reglab/housing_qa huggingface dataset:
CT Gen Stat § 38a-479ooo (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-479ooo - Definitions.

 For the purposes of this part:(1) “Commissioner” means the Insurance Commissioner.(2) “Department” means the Insurance Department.(3) “Drug” has the same meaning as provided in section 21a-92.(4) “Health care plan” means an individual or a group health insurance policy that provides coverage of the types specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 and includes coverage for outpatient prescription drugs.(5) “Health carrier” means an insurance company, 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 care plan in this state.(6) “Person” has the same meaning as provided in section 38a-1.(7) “Pharmacist” has the same meaning as provided in section 38a-479aaa.(8) “Pharmacist services” has the same meaning as provided in section 38a-479aaa.(9) “Pharmacy” has the same meaning as provided in section 38a-479aaa.(10) “Pharmacy benefits manager” or “manager” means any person that administers the prescription drug, prescription device, pharmacist services or prescription drug and device and pharmacist services portion of a health care plan on behalf of a health carrier.(11) (A) “Rebate” means a discount or concession, which affects the price of an outpatient prescription drug, that a pharmaceutical manufacturer directly provides to a (i) health carrier for an outpatient prescription drug manufactured by the pharmaceutical manufacturer, or (ii) pharmacy benefits manager after the manager processes a claim from a pharmacy or a pharmacist for an outpatient prescription drug manufactured by the pharmaceutical manufacturer.(B) “Rebate” does not mean a bona fide service fee, as such term is defined in Section 447.502 of Title 42 of the Code of Federal Regulations, as amended from time to time.(12) “Specialty drug” means a prescription outpatient specialty drug covered under the Medicare Part D program established pursuant to Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, as amended from time to time, that exceeds the specialty tier cost threshold established by the Centers for Medicare and Medicaid Services.(P.A. 18-41, S. 1.)History: P.A. 18-41 effective January 1, 2020.
CT Gen Stat § 38a-479qqq (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-479qqq - Annual report by health carriers. Regulations.

 (a) Each health carrier that delivers, issues for delivery, renews, amends or continues a health care plan on or after January 1, 2021, shall submit the following information and data to the commissioner, for such health care plan for the immediately preceding calendar year, at the time that such health carrier submits a rate filing for such health care plan pursuant to sections 38a-183, 38a-481, or 38a-513, as applicable:(1) For covered outpatient prescription drugs that were prescribed to insureds under such health care plan during such calendar year, the names of:(A) The twenty-five most frequently prescribed outpatient prescription drugs;(B) The twenty-five outpatient prescription drugs that the health care plan covered at the greatest cost, calculated by using the total annual plan spending by such health care plan for each outpatient prescription drug; and(C) The twenty-five outpatient prescription drugs that experienced the greatest year-over-year increase in cost, calculated by using the total annual plan spending by such health care plan for each outpatient prescription drug.(2) The portion of the premium for such health care plan that is attributable to each of the following categories of covered outpatient prescription drugs that were prescribed to insureds under such health care plan during such calendar year:(A) Brand name drugs;(B) Generic drugs; and(C) Specialty drugs.(3) The year-over-year increase, calculated on a per member, per month basis and expressed as a percentage, in the total annual cost of each category of covered outpatient prescription drugs set forth in subdivision (2) of this subsection.(4) A comparison, calculated on a per member, per month basis, of the year-over-year increase in the cost of covered outpatient prescription drugs to the year-over-year increase in the costs of other contributors to the premium cost of such health care plan.(5) The name of each specialty drug covered during such calendar year.(6) The names of the twenty-five most frequently prescribed outpatient prescription drugs for which the health carrier received rebates from pharmaceutical manufacturers during such calendar year.(b) The commissioner may adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of this section.(P.A. 18-41, S. 3.)History: P.A. 18-41 effective January 1, 2020.
CT Gen Stat § 38a-479rrr (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-479rrr - Annual certification by health carriers.

 Beginning on March 1, 2022, and annually thereafter, each health carrier shall submit to the commissioner, in a form and manner prescribed by the commissioner, a written certification for the immediately preceding calendar year, certifying that the health carrier accounted for all rebates in calculating the premium for health care plans that such health carrier delivered, issued for delivery, renewed, amended or continued during such calendar year.(P.A. 18-41, S. 4.)History: P.A. 18-41 effective January 1, 2020.
CT Gen Stat § 38a-479sss (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-479sss - Annual report by commissioner to the General Assembly re outpatient prescription drug costs.

