reglab/housing_qa huggingface dataset:
CT Gen Stat § 38a-477a (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-477a - Notification by Insurance Commissioner of required benefits and policy forms.

 The Insurance Commissioner shall provide written or electronic notification to each insurance company, fraternal benefit society, hospital service corporation, medical service corporation, health care center or any other entity that delivers or issues for delivery, in this state, any individual or group health insurance plan (1) of any benefits required to be provided in such plan pursuant to this chapter, or of any modification to such benefits on or after October 1, 2006, at least thirty days prior to the date such benefits or modification becomes effective, and (2) instructing such company, society, corporation, center or other entity to submit to the Insurance Commissioner, prior to the date such benefits or modification becomes effective or upon the renewal date of the plan, any necessary policy forms, in accordance with the provisions of section 38a-481 or 38a-513, as applicable, that reflect such benefits or modification.(P.A. 06-188, S. 35; P.A. 08-147, S. 6.)History: P.A. 08-147 authorized electronic notification provided by commissioner.
CT Gen Stat § 38a-477bb (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-477bb - Cost-sharing re facility fees.

 (a) As used in this section, “campus”, “facility fee”, “health system”, “hospital” and “hospital-based facility” have the same meanings as provided in section 19a-508c.(b) (1) Each health insurer, health care center or other entity that delivers, issues for delivery, renews, amends or continues, on or after January 1, 2016, an individual or a group health insurance policy or health benefit plan providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 in this state, and includes in a contract entered into, renewed or amended on or after October 1, 2015, with a hospital, a health system or a hospital-based facility, reimbursement to such hospital, health system or hospital-based facility for a facility fee for outpatient health care services that are provided at a hospital-based facility located off-site from a hospital campus, shall not impose any separate copayment for such fee.(2) With respect to an insured covered under such policy or plan, who has not satisfied the deductible applicable to such policy or plan at the time of the provision of the applicable health care service, no such hospital, health system or hospital-based facility may collect from such insured for any applicable facility fee more than the facility fee reimbursement rate agreed to by such insurer, center or other entity pursuant to such contract.(P.A. 15-146, S. 14.)
CT Gen Stat § 38a-477c (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-477c - Disclosure of state and federal medical loss ratio with each health insurance application.

 An insurer or health care center shall include a written notice with each application for individual or group health insurance coverage that discloses such insurer's or health care center's state medical loss ratio and federal medical loss ratio, as both terms are defined in section 38a-478l, as reported in the last Consumer Report Card on Health Insurance Carriers in Connecticut, to an applicant at the time of application for coverage.(P.A. 09-46, S. 2; P.A. 11-58, S. 50.)History: P.A. 11-58 added federal medical loss ratio to information disclosed with application for health insurance coverage and made conforming changes, effective January 1, 2012.
CT Gen Stat § 38a-477d (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-477d - Information to be made available to consumers.

