reglab/statecodes huggingface dataset:
Connecticut Administrative Code › Title 38a - Insurance Department › 528a - Group Short-Term Care Insurance › Section 38a-528a-4 - Minimum standards

Current through July 10, 2024
No group insurance policy or certificate shall be advertised,
				solicited or issued for delivery in this state as a group short-term care
				policy or certificate that does not meet the minimum standards set forth in
				this section. The standards set forth in this section are minimum standards and
				do not preclude the inclusion of other provisions or benefits that are not
				inconsistent with these standards.
(a)
Continuation.
(1) All group
			 short-term care policies and certificates shall include a provision which
			 allows the certificate holder to continue coverage or convert to an individual
			 short-term care policy in the event of the cancellation, nonrenewal or
			 termination of the group policy. Conversion is to be made without evidence of
			 insurability and without pre-existing conditions limitations or waiting
			 periods, with an effective date that coincides with the date coverage ceased
			 under the group short-term care policy.
(2) Any insured individual whose eligibility
			 for group short-term care coverage is based upon his or her relationship to
			 another person shall be entitled to continue coverage under the group
			 short-term care policy or convert to an individual short-term care policy upon
			 termination of the relationship by death or dissolution of marriage. Conversion
			 is to be made without evidence of insurability, without pre-existing conditions
			 limitations or waiting periods, and with an effective date that coincides with
			 the date coverage ceased under the group short-term care policy
(3) If a group short-term care policy is
			 replaced by another policy or contract issued to the same policyholder, the
			 succeeding carrier shall offer coverage to all persons covered under the
			 previous policy or contract on the date of its termination. Coverage shall be
			 made available without evidence of insurability or pre-existing conditions
			 limitations or waiting periods and with an effective date that coincides with
			 the termination of coverage under the preceding policy.
Connecticut Administrative Code › Title 38a - Insurance Department › 528a - Group Short-Term Care Insurance › Section 38a-528a-5 - Prohibition against pre-existing conditions and probationary periods in replacement policies

Current through July 10, 2024
If a group short-term care certificate replaces another group
				or individual short-term care or long-term care policy or certificate the
				replacing insurer shall waive any time periods applicable to pre-existing
				conditions and probationary periods in the new group short-term care
				certificate for similar benefits to the extent that similar exclusions have
				been satisfied under the original policy or certificate.
Connecticut Administrative Code › Title 38a - Insurance Department › 528a - Group Short-Term Care Insurance › Section 38a-528a-6 - Required disclosure provisions

Current through July 10, 2024
(a)
Continuation.
Group short-term care certificates shall contain a
			 provision, appropriately captioned, which describes how the coverage may be
			 continued or converted.
(b)
Riders and Endorsements
. Except for riders or endorsements by
			 which the insurer effectuates a request made in writing by the insured or
			 exercises a specifically reserved right under a group short-term care
			 certificate, all riders or endorsements added to a group short-term care
			 certificate after date of issue or at reinstatement or renewal shall require a
			 signed acceptance by the insured. After date of certificate issue, any rider or
			 endorsement that increases benefits or coverage with a concomitant increase in
			 premium during the certificate term shall be agreed to in writing signed by the
			 insured, except if the increased benefits or coverage is required by law. Where
			 a separate additional premium is charged for benefits provided in connection
			 with riders or endorsements, such premium charge shall be set forth in the
			 certificate, rider or endorsement.
(c)
Limitations
. If a group
			 short-term care certificate contains any limitation with respect to preexisting
			 conditions, such limitation shall appear as a separate paragraph of the
			 certificate and shall be labeled "PRE-EXISTING CONDITIONS
			 LIMITATION."
(d)
Other
			 Limitations or Conditions on Eligibility for Benefits.
A group
			 short-term care certificate shall set forth a description of any limitations or
			 conditions for eligibility, including any required number of days of
			 confinement, in a separate paragraph of the certificate and shall label such
			 paragraph "Limitations or Conditions on Eligibility for Benefits."
Connecticut Administrative Code › Title 38a - Insurance Department › 528a - Group Short-Term Care Insurance › Section 38a-528a-7 - Prohibition against post claims underwriting

