reglab/housing_qa huggingface dataset:
CT Gen Stat § 38a-511 (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-511 - Copayments re in-network imaging services.

 (a) No health insurer, health care center, hospital service corporation, medical service corporation or fraternal benefit society that provides coverage under an individual health insurance policy or contract for magnetic resonance imaging or computed axial tomography may (1) require total copayments in excess of three hundred seventy-five dollars for all such in-network imaging services combined annually, or (2) require a copayment in excess of seventy-five dollars for each in-network magnetic resonance imaging or computed axial tomography, provided the physician ordering the radiological services and the physician rendering such services are not the same person or are not participating in the same group practice.(b) No health insurer, health care center, hospital service corporation, medical service corporation or fraternal benefit society that provides coverage under an individual health insurance policy or contract for positron emission tomography may (1) require total copayments in excess of four hundred dollars for all such in-network imaging services combined annually, or (2) require a copayment in excess of one hundred dollars for each in-network positron emission tomography, provided the physician ordering the radiological service and the physician rendering such service are not the same person or are not participating in the same group practice.(c) The provisions of subsections (a) and (b) of this section shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493.(P.A. 06-180, S. 1; 07-54, S. 3; P.A. 10-5, S. 25; P.A. 18-68, S. 14; July Sp. Sess. P.A. 20-4, S. 25.)History: P.A. 07-54 made technical changes in Subsecs. (a) and (b), effective May 22, 2007; P.A. 10-5 replaced reference to Sec. 38a-520 with reference to Sec. 38a-493 in Subsec. (c), effective May 5, 2010; P.A. 18-68 made a technical change in Subsec. (c); July Sp. Sess. P.A. 20-4 amended Subsec. (c) by substituting “high deductible health plan” for “high deductible plan”.See Sec. 38a-550 for similar provisions re group policies.
CT Gen Stat § 38a-511a (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-511a - Copayments re in-network physical therapy services and in-network occupational therapy services.

 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 shall impose copayments that exceed a maximum of thirty dollars per visit for in-network (1) physical therapy services rendered by a physical therapist licensed under section 20-73, or (2) occupational therapy services rendered by an occupational therapist licensed under section 20-74b or 20-74c.(P.A. 13-307, S. 1; P.A. 14-97, S. 3.)History: P.A. 13-307 effective January 1, 2015; P.A. 14-97 designated existing provisions re copayment limit for physical therapy services as Subdiv. (1) and added Subdiv. (2) re copayment limit for occupational therapy services, effective January 1, 2015.See Sec. 38a-550a for similar provisions re group policies.
CT Gen Stat § 38a-512 (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-512 - Applicability of statutes to certain major medical expense policies.

 Any policy providing major medical expense coverage that is written to complement underlying hospital, medical and surgical expense coverage shall not be required, unless otherwise specifically provided, to include the benefits required in the underlying hospital, medical and surgical expense coverage. Except as otherwise provided in this title, the provisions of sections 38a-513, 38a-529, 38a-532, 38a-545 and 38a-547 shall not apply to any subscriber contract issued by a health care center.(P.A. 90-243, S. 96; P.A. 03-199, S. 6; P.A. 15-118, S. 68.)History: P.A. 03-199 deleted provision re inapplicability of Sec. 38a-546 to subscriber contracts issued by a health care center; P.A. 15-118 added “Except as otherwise provided in this title,” and made technical changes.
CT Gen Stat § 38a-512b (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-512b - Termination of coverage of children in group policies. Coverage for stepchildren.

 Each 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, amended, renewed or continued in this state shall provide that coverage of a child shall terminate no earlier than the policy anniversary date on or after whichever of the following occurs first, the date on which the child: Becomes covered under a group health plan through the dependent's own employment; or attains the age of twenty-six. Each such policy shall cover a stepchild on the same basis as a biological child.(P.A. 11-58, S. 38.)History: P.A. 11-58 effective July 2, 2011.See Sec. 38a-497 for similar provisions re individual policies.
CT Gen Stat § 38a-512c (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-512c - Annual and lifetime limits.