 (a) Each insurer, health care center, hospital service corporation, medical service corporation, fraternal benefit society or other entity that delivers, issues for delivery, renews, amends or continues a health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 in this state, shall:(1) Make available to consumers, in an easily readable, accessible and understandable format, the following information for each such policy: (A) Any coverage exclusions; (B) any restrictions on the use or quantity of a covered benefit, including on prescription drugs or drugs administered in a physician's office or a clinic; (C) a specific description of how prescription drugs are included or excluded from any applicable deductible, including a description of other out-of-pocket expenses that apply to such drugs; (D) the specific dollar amount of any copayment and the percentage of any coinsurance imposed on each covered benefit, including each covered prescription drug; and (E) information regarding any process available to consumers, and all documents necessary, to seek coverage of a noncovered outpatient prescription drug;(2) Make available to consumers a way to determine accurately (A) whether a specific prescription drug is available under such policy's drug formulary; (B) the coinsurance, copayment, deductible or other out-of-pocket expense applicable to such drug; (C) whether such drug is covered when dispensed by a physician or a clinic; (D) whether such drug requires prior authorization or the use of step therapy; (E) whether specific types of health care specialists are in-network; and (F) whether a specific health care provider or hospital is in-network.(b) (1) Each insurer, health care center, hospital service corporation, medical service corporation, fraternal benefit society or other entity shall make the information required under subsection (a) of this section available to consumers at the time of enrollment and shall post such information on its Internet web site.(2) The Connecticut Health Insurance Exchange, established pursuant to section 38a-1081, shall post links on its Internet web site to such information for each qualified health plan that is offered or sold through the exchange.(c) The Insurance Commissioner shall post links on the Insurance Department's Internet web site to any on-line tools or calculators to help consumers compare and evaluate health insurance policies and plans.(P.A. 15-146, S. 7; P.A. 17-15, S. 43, 44; P.A. 18-41, S. 11.)History: P.A. 15-146 effective January 1, 2016; P.A. 17-15 made technical changes in Subsecs. (a)(2)(D) and (c); P.A. 18-41 amended Subsec. (a)(1) by adding “, accessible” and Subpara. (E) re coverage of noncovered outpatient prescription drugs, effective January 1, 2020.
CT Gen Stat § 38a-477dd (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-477dd - Contracts with health carriers. Certain provisions concerning disclosures to covered persons prohibited.

 Notwithstanding any provision of the general statutes, and to the maximum extent permitted by applicable law, no contract entered into or amended by a health carrier, as defined in section 38a-591a, on or after January 1, 2020, shall contain any provision prohibiting or penalizing, including, but not limited to, through increased utilization review, reduced payments or other financial disincentives, disclosure of any information to a covered person, as defined in section 38a-591a, concerning:(1) The cost of a covered benefit, including, but not limited to, the cash price of a covered benefit; or(2) The availability and cost of any health care service or product that is therapeutically equivalent to a covered benefit, including, but not limited to, the cash price of any such health care service or product.(P.A. 19-117, S. 238.)History: P.A. 19-117 effective January 1, 2020.
CT Gen Stat § 38a-477e (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-477e - Health carriers to maintain Internet web site and toll-free telephone number. Available information. Exception.

 (a) On and after January 1, 2017, each health carrier, as defined in section 19a-755b, shall maintain an Internet web site and toll-free telephone number that enables consumers to request and obtain: (1) Information on in-network costs for inpatient admissions, health care procedures and services, including (A) the allowed amount for, at a minimum, admissions and procedures reported to the executive director of the Office of Health Strategy pursuant to section 19a-755b for each health care provider in the state; (B) the estimated out-of-pocket costs that a consumer would be responsible for paying for any such admission or procedure that is medically necessary, including any facility fee, coinsurance, copayment, deductible or other out-of-pocket expense; and (C) data or other information concerning (i) quality measures for the health care provider, (ii) patient satisfaction, to the extent such information is available, (iii) a directory of participating providers, as defined in section 38a-472f, in accordance with the provisions of section 38a-477h; and (2) information on out-of-network costs for inpatient admissions, health care procedures and services.(b) A health carrier shall advise the consumer when providing the information on out-of-pocket costs that the amounts are estimates and that the consumer's actual cost may vary due to health care provider contractual changes, the need for unforeseen services that arise out of the proposed admission or procedure or other circumstances.(c) The provisions of this section shall not apply to a health carrier with less than forty thousand covered lives in the state. If in any year, a health carrier exceeds forty thousand covered lives in the state, the provisions of this section shall begin to apply on January first in the following year.(P.A. 15-146, S. 5; P.A. 16-77, S. 3; 16-205, S. 5; P.A. 17-15, S. 45; June Sp. Sess. P.A. 17-2, S. 123; P.A. 18-91, S. 6.)History: P.A. 16-77 amended Subsec. (a) by replacing “July 1, 2016” with “January 1, 2017”, and added Subsec. (c) re health carriers to which provisions of section do not apply, effective June 2, 2016; P.A. 16-205 amended Subsec. (a) by adding reference to Sec. 38a-1084a, deleting former Subdiv. (1)(C)(iii) to (1)(C)(v) and adding new Subdiv. (1)(C)(iii) re directory of participating providers, effective January 1, 2017; P.A. 17-15 amended Subsec. (a)(1)(C)(iii) by replacing reference to Sec. 38a-472f with reference to Sec. 38a-477h; June Sp. Sess. P.A. 17-2 amended Subsec. (a) by replacing “38a-1084a” with “19a-755b”, effective October 31, 2017; P.A. 18-91 amended Subsec. (a) by replacing “exchange” with “executive director of the Office of Health Strategy”, effective May 14, 2018.
CT Gen Stat § 38a-477f (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-477f - Contract provision prohibiting certain disclosures prohibited.

