reglab/statecodes huggingface dataset:
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-479eee. - Claims payment to be made by electronic funds transfer upon written request.

Upon written request from a pharmacy, a pharmacy benefits manager shall pay claims to such pharmacy by electronic funds transfer. Any such payments shall be made within the time periods specified under subparagraph (B) of subdivision (15) of section 38a-816.
(P.A. 07-200, S. 5; P.A. 14-193, S. 4.)
History: P.A. 07-200 effective January 1, 2008; P.A. 14-193 replaced former provisions re investigations and hearings with provisions re electronic funds transfer payments.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-479fff. - Expiration of certificates of registration. Renewal. Fees.

(a) All certificates of registration issued under section 38a-479ccc shall expire annually on December thirty-first.
(b) Any person seeking to renew a certificate of registration shall apply to the commissioner, in writing, on a form provided by the commissioner. The application for renewal shall be in such form as the commissioner prescribes. Such application shall be accompanied by a nonrefundable fee of fifty dollars. Any late payment of such fee shall include a penalty fee of fifty dollars.
(P.A. 07-200, S. 6.)
History: P.A. 07-200 effective January 1, 2008.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-479ggg. - Regulations.

The commissioner shall adopt regulations, in accordance with chapter 54, to implement the provisions of sections 38a-479aaa to 38a-479hhh, inclusive. Such regulations shall specify the contents of the application form and any other form or report required under the provisions of said sections.
(P.A. 07-200, S. 7.)
History: P.A. 07-200 effective January 1, 2008.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-479hhh. - Investigations and hearings. Powers of commissioner. Appeals.

(a) The commissioner may conduct investigations and hold hearings on any matter under the provisions of sections 38a-479aaa to 38a-479iii, inclusive. The commissioner may issue subpoenas, administer oaths, compel testimony and order the production of books, records and documents. If any person refuses to appear, to testify or to produce any book, record, paper or document when so ordered, upon application of the commissioner, a judge of the Superior Court may make such order as may be appropriate to aid in the enforcement of this section.
(b) Any person aggrieved by an order or decision of the commissioner under sections 38a-479aaa to 38a-479iii, inclusive, may appeal therefrom in accordance with the provisions of section 4-183.
(P.A. 07-200, S. 8; P.A. 14-193, S. 5.)
History: P.A. 07-200 effective January 1, 2008; P.A. 14-193 added Subsec. (a) re investigations and hearings, designated existing provision re person aggrieved by order or decision as Subsec. (b) and amended same by adding reference to Sec. 38a-479iii.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-480. (Formerly Sec. 38-174). - Applicability of statutes to certain policies and contracts.

(a) Nothing in sections 38a-481 to 38a-488, inclusive, shall apply to or affect (1) any policy of liability or workers' compensation insurance; (2) any group health insurance policy as defined by the commissioner; (3) life insurance, endowment or annuity contracts or contracts supplemental thereto which contain only such provisions relating to health insurance as (A) provide additional benefits in case of death by accidental means and (B) operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant becomes totally and permanently disabled as defined by the contract or supplemental contract; (4) fraternal benefit societies, except as provided by section 38a-640; (5) insurance, issued in conjunction with an automobile liability policy subject to sections 38a-19 and 38a-363 to 38a-388, inclusive, providing reimbursement for medical, surgical, ambulance, hospital, nursing or funeral expenses, or indemnity for other loss, resulting from injuries sustained by any person, including the named insured, arising out of the ownership, maintenance or use of an automobile, or issued in conjunction with other kinds of liability insurance providing reimbursement for medical, surgical, ambulance, hospital, nursing or funeral expenses resulting from injuries sustained by any person, including the named insured, in connection with the premises or operations insured.
(b) Except as otherwise provided in this title, the provisions of sections 38a-481 to 38a-488, inclusive, 38a-492, 38a-502 and 38a-505 shall not apply to any subscriber contract issued by a health care center.
(1949 Rev., S. 6188; 1951, 1953, S. 2842d; 1957, P.A. 448, S. 46; 1967, P.A. 326; P.A. 79-376, S. 59; P.A. 88-326, S. 5; P.A. 90-243, S. 71; P.A. 15-118, S. 67; 15-247, S. 36.)
History: 1967 act added proviso in Subdiv. (2) re furnishing of information which insurer would be required to certify to plan administrator under federal Welfare and Pension Plans Disclosure Act; P.A. 79-376 added reference to Secs. 38-166 to 38-172 and substituted “workers' compensation” for “workmen's compensation”; P.A. 88-326 required the commissioner to adopt regulations establishing a procedure for review of group health and accident policies, life insurance policies and annuity contracts, and added a new Subsec. (b) concerning the commissioner's disapproval of any policy form; P.A. 90-243 substituted reference to “group health insurance policy” for reference to accident and health policies, deleted former provisions re commissioner's approval of forms and re group policies and added a new Subsec. (b) exempting health care centers from certain statutory provisions; Sec. 38-174 transferred to Sec. 38a-480 in 1991; P.A. 15-118 amended Subsec. (b) to add “Except as otherwise provided in this title,” and make technical change; P.A. 15-247 made identical changes as P.A. 15-118, effective July 10, 2015.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.)
2023 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.
2023 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).
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
See Sec. 38a-514c for similar provisions re group policies.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-488d. - Coverage for substance abuse services provided pursuant to court order.