 (a) No 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 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-518q, 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. 43; P.A. 17-15, S. 59; P.A. 18-10, S. 10.)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 designating existing provisions re Affordable Care Act as Subdiv. (1), and adding Subdiv. (2) re Sec. 38a-518q and regulations adopted thereunder, effective January 1, 2019.See Sec. 38a-482c for similar provisions re individual policies.
CT Gen Stat § 38a-513a (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-513a - Time limits for coverage determinations. Notice requirements.

 Section 38a-513a is repealed, effective October 1, 2015.(P.A. 99-284, S. 13; P.A. 10-24, S. 2; P.A. 11-19, S. 24; P.A. 15-118, S. 71.)
CT Gen Stat § 38a-513b (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-513b - Coverage and notice re experimental treatments. Appeals.

 (a) Each group 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. 16, 60; P.A. 11-58, S. 82; P.A. 12-145, S. 44.)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-483c for similar provisions re individual policies.
CT Gen Stat § 38a-513c (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-513c - Group 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 group 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. 2; P.A. 11-19, S. 22.)History: P.A. 07-75 effective January 1, 2008; P.A. 11-19 made technical changes.See Sec. 38a-482a for similar provisions re individual policies.
CT Gen Stat § 38a-513d (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-513d - Insurers prohibited from issuing policy with limited coverage to employer as replacement for a comprehensive health insurance plan. Disclosure required in policy providing limited coverage. Limited coverage defined.

 (a) No insurer, health care center, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, continuing or amending any group health insurance policy in this state on or after January 1, 2008, shall deliver or issue for delivery in this state any policy providing limited coverage to any employer as a replacement for a comprehensive health insurance plan for its employees.(b) Each group 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).”(c) 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. 2; P.A. 08-147, S. 12.)History: P.A. 07-96 effective July 1, 2007; P.A. 08-147 redefined “limited coverage” in Subsec. (c) to specify fixed dollar benefits of less than $20,000 on any core services.See Sec. 38a-482b for similar provisions re individual policies.
CT Gen Stat § 38a-513g (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-513g - Employer submission of plan cost information to Comptroller.

 (a) For the purposes of this section, “employer” has the same meaning as provided in section 38a-513f.(b) Not later than October first, annually, each employer that sponsors a fully insured group health insurance policy for its active employees, early retirees and retirees that provides coverage of the type specified in subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 shall submit electronically to the Comptroller, in a form prescribed by the Comptroller, the following information: For the two policy years immediately preceding, the percentage increase or decrease in the policy or plan costs, calculated as the total premium costs, inclusive of any premiums or contributions paid by active employees, early retirees and retirees, divided by the total number of active employees, early retirees and retirees covered by such policy.(P.A. 11-58, S. 9.)History: P.A. 11-58 effective July 1, 2011.
CT Gen Stat § 38a-514a (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-514a - Biologically-based mental illness. Coverage required.

 Section 38a-514a is repealed, effective January 1, 2000.(P.A. 97-99, S. 27; June 18 Sp. Sess. P.A. 97-8, S. 62, 88; P.A. 99-284, S. 59, 60.)
CT Gen Stat § 38a-514c (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-514c - Mental health and substance use disorder benefits. Nonquantitative treatment limitations.

 No 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 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. 3.)History: P.A. 19-159 effective January 1, 2020.
CT Gen Stat § 38a-514d (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-514d - Coverage for substance abuse services provided pursuant to court order.

 No group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 that is delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2020, shall deny coverage for covered substance abuse services solely because such substance abuse services were provided pursuant to an order issued by a court of competent jurisdiction.(P.A. 19-159, S. 5.)History: P.A. 19-159 effective January 1, 2020.
CT Gen Stat § 38a-515 (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-515 - Continuation of coverage of mentally or physically handicapped children.