 (a) On and after January 1, 2016, no contract entered into or renewed between a health care provider and a health carrier shall contain a provision prohibiting disclosure of (1) billed or allowed amounts, reimbursement rates or out-of-pocket costs, or (2) any data to the all-payer claims database program established under section 19a-755a. Information described in subdivisions (1) and (2) of this subsection may be used to assist consumers and institutional purchasers in making informed decisions regarding their health care and informed choices among health care providers and allow comparisons between prices paid by various health carriers to health care providers.(b) On and after October 1, 2017, no contract entered into between a health care provider, or any agent or vendor retained by the health care provider to provide data or analytical services to evaluate and manage health care services provided to the health carrier's plan participants, and a health carrier shall contain a provision prohibiting disclosure of (1) billed or allowed amounts, reimbursement rates or out-of-pocket costs, or (2) any data to the all-payer claims database program established under section 19a-755a. Information described in subdivisions (1) and (2) of this subsection may be used to assist consumers and institutional purchasers in making informed decisions regarding their health care and informed choices among health care providers and allow comparisons between prices paid by various health carriers to health care providers.(c) If a contract described in subsection (a) or (b) of this section, whichever is applicable, contains a provision prohibited under the applicable subsection, such provision shall be void and unenforceable. The invalidity or unenforceability of any contract provision under this subsection shall not affect any other provision of the contract.(P.A. 15-146, S. 4; P.A. 17-241, S. 3; June Sp. Sess. P.A. 17-2, S. 122.)History: P.A. 17-241 designated existing provisions re contract entered into on and after January 1, 2016 between health care provider and health carrier as Subsec. (a) and amending same to replace “and (2)” with “or (2)”, and replace “for the purpose of assisting” with “information described in subdivisions (1) and (2) of this subsection may be used to assist”, added Subsec. (b) re contract entered into on and after October 1, 2017 between health care provider, or its agent or vendor, and health carrier, and added Subsec. (c) re contract provisions prohibited under subsection to be void and unenforceable; June Sp. Sess. P.A. 17-2 amended Subsecs. (a)(2) and (b)(2) by replacing “38a-1091” with “19a-755a”, effective October 31, 2017.See Sec. 19a-755b re applicable definitions.
CT Gen Stat § 38a-478b (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-478b - Penalty for managed care organization's failure to file data and reports. Commissioner's report to the Governor and the General Assembly on organizations that fail to file data and reports.