 Not later than March 1, 2022, and annually thereafter, the commissioner shall submit a report, in accordance with section 11-4a, to the joint standing committee of the General Assembly having cognizance of matters relating to insurance. The report shall contain (1) an aggregation of the information and data submitted to the commissioner pursuant to section 38a-479qqq for the immediately preceding calendar year, (2) a description of the impact of the cost of outpatient prescription drugs on health insurance premiums in this state, and (3) such other information as the commissioner, in the commissioner's discretion, deems relevant to the cost of outpatient prescription drugs in this state.(P.A. 18-41, S. 5.)History: P.A. 18-41 effective January 1, 2020.
CT Gen Stat § 38a-479ttt (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-479ttt - Annual report by commissioner to the General Assembly re prescription drug rebates.

 Not later than March 1, 2021, and annually thereafter, the commissioner shall prepare a report, for the immediately preceding calendar year, describing the rebate practices of health carriers. The report shall contain (1) an explanation of the manner in which health carriers accounted for rebates in calculating premiums for health care plans delivered, issued for delivery, renewed, amended or continued during such year, (2) a statement disclosing whether, and describing the manner in which, health carriers made rebates available to insureds at the point of purchase during such year, (3) any other manner in which health carriers applied rebates during such year, and (4) such other information as the commissioner, in the commissioner's discretion, deems relevant for the purposes of this section. The commissioner shall publish a copy of the report on the department's Internet web site.(P.A. 18-41, S. 6.)History: P.A. 18-41 effective January 1, 2020.
CT Gen Stat § 38a-482a (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-482a - Individual health insurance policy to contain definition of “medically necessary” or “medical necessity”.

 (a) No insurer, health care center, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, continuing or amending any individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 38a-469 in this state shall deliver or issue for delivery in this state any such policy unless such policy contains a definition of “medically necessary” or “medical necessity” as follows: “Medically necessary” or “medical necessity” means health care services that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are: (1) In accordance with generally accepted standards of medical practice; (2) clinically appropriate, in terms of type, frequency, extent, site and duration and considered effective for the patient's illness, injury or disease; and (3) not primarily for the convenience of the patient, physician or other health care provider and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury or disease. For the purposes of this subsection, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community or otherwise consistent with the standards set forth in policy issues involving clinical judgment.(b) The provisions of subsection (a) of this section shall not apply to any insurer, health care center, hospital service corporation, medical service corporation or other entity that has entered into any national settlement agreement until the expiration of any such agreement.(P.A. 07-75, S. 1; P.A. 11-19, S. 21.)History: P.A. 07-75 effective January 1, 2008; P.A. 11-19 made technical changes.See Sec. 38a-513c for similar provisions re group policies.
CT Gen Stat § 38a-482b (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-482b - Individual health insurance policy providing limited coverage to include disclosure. Limited coverage defined.

 (a) Each individual health insurance policy, subscriber contract or certificate of coverage delivered or issued for delivery in this state on or after January 1, 2008, that provides limited coverage, and any marketing material, application for coverage and enrollment material relative to such policy, contract or certificate, shall include the following statement printed in capital letters in not less than twelve-point boldface type and located in a conspicuous manner on such document:“THIS LIMITED HEALTH BENEFITS PLAN DOES NOT PROVIDE COMPREHENSIVE MEDICAL COVERAGE. IT IS A BASIC OR LIMITED BENEFITS POLICY AND IS NOT INTENDED TO COVER ALL MEDICAL EXPENSES. THIS PLAN IS NOT DESIGNED TO COVER THE COSTS OF SERIOUS OR CHRONIC ILLNESS. IT CONTAINS SPECIFIC DOLLAR LIMITS THAT WILL BE PAID FOR MEDICAL SERVICES WHICH MAY NOT BE EXCEEDED. IF THE COST OF SERVICES EXCEEDS THOSE LIMITS, THE BENEFICIARY AND NOT THE INSURER IS RESPONSIBLE FOR PAYMENT OF THE EXCESS AMOUNTS. THE SPECIFIC DOLLAR LIMITS ARE AS FOLLOWS: (INSURER TO SPECIFY SUCH AMOUNTS).”(b) For the purposes of this section, “limited coverage” means an insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 that contains an annual maximum benefit of less than one hundred thousand dollars or fixed dollar benefits of less than twenty thousand dollars on any core services. For the purpose of this section, “core services” means medical, surgical and hospital services, including inpatient and outpatient physician, laboratory and imaging services.(P.A. 07-96, S. 1; P.A. 08-147, S. 11.)History: P.A. 07-96 effective July 1, 2007; P.A. 08-147 redefined “limited coverage” in Subsec. (b) to specify fixed dollar benefits of less than $20,000 on any core services.See Sec. 38a-513d for similar provisions re group policies.
CT Gen Stat § 38a-482c (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-482c - Annual and lifetime limits.