Current through July 10, 2024
(a) All
			 applications for group short-term care certificates except those that are
			 guaranteed issue shall contain clear and unambiguous questions designed to
			 ascertain the health condition of the applicant.
(b) If an application for group short-term
			 care insurance contains a question that asks whether the applicant has had
			 medication prescribed, it shall also ask the applicant to list the medication
			 that has been prescribed. If the medications listed in such application were
			 known by the insurer or should have been known at the time of application to be
			 directly related to a medical condition for which coverage would otherwise be
			 denied, then the certificate shall not be rescinded for that
			 condition.
(c) Except for
			 certificates that are guaranteed issue:
(1)
			 The following language shall be set out conspicuously and in close conjunction
			 with the applicant's signature block on an application for group short-term
			 care insurance:
Caution: If your answers on this application are
				incorrect or untrue, (insurer) has the right to deny benefits or rescind your
				coverage.
(2) The
			 following language or language substantially similar to the following, shall be
			 set out conspicuously on the group short-term care certificate at the time of
			 delivery:
Caution: The issuance of this group short-term care
				insurance certificate is based upon your responses to the questions on your
				application. A copy of your application (is enclosed) (was retained by you when
				you applied). If your answers are incorrect or untrue, the insurer has the
				right to deny benefits or rescind your coverage. The best time to clear up any
				questions is now, before a claim arises! If, for any reason any of your answers
				are incorrect, contact the insurer at this address: (Insert
				address).
Connecticut Administrative Code › Title 38a - Insurance Department › 528a - Group Short-Term Care Insurance › Section 38a-528a-8 - Filing requirements

Current through July 10, 2024
(a) All filings of
			 rates and rating schedules shall be accompanied by an actuarial certification
			 demonstrating that expected claims in relation to premiums comply with a loss
			 ratio of not less than sixty percent (60%) when combined with actual experience
			 to date. Filings of rate revisions shall also demonstrate that the anticipated
			 loss ratio over the entire future period for which the revised rates are
			 computed to provide coverage can be expected to meet the required loss ratio
			 standard.
(b) Insurers shall submit
			 with each group policy or certificate form that they file for approval a
			 description of the method used to determine the standard for the payment of
			 group policy or certificate benefits, including ''usual and customary,'' ''
			 reasonable and customary'' or other standards.
(c) Every insurer providing group short-term
			 care insurance in this state shall provide a copy of any group short-term care
			 insurance advertisement intended for use in this state whether through written,
			 radio or television medium to the Insurance Commissioner for review or approval
			 to the extent this may be required in accordance with regulations adopted
			 pursuant to Section 38a-819 of the Connecticut General Statutes. All such
			 advertisements shall be retained as provided in Section
			 38a-819-18 of the Regulations of
			 Connecticut State Agencies.
Connecticut Administrative Code › Title 38a - Insurance Department › 528a - Group Short-Term Care Insurance › Section 38a-528a-9 - Standards for marketing

Current through July 10, 2024
(a) Every insurer
			 marketing group short-term care insurance coverage in this state, directly or
			 through producers, shall:
(1) Establish
			 marketing procedures to assure that any comparison of policies or certificates
			 by its agents or other producers will be fair and accurate.
(2) Establish marketing procedures to assure
			 excessive insurance is not sold or issued.
(3) Display prominently by type, stamp or
			 other appropriate means on the first page of the outline of coverage and policy
			 or certificate the following: "Notice to buyer: This policy or certificate may
			 not cover all of the costs associated with short-term care incurred by the
			 buyer during the period of coverage. The buyer is advised to review carefully
			 all policy or certificate limitations."
(4) Inquire and otherwise make every
			 reasonable effort to identify whether a prospective applicant or insured for
			 group short-term care insurance already has accident and sickness, group or
			 individual short-term care or long-term care insurance and the types and
			 amounts of any such insurance.
(5)
			 Establish auditable procedures for verifying compliance with this
			 subsection.
(6) Provide, at
			 solicitation, written notice to the prospective certificate holder of the
			 availability of any insurance counseling program that may be provided or
			 approved by any state agency for this purpose, together with the name, address
			 and telephone number of such program.
Connecticut Administrative Code › Title 38a - Insurance Department › 528a - Group Short-Term Care Insurance › Section 38a-528a-10 - Suitability of recommended purchase