 (a) Each managed care organization, as defined in section 38a-478, that fails to file the data, reports or information required by sections 38a-478 to 38a-478u, inclusive, 38a-479aa, 38a-591a to 38a-591h, inclusive, and 38a-993 shall pay a late fee of one hundred dollars per day for each day from the due date of such data, reports or information to the date of filing. Each managed care organization that files incomplete data, reports or information shall be so informed by the commissioner, shall be given a date by which to remedy such incomplete filing and shall pay said late fee commencing from the new due date.(b) On June first annually, the commissioner shall submit to the Governor and to the joint standing committees of the General Assembly having cognizance of matters relating to public health and insurance, a list of those managed care organizations that have failed to file any data, report or information required by sections 38a-478 to 38a-478u, inclusive, 38a-479aa, 38a-591a to 38a-591h, inclusive, and 38a-993.(P.A. 97-99, S. 3; P.A. 99-284, S. 52, 60; P.A. 00-196, S. 23; June Sp. Sess. P.A. 01-4, S. 24; P.A. 11-58, S. 71.)History: P.A. 99-284 deleted obsolete references to Sec. 38a-514a, effective January 1, 2000; P.A. 00-196 made a technical change in Subsec. (b); June Sp. Sess. P.A. 01-4 replaced references to Sec. 19a-647 with references to Sec. 38a-479aa; P.A. 11-58 replaced references to Secs. 38a-226 to 38a-226d with “sections 38a-591a to 38a-591h, inclusive,” and made technical changes, effective July 1, 2011.
CT Gen Stat § 38a-478d (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-478d - Provider directory. Notification to enrollee of termination or withdrawal of enrollee's primary care provider.

 For any contract delivered, issued for delivery, renewed, amended or continued in this state, each managed care organization shall:(1) Provide at least annually to each enrollee a provider directory that conforms to the requirements of section 38a-477h. Such directory shall include, under a separate category or heading, participating advanced practice registered nurses; and(2) For a managed care plan that requires the selection of a primary care provider:(A) Allow an enrollee to designate a participating, in-network physician or a participating, in-network advanced practice registered nurse as such enrollee's primary care provider; and(B) Provide notification in accordance with subsection (g) of section 38a-472f to each such enrollee upon the termination or withdrawal of the enrollee's primary care provider.(P.A. 97-99, S. 5; P.A. 07-18, S. 1; P.A. 11-199, S. 1; P.A. 16-205, S. 6.)History: P.A. 07-18 amended Subdiv. (1) to require that list of providers be given in writing or through the Internet at the option of enrollee and amended Subdiv. (2) to limit notification to enrollee in a managed care plan that requires selection of a primary care physician; P.A. 11-199 substantially revised section to require managed care organizations to include in their provider listings advanced practice registered nurses under a separate category or heading and to allow enrollees to designate a participating, in-network physician or a participating, in-network advanced practice registered nurse as such enrollee's primary care provider; P.A. 16-205 deleted former Subdiv. (1) re listing of providers, redesignated existing Subdiv. (2) as Subdiv. (1) and amended same by adding provision re provider directory and making a conforming change, and redesignated existing Subdiv. (3) re managed care plan as Subdiv. (2) and amended same by replacing “, as soon as possible” with reference to Sec. 38a-472f(g) in Subpara. (B), effective January 1, 2017.
CT Gen Stat § 38a-478e (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-478e - Medical protocols. Procedure prior to change. Physician input. Notification of change.

 (a) Each managed care organization shall, prior to implementing new medical protocols or substantially or materially altering existing medical protocols, obtain input from physicians actively practicing in Connecticut and practicing in the relevant specialty areas. The managed care organization shall also seek input from physicians who are not employees of or consultants, other than to the extent a person is an employee or consultant solely for the purposes of this subsection, to the managed care organization provided the input is not unreasonably withheld. The managed care organization shall obtain the input in a manner permitting verification by the commissioner and shall document the process by which it obtained the input. For the purpose of this section, “medical protocols” shall include, but not be limited to, drug formularies or lists of covered drugs.(b) Each managed care organization shall (1) make available, upon the request of a participating provider, its medical protocols for examination during regular business hours at the principal Connecticut headquarters of the managed care organization, and (2) if a managed care organization denies a treatment, service or procedure, the organization shall furnish, upon the request of a participating provider, a copy of the relevant medical protocol to the participating provider, along with an explanation of the denial at the time the denial is made.(P.A. 97-99, S. 6; P.A. 00-216, S. 7, 28.)History: P.A. 00-216 amended Subsec. (a) by making a technical change and adding provision defining “medical protocols” to include drug formularies or lists of covered drugs, effective July 1, 2000.
CT Gen Stat § 38a-478f (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-478f - Provider profile development requirements.

