding references to “any other entity” and “certificate” and added Subsec. (b) prohibiting the incorporation of factors for age, gender and previous claim or medical condition history, into the insurer's rate schedule, effective January 1, 1994; May 25 Sp. Sess. P.A. 94-1 amended Subsec. (a) by making technical change, effective July 1, 1994; P.A. 05-20 made technical changes and amended Subsec. (b) to reference “determinations to grant coverage” and plans “H” to “J”, inclusive, “issued prior to January 1, 2006” re use of claims history and medical condition, effective July 1, 2005; P.A. 11-19 amended Subsec. (b) to delete provisions re Medicare supplement plans “H” to “J”; P.A. 17-15 made technical changes.
CT Gen Stat § 38a-474 (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-474 - Medicare supplement policy rate increases: Procedure. Age, gender, previous claim or medical history rating prohibited.

 (a) Any insurance company, fraternal benefit society, hospital service corporation, medical service corporation, health care center or other entity that delivers, issues for delivery, renews, amends or continues in this state any Medicare supplement policy or certificate, as defined in sections 38a-495, 38a-495a and 38a-522, seeking to change its rates shall file a request for such change with the Insurance Department at least sixty days prior to the proposed effective date of such change. The Insurance Department shall review the request and, with respect to requests for an increase in rates, shall hold a public hearing on such increase. The Insurance Commissioner shall approve or deny the request not later than forty-five days after its receipt. The Insurance Commissioner shall adopt regulations, in accordance with chapter 54, to set requirements for the submission of data pertaining to a request to change rates and to define the policies utilized in making a decision on such change in rates.(b) No insurance company, fraternal benefit society, hospital service corporation, medical service corporation, health care center or other entity that delivers or issues for delivery in this state any Medicare supplement policies or certificates shall incorporate in its rates or determinations to grant coverage for Medicare supplement insurance policies or certificates any factors or values based on the age, gender, previous claims history or the medical condition of the person covered by such policy or certificate.(P.A. 90-81; P.A. 91-406, S. 10, 29; P.A. 93-390, S. 4, 8; P.A. 94-39, S. 4; P.A. 05-20, S. 2; P.A. 11-19, S. 28; P.A. 12-145, S. 53; P.A. 17-15, S. 39.)History: P.A. 91-406 corrected an internal reference; P.A. 93-390 added references to “health care centers” and “any other entity” for statutory consistency and added Subsec. (b) prohibiting the incorporation of factors for age, gender and previous claim or medical condition history, into insurer's rate schedule, effective January 1, 1994; P.A. 94-39 substituted “change” for the references to “increase” and added a provision in Subsec. (a) that with respect to requests for an increase in rates a public hearing must be held by the insurance department; P.A. 05-20 made technical changes and amended Subsec. (b) to reference “determinations to grant coverage” and plans “H” to “J”, inclusive, “issued prior to January 1, 2006” re use of claims history and medical condition, effective July 1, 2005; P.A. 11-19 amended Subsec. (b) to delete provisions re Medicare supplement plans “H” to “J”; P.A. 12-145 amended Subsec. (a) to add “amends” re policy or certificate, delete 1990 and 1994 date references, and make technical changes, effective January 1, 2013; P.A. 17-15 made technical changes.See Sec. 38a-481 re Medicare supplement policy rates.
CT Gen Stat § 38a-476b (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-476b - Standards re psychotropic drug availability in health plans.

 Notwithstanding any provision of the general statutes or the regulations of Connecticut state agencies, no mental health care benefit provided under state law, or with state funds or to state employees may, through the use of a drug formulary, list of covered drugs or any other means: (1) Limit the availability of psychotropic drugs that are the most effective therapeutically indicated pharmaceutical treatment with the least probability of adverse side effects; or (2) require utilization of psychotropic drugs that are not the most effective therapeutically indicated pharmaceutical treatment with the least probability of adverse side effects. Nothing in this section shall be construed to limit the authority of a physician to prescribe a drug that is not the most recent pharmaceutical treatment. Nothing in this section shall be construed to prohibit differential copays among pharmaceutical treatments or to prohibit utilization review.(P.A. 01-171, S. 17.)
CT Gen Stat § 38a-476c (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-476c - Policies and contracts with variable network and enrollee cost-sharing. Approval. Limitations.

 (a) The Insurance Commissioner shall approve any health insurance policy or contract, including, but not limited to, a policy or contract filed by a health care center, that uses variable networks and enrollee cost-sharing as set forth in subsection (b) of this section if (1) the policy or contract meets the requirements of this title, (2) the policy or contract form or amendment thereto filed with the commissioner is accompanied by a rate filing for the policy or contract and (3) the commissioner finds that the rate filing reflects a reasonable reduction in premiums or fees as compared to policies or contracts that do not use such variable networks and enrollee cost-sharing.(b) Such policies and contracts shall be limited to policies and contracts that: (1) Offer choices among provider networks of different size; (2) offer different deductibles depending on the type of health care facility used; or (3) offer prescription drug benefits that use any combination of deductibles, coinsurance not to exceed thirty per cent or copayments, including combinations of such deductibles, coinsurance or copayments at different benefit levels.(P.A. 05-238, S. 7.)