 (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 that provides that coverage of a dependent child of an employee or other member of the covered group shall terminate upon attainment of the limiting age for dependent children specified in the policy shall also provide in substance that attainment of the limiting age shall not operate to terminate the coverage of the child if at such date the child is and continues thereafter to be both (1) incapable of self-sustaining employment by reason of mental or physical handicap, as certified by the child's physician or advanced practice registered nurse on a form provided by the insurer, hospital service corporation, medical service corporation or health care center, and (2) chiefly dependent upon such employee or member for support and maintenance.(b) Proof of the incapacity and dependency shall be furnished to the insurer, hospital service corporation, medical service corporation or health care center by the employee or member within thirty-one days of the child's attainment of the limiting age. The insurer, corporation or center may at any time require proof of the child's continuing incapacity and dependency. After a period of two years has elapsed following the child's attainment of the limiting age the insurer, corporation or center may require periodic proof of the child's continuing incapacity and dependency but in no case more frequently than once every year.(P.A. 90-243, S. 99; P.A. 11-19, S. 34; P.A. 15-118, S. 13; P.A. 16-39, S. 62; P.A. 17-15, S. 60.)History: P.A. 11-19 inserted “renewed, amended or continued” and made technical changes in Subsec. (a), effective January 1, 2012; P.A. 15-118 made technical changes; P.A. 16-39 amended Subsec. (a)(1) by adding reference to advanced practice registered nurse; P.A. 17-15 amended Subsec. (a) to delete “more than one hundred twenty days after July 1, 1971,”.See Sec. 38a-489 for similar provisions re individual policies.
CT Gen Stat § 38a-516 (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-516 - Coverage for newly born children. Notification to insurer.

 (a) Each group health insurance policy delivered, issued for delivery, renewed, amended or continued in this state providing coverage of the type specified in subdivisions (1), (2), (4), (6), (11) and (12) of section 38a-469 for a family member of the insured or subscriber shall, as to such family member's coverage, also provide that the health insurance benefits applicable for children shall be payable with respect to a newly born child of the insured or subscriber from the moment of birth.(b) Coverage for such newly born child shall consist of coverage for injury and sickness including necessary care and treatment of medically diagnosed congenital defects and birth abnormalities within the limits of the policy.(c) If payment of a specific premium fee is required to provide coverage for a child, the policy may require that notification of birth of such newly born child and payment of the required premium or fees shall be furnished to the insurer, hospital service corporation, medical service corporation or health care center not later than sixty-one days after the date of birth in order to continue coverage beyond such sixty-one-day period, provided failure to furnish such notice or pay such premium shall not prejudice any claim originating within such sixty-one-day period.(P.A. 90-243, S. 100; P.A. 11-19, S. 36; 11-171, S. 4; P.A. 12-145, S. 13.)History: P.A. 11-19 inserted “delivered, issued for delivery, renewed, amended or continued in this state” in Subsec. (a), made technical changes in Subsec. (c), and deleted former Subsec. (d) re application of section to policies delivered or issued for delivery on or after October 1, 1974, or amended, effective January 1, 2012; P.A. 11-171 inserted “delivered, issued for delivery, renewed, amended or continued in this state” and made a technical change in Subsec. (a), increased time period for insured to notify insurer of birth of child and pay required premium or fee from 31 days to 61 days after birth and made technical changes in Subsec. (c), and deleted former Subsec. (d) re application of section to policies delivered or issued for delivery on or after October 1, 1974, or amended, effective January 1, 2012; P.A. 12-145 made a technical change in Subsec. (a), effective June 15, 2012.See Sec. 38a-490 for similar provisions re individual policies.
CT Gen Stat § 38a-516b (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-516b - Coverage for hearing aids.

 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 hearing aids. Such hearing aids shall be considered durable medical equipment under the policy and the policy may limit the hearing aid benefit to one hearing aid per ear within a twenty-four-month period.(P.A. 01-171, S. 16; P.A. 12-145, S. 48; P.A. 19-133, S. 2.)History: P.A. 12-145 deleted “on or after October 1, 2001”, effective June 15, 2012; P.A. 19-133 deleted reference to children 12 years of age or younger and substituted provision restricting benefit to 1 hearing aid per ear within 24 month period for provision restricting benefit to $1,000 within 24-month period, effective January 1, 2020.
CT Gen Stat § 38a-516c (2020)
2020 Connecticut General Statutes|Title 38a - Insurance|Chapter 700c - Health Insurance|Section 38a-516c - Coverage for craniofacial disorders.

 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 on or after October 1, 2003, shall provide coverage for medically necessary orthodontic processes and appliances for the treatment of craniofacial disorders for individuals eighteen years of age or younger if such processes and appliances are prescribed by a craniofacial team recognized by the American Cleft Palate-Craniofacial Association, except that no coverage shall be required for cosmetic surgery.(P.A. 03-37, S. 2.)See Sec. 38a-490c for similar provisions re individual policies.