 Each managed care organization, in developing provider profiles or otherwise measuring health care provider performance, shall: (1) Make allowances for the severity of illness or condition of the patient mix; (2) make allowances for patients with multiple illnesses or conditions; (3) make available to the commissioner documentation of how the managed care organization makes such allowances; and (4) inform enrollees and participating providers, upon request, how the managed care organization considers patient mix when profiling or evaluating providers.(P.A. 97-99, S. 7.)
CT Gen Stat § 38a-478h (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-478h - Contract requirements and notice for removal or departure of provider. Retaliatory action prohibited.

 (a) Each contract delivered, issued for delivery, renewed, amended or continued in this state between a managed care organization and a participating provider shall conform to the requirements of section 38a-477g and shall include notice provisions for the removal or departure of such provider in accordance with subsection (g) of section 38a-472f.(b) No managed care organization shall take or threaten to take any action against any provider in retaliation for such provider's assistance to an enrollee under the provisions of section 38a-591g.(P.A. 97-99, S. 9; P.A. 11-58, S. 72; P.A. 16-205, S. 7.)History: P.A. 11-58 made a technical change in Subsec. (a) and replaced references to Secs. 38a-226c(e) and 38a-478n with “section 38a-591g” in Subsec. (c), effective July 1, 2011; P.A. 16-205 amended Subsec. (a) by replacing provisions re advance written notice for withdrawal or termination of agreement with provisions re requirements of Sec. 38a-477g and notice provisions of Sec. 38a-472f(g), deleted former Subsec. (b) re exceptions and redesignated existing Subsec. (c) re managed care organization taking action against provider as Subsec. (b), effective January 1, 2017.
CT Gen Stat § 38a-478i (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-478i - Limitation on enrollee rights prohibited.

 No contract delivered, issued for delivery, renewed, amended or continued in this state between a managed care organization and a participating provider shall prohibit or limit any cause of action or contract rights an enrollee otherwise has.(P.A. 97-99, S. 10; P.A. 12-145, S. 41.)History: P.A. 12-145 deleted “on and after October 1, 1997,”, effective June 15, 2012.
CT Gen Stat § 38a-478j (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-478j - Coinsurance and deductible payments based on negotiated discounts.

 Each managed care plan that requires a deductible or percentage coinsurance payment by the insured shall calculate the insured's deductible or coinsurance payment on the lesser of the provider's or vendor's charges for the goods or services or the amount payable by the managed care organization or a subcontractor of such managed care organization for such goods or services, except as otherwise required by the laws of a foreign state when applicable to providers, vendors or patients in such foreign state.(P.A. 97-99, S. 11; June 18 Sp. Sess. P.A. 97-8, S. 59, 88; P.A. 19-117, S. 239.)History: June 18 Sp. Sess. P.A. 97-8 added exception re laws of a foreign state, effective July 1, 1997; P.A. 19-117 added references to deductible and added “or a subcontractor of such managed care organization”, effective January 1, 2020.
CT Gen Stat § 38a-478k (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-478k - Gag clauses prohibited.

 (a) No contract delivered, issued for delivery, renewed, amended or continued in this state between a managed care organization and a participating provider shall prohibit the provider from discussing with an enrollee any treatment options and services available in or out of network, including experimental treatments.(b) No contract delivered, issued for delivery, renewed, amended or continued in this state between a managed care organization and a participating provider shall prohibit the provider from disclosing, to an enrollee who inquires, the method the managed care organization uses to compensate the provider.(P.A. 97-99, S. 12; P.A. 12-145, S. 42.)History: P.A. 12-145 deleted “on and after October 1, 1997,”, effective June 15, 2012.