No individual 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. 4.)
History: P.A. 19-159 effective January 1, 2020.
See Sec. 38a-514d for similar provisions re group policies.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-488f. - Coverage for services provided under the Collaborative Care Model.

(a) For the purposes of this section:
(1) “Collaborative Care Model” means the integrated delivery of behavioral health and primary care services by a primary care team that includes a primary care provider, a behavioral care manager, a psychiatric consultant and a database used by the behavioral care manager to track patient progress;
(2) “CPT code” means a code number under the Current Procedural Terminology system developed by the American Medical Association; and
(3) “HCPCS code” means a code number under the Healthcare Common Procedure Coding System developed by the federal Centers for Medicare and Medicaid Services.
(b) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 and delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2023, shall provide coverage for health care services that a primary care provider provides to an insured under the Collaborative Care Model. Such services shall include, but need not be limited to, services with a CPT code of 99484, 99492, 99493 or 99494 or HCPCS code of G2214, or any subsequent corresponding code.
(P.A. 22-47, S. 47.)
History: P.A. 22-47 effective January 1, 2023.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-488g. - Acute inpatient psychiatric coverage. Prior authorization not required.

(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, renewed, amended or continued in this state on or after January 1, 2023, that provides coverage for acute inpatient psychiatric services shall require prior authorization for such services that are provided to an insured: (1) Following the insured's admission to a hospital emergency department; (2) upon the referral of the insured's treating physician licensed pursuant to chapter 370, psychologist licensed pursuant to chapter 383 or advanced practice registered nurse licensed pursuant to chapter 378 if (A) there is imminent danger to the insured's health or safety, or (B) the insured poses an imminent danger to the health or safety of others; or (3) at an urgent crisis center, as defined in section 38a-477aa. Nothing in this section shall preclude a health carrier from using other forms of utilization review, including, but not limited to, concurrent and retrospective review.
(b) Any health care provider who refers an insured for the acute inpatient psychiatric services described in subsection (a) of this section shall provide to the insured, at the time of such referral, a written notice disclosing that the insured may: (1) Incur out-of-pocket costs if such services are not covered by such insured's health insurance policy; and (2) choose to wait for an in-network bed for such services or risk incurring costs for out-of-network care if such services are provided on an out-of-network basis.
(c) Any health care provider who provides the acute inpatient psychiatric services described in subsection (a) of this section shall provide to the insured, at the time the insured is admitted for such services, a written notice disclosing to the insured that the insured may: (1) Incur out-of-pocket costs if such services are not covered by such insured's health insurance policy; and (2) choose to wait for an in-network bed for such services or risk incurring costs for out-of-network care if such services are provided on an out-of-network basis.
(d) The provisions of this section shall apply to a high deductible health plan, as that term is used in subsection (f) of section 38a-493, to the maximum extent permitted by federal law, except if such plan is used to establish a medical savings account or an Archer MSA pursuant to Section 220 of the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as amended from time to time, or a health savings account pursuant to Section 223 of said Internal Revenue Code, as amended from time to time, the provisions of this section shall apply to such plan to the maximum extent that (1) is permitted by federal law; and (2) does not disqualify such account for the deduction allowed under said Section 220 or 223, as applicable.
(P.A. 22-47, S. 55.)
History: P.A. 22-47 effective January 1, 2023.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-489. (Formerly Sec. 38-174e). - Continuation of coverage of mentally or physically handicapped children.

Each individual 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, renewed, amended or continued in this state that provides that coverage of a dependent child 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, physician assistant 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 the policyholder or subscriber 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 policyholder or subscriber within thirty-one days of the child's attainment of the limiting age. The insurer, corporation or health care 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 health care center may require periodic proof of the child's continuing incapacity and dependency but in no case more frequently than once every year.
(1971, P.A. 408, S. 1, 2; P.A. 87-207, S. 1; P.A. 90-243, S. 79; P.A. 11-19, S. 33; P.A. 15-118, S. 4; P.A. 16-39, S. 57; P.A. 17-15, S. 50; P.A. 21-196, S. 62.)
History: P.A. 87-207 amended Subsecs. (a) and (b) to provide that for individual and group policies the continuation rights for children are applicable if the child is incapable of employment by reason of mental or physical handicap which has been certified by the child's physician; P.A. 90-243 substituted reference to “health insurance policy” for reference to hospital or medical expense policies and contracts, divided former Subsec. (a) into Subsecs. (a) and (b), added a reference to “health care center” and deleted former Subsec. (b) re group policies; Sec. 38-174e transferred to Sec. 38a-489 in 1991; 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,”; P.A. 21-196 amended Subsec. (a) by adding reference to physician assistant.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-490. (Formerly Sec. 38-174g). - Coverage for newly born children. Notification to insurer.