 (a) No individual 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 include an annual or lifetime limit on the dollar value of benefits for a covered individual, for covered benefits that are essential health benefits, as defined in (1) the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, or regulations adopted thereunder, or (2) section 38a-492q, or regulations adopted thereunder.(b) This section shall not prohibit the inclusion of a lifetime limit on specific covered benefits that are not essential health benefits, provided the lifetime limit for reasonable charges or, when applicable, the allowance agreed upon by a health care provider and an insurer, health care center, hospital service corporation, medical service corporation or fraternal benefit society for charges actually incurred for any specific covered benefit, shall be not less than one million dollars per covered individual.(P.A. 11-58, S. 42; P.A. 17-15, S. 48; P.A. 18-10, S. 9.)History: P.A. 11-58 effective July 2, 2011; P.A. 17-15 made a technical change in Subsec. (a); P.A. 18-10 amended Subsec. (a) by provision prohibiting annual limit for essential health benefits, designating existing provisions re Affordable Care Act as Subdiv. (1), and adding Subdiv. (2) prohibiting annual and lifetime limits for essential health benefits under Sec. 38a-492q or regulations adopted thereunder, effective January 1, 2019.See Sec. 38a-512c for similar provisions re group policies.
CT Gen Stat § 38a-483a (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-483a - Exclusionary riders for individual health insurance policies. Regulations.

 Notwithstanding the provisions of section 38a-476, the Insurance Commissioner may adopt regulations, in accordance with the provisions of chapter 54, to allow exclusionary riders to be issued for individual health insurance policies that are not subject to Section 2701 of the Public Health Service Act, as set forth in the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time.(June 18 Sp. Sess. P.A. 97-8, S. 71, 88; P.A. 17-15, S. 49.)History: June 18 Sp. Sess. P.A. 97-8 effective July 1, 1997; P.A. 17-15 made a technical change.
CT Gen Stat § 38a-483b (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-483b - Time limits for coverage determinations. Notice requirements.

 Section 38a-483b is repealed, effective October 1, 2015.(P.A. 99-284, S. 12; P.A. 10-24, S. 1; P.A. 11-19, S. 23; P.A. 15-118, S. 71.)
CT Gen Stat § 38a-483c (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-483c - Coverage and notice re experimental treatments. Appeals.

 (a) Each individual health insurance policy delivered, issued for delivery, renewed, amended or continued in this state shall define the extent to which it provides coverage for experimental treatments.(b) No such health insurance policy may deny a procedure, treatment or the use of any drug as experimental if such procedure, treatment or drug, for the illness or condition being treated, or for the diagnosis for which it is being prescribed, has successfully completed a phase III clinical trial of the federal Food and Drug Administration.(c) Any person who has been diagnosed with a condition that creates a life expectancy in that person of less than two years and who has been denied an otherwise covered procedure, treatment or drug on the grounds that it is experimental may request an expedited appeal as provided in section 38a-591e and may appeal a denial thereof to the Insurance Commissioner in accordance with the procedures established in section 38a-591g.(P.A. 99-284, S. 15, 60; P.A. 11-58, S. 81; P.A. 12-145, S. 43.)History: P.A. 99-284 effective January 1, 2000; P.A. 11-58 amended Subsec. (c) to replace references to Secs. 38a-226c and 38a-478n with “section 38a-591e” and “section 38a-591g”, respectively, and deleted former Subsec. (d) re appeal of a procedure, treatment or drug denied on grounds that such procedure, treatment or drug is experimental, effective July 1, 2011; P.A. 12-145 amended Subsec. (a) to delete “on or after January 1, 2000”, effective June 15, 2012.See Sec. 38a-513b for similar provisions re group policies.
CT Gen Stat § 38a-484. (Formerly Sec. 38-168) (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-484. (Formerly Sec. 38-168) - Policy provisions not to be less favorable than standard. Validity of policy issued in violation of law.