(a) Each individual 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), (10), (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 or subscription fee is required to provide coverage for a child, the policy or contract 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 or fees shall not prejudice any claim originating within such sixty-one-day period.
(P.A. 74-6, S. 1–4; P.A. 90-243, S. 80; P.A. 11-19, S. 35; 11-171, S. 3; P.A. 12-145, S. 12.)
History: P.A. 90-243 substituted references to “health insurance policies” for references to hospital and medical expense policies and contracts, specified applicability to individual policies only, and applied provisions to “health care centers”; Sec. 38-174g transferred to Sec. 38a-490 in 1991; P.A. 11-19 inserted “delivered, issued for delivery, renewed, amended or continued in this state” and made a technical change 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 or renewed, 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 or renewed, effective January 1, 2012; P.A. 12-145 made a technical change in Subsec. (a), effective June 15, 2012.
See Sec. 38a-516 for similar provisions re group policies.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-490b. - Coverage for hearing aids.

Each 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 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. 15; P.A. 12-145, S. 47; P.A. 19-133, S. 1.)
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.
See Sec. 38a-516b for similar provisions re group policies.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-490c. - Coverage for craniofacial disorders.

Each 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 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. 1.)
See Sec. 38a-516c for similar provisions re group policies.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-490d. - Mandatory coverage for blood lead screening and risk assessment.

Each 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 on or after January 1, 2009, shall provide coverage for blood lead screening and risk assessments ordered by a primary care provider pursuant to section 19a-111g.
(June Sp. Sess. P.A. 07-2, S. 51.)
History: June Sp. Sess. P.A. 07-2 effective January 1, 2009.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-491. (Formerly Sec. 38-174h). - Coverage for services performed by dentists in certain instances.

Whenever the term “physician” or “doctor” is used in any individual health insurance policy delivered, issued for delivery or renewed in this state on or after October 1, 1975, it shall be deemed to include persons licensed, under the provisions of chapter 379, to engage in the practice of dentistry or dental medicine, when benefits under such policy or contract for care, treatment or services rendered or procedures performed by such person would be payable if rendered or performed by a person licensed under chapter 370.
(P.A. 75-449; P.A. 90-243, S. 81.)
History: P.A. 90-243 substituted reference to “health insurance policy” for reference to hospital and medical expense policies and contracts and specified applicability to individual policies only; Sec. 38-174h transferred to Sec. 38a-491 in 1991.
See Sec. 38a-517 for similar provisions re group policies.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-491a. - Coverage for in-patient, outpatient or one-day dental services in certain instances.

(a) Each 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 provide coverage for general anesthesia, nursing and related hospital services provided in conjunction with in-patient, outpatient or one-day dental services if the following conditions are met:
(1) The anesthesia, nursing and related hospital services are deemed medically necessary by the treating dentist or oral surgeon and the patient's primary care physician in accordance with the health insurance policy's requirements for prior authorization of services; and
(2) The patient is either (A) determined by a licensed dentist, in conjunction with a licensed physician who specializes in primary care, to have a dental condition of significant dental complexity that it requires certain dental procedures to be performed in a hospital, or (B) a person who has a developmental disability, as determined by a licensed physician who specializes in primary care, that places the person at serious risk.
(b) The expense of such anesthesia, nursing and related hospital services shall be deemed a medical expense under such health insurance policy and shall not be subject to any limits on dental benefits under such policy.
(P.A. 99-284, S. 40, 60; P.A. 00-135, S. 13, 21; P.A. 03-58, S. 1; P.A. 10-5, S. 20.)
History: P.A. 99-284 effective January 1, 2000; P.A. 00-135 added outpatient or one-day dental services, effective May 26, 2000; P.A. 03-58 divided existing provisions into Subsecs. (a) and (b) and deleted “a child under the age of four who is” in Subsec. (a)(2)(A); P.A. 10-5 made technical changes in Subsec. (a), effective January 1, 2011.
See Sec. 38a-517a for similar provisions re group policies.
2023 Connecticut General Statutes › Title 38a - Insurance › Chapter 700c - Health Insurance › Section 38a-491b. - Assignment of benefits to a dentist or oral surgeon.

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 in this state providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469, and no dental services plan offering or administering dental services, may refuse to accept or make reimbursement pursuant to an assignment of benefits made to a dentist or oral surgeon by an insured, subscriber or enrollee, provided (1) the dentist or oral surgeon charges the insured, subscriber or enrollee no more for services than the dentist or surgeon charges uninsured patients for the same services, and (2) the dentist or oral surgeon allows the insurer, health care center, corporation or entity to review the records related to the insured, subscriber or enrollee during regular business hours. The insurer, health care center, corporation or entity shall give the dentist or oral surgeon at least forty-eight hours' notice prior to such review. As used in this section, “assignment of benefits” means the transfer of dental care coverage reimbursement benefits or other rights under an insurance policy, subscription contract or dental services plan by an insured, subscriber or enrollee to a dentist or oral surgeon.
(P.A. 00-33, S. 1, 3; P.A. 11-19, S. 25.)
History: P.A. 00-33 effective July 1, 2000; P.A. 11-19 made technical changes.
See Sec. 38a-517b for similar provisions re group policies.