 (a) No policy provision which is not subject to section 38a-483 shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof that are subject to sections 38a-481 to 38a-488, inclusive.(b) A policy delivered or issued for delivery to any person in this state in violation of said sections shall be held valid but shall be construed as provided in said sections. When any provision in a policy subject to said sections is in conflict with any provision of said sections, the rights, duties and obligations of the insurer, the insured and the beneficiary shall be governed by the provisions of said sections.(1949 Rev., S. 6185; 1951, S. 2838d; P.A. 14-235, S. 27.)History: Sec. 38-168 transferred to Sec. 38a-484 in 1991; P.A. 14-235 made a technical change in Subsec. (a).
CT Gen Stat § 38a-485. (Formerly Sec. 38-169) (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-485. (Formerly Sec. 38-169) - Copy of application to be part of new policy or to be furnished with renewal. Alteration of application.

 (a) The insured shall not be bound by any statement made in an application for an individual health insurance policy unless a copy of such application is attached to or endorsed on the policy when issued as a part thereof. If any such policy delivered or issued for delivery to any person in this state is reinstated or renewed, and the insured or the beneficiary or assignee of such policy makes written request to the insurer for a copy of the application, if any, for such reinstatement or renewal, the insurer shall, within fifteen days after the receipt of such request at its home office or any branch office of the insurer, deliver or mail to the person making such request, a copy of such application. If such copy is not so delivered or mailed, the insurer shall be precluded from introducing such application as evidence in any action or proceeding based upon or involving such policy or its reinstatement or renewal.(b) No alteration of any written application for any such policy shall be made by any person other than the applicant without his written consent, except that insertions may be made by the insurer, for administrative purposes only, in such manner as to indicate clearly that such insertions are not to be ascribed to the applicant.(c) The falsity of any statement in the application for any policy covered by sections 38a-481 to 38a-488, inclusive, may not bar the right to recovery thereunder unless such false statement materially affected either the acceptance of the risk or the hazard assumed by the insurer.(1949 Rev., S. 6184; 1951, S. 2839d; P.A. 90-243, S. 75.)History: P.A. 90-243 added reference to “an individual health insurance” policy; Sec. 38-169 transferred to Sec. 38a-485 in 1991.Annotation to former section 38-169:Cited. 214 C. 303.
CT Gen Stat § 38a-486. (Formerly Sec. 38-170) (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-486. (Formerly Sec. 38-170) - Certain acts not to operate as waiver of rights.

 The acknowledgment by any insurer of the receipt of notice given under any individual health insurance policy, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim thereunder shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under such policy.(1949 Rev., S. 6183; 1951, S. 2840d; P.A. 90-243, S. 76.)History: P.A. 90-243 added reference to “an individual health insurance” policy; Sec. 38-170 transferred to Sec. 38a-486 in 1991.
CT Gen Stat § 38a-487. (Formerly Sec. 38-171) (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-487. (Formerly Sec. 38-171) - Coverage after termination date of policy.

 If any individual health insurance policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which a premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which the premium has been accepted. If the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.(1951, S. 2841d; P.A. 90-243, S. 77.)History: P.A. 90-243 added reference to “an individual health insurance” policy; Sec. 38-171 transferred to Sec. 38a-487 in 1991.
CT Gen Stat § 38a-488. (Formerly Sec. 38-172) (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-488. (Formerly Sec. 38-172) - Discrimination.

 Discrimination between individuals of the same class in the amount of premiums or rates charged for any individual health insurance policy, or in the benefits payable thereon, or in any of the terms or conditions of such policy, or in any other manner, is prohibited.(1949 Rev., S. 6188; 1951, S. 2844d; P.A. 90-243, S. 78.)History: P.A. 90-243 substituted reference to “individual health insurance” policy for reference to policies under Secs. 38-165 to 38-172; Sec. 38-172 transferred to Sec. 38a-488 in 1991.See Sec. 38a-446 re prohibition against discrimination in favor of individuals by life insurance companies.See Sec. 38a-447 re prohibition of discrimination against persons on basis of race.See Sec. 38a-816 re unfair practices.
CT Gen Stat § 38a-488c (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-488c - Mental health and substance use disorder benefits. Nonquantitative treatment limitations.

 No individual 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 on or after January 1, 2020, shall apply a nonquantitative treatment limitation to mental health and substance use disorder benefits unless such policy applies such limitation to such benefits in a manner that is comparable to, and not more stringent than, the manner in which such policy applies such limitation to medical and surgical benefits. For the purposes of this section, “nonquantitative treatment limitation” and “mental health and substance use disorder benefits” have the same meaning as provided in section 38a-477ee.(P.A. 19-159, S. 2.)History: P.A. 19-159 effective January 1, 2020.