Current through July 10, 2024
(a) A producer who
			 recommends the purchase or replacement of a group or individual short-term care
			 policy or certificate shall have reasonable grounds for believing that the
			 recommendation is suitable for the applicant upon the basis of the facts, if
			 any, disclosed by the applicant concerning his or her health and financial
			 circumstances.
(b) Before selling
			 any group short-term care certificate, a producer shall make reasonable efforts
			 to obtain information concerning the applicant's health and financial
			 circumstances.
(c) Before issuing
			 any group short-term care certificate, a direct response insurer shall have
			 reasonable grounds for believing that the purchase of such certificate, whether
			 or not it involves the replacement of existing coverage, is suitable for the
			 applicant upon the basis of the facts, if any, disclosed by the applicant
			 concerning his or her health and financial circumstances.
(d) Every direct response insurer shall
			 include questions on its applications for group short-term care insurance that
			 are reasonably designed to obtain information concerning the applicant's health
			 and financial circumstances.
Connecticut Administrative Code › Title 38a - Insurance Department › 528a - Group Short-Term Care Insurance › Section 38a-528a-11 - Non-forfeiture of benefits

Current through July 10, 2024
An insurer may offer the option to purchase a certificate that
				provides a non-forfeiture benefit in the form of a return of premium, full
				benefits for a reduced benefit period, reduced benefits for the full benefit
				period, or another benefit that is acceptable to the Commissioner. A
				certificate that provides a non-forfeiture benefit shall include a schedule of
				this benefit.
Connecticut Administrative Code › Title 38a - Insurance Department › 528a - Group Short-Term Care Insurance › Section 38a-528a-12 - Inflation protection

Current through July 10, 2024
(a) An insurer
			 shall offer the option to purchase a certificate that provides for meaningful
			 periodic benefit level increases to account for reasonably anticipated
			 increases in the costs of short-term care. Inflation protection includes:
(1) Increases in benefit levels annually in a
			 manner so that the increases are compounded annually at a stated interest
			 rate;
(2) The right to periodically
			 increase benefit levels without providing evidence of insurability or health
			 status so long as the option for the previous period has not been declined. The
			 amount of the additional benefit shall be no less than the difference between
			 the existing certificate benefit and that benefit compounded annually at a
			 stated interest rate for the period beginning with the purchase of the existing
			 benefit and extending until the year in which the offer is made; or
(3) A specified percentage of actual or
			 reasonable charges, not including a maximum specified indemnity amount or
			 limit.
Connecticut Administrative Code › Title 38a - Insurance Department › 528a - Group Short-Term Care Insurance › Section 38a-528a-14 - Replacement

Current through July 10, 2024
(a) Application forms shall include the
			 following questions designed to elicit information as to whether, as of the
			 date of the application, the applicant has another group or individual
			 short-term care or long-term care policy or certificate in force or whether a
			 group short-term care certificate is intended to replace any other group or
			 individual accident and sickness policy or certificate, group or individual
			 short-term care or long-term care policy or certificate presently in force. A
			 supplementary application or other form to be signed by the applicant and
			 producer, except where the coverage is sold without a producer, containing such
			 questions may be used.
(1) Do you have a group
			 or individual long-term care or another group or individual short-term care
			 insurance policy or certificate in force (including a health care service
			 contract or health maintenance organization contract)?
(2) Did you have a group or individual
			 long-term care or another group or individual short-term care insurance policy
			 or certificate in force during the last twelve (12) months? If so, with which
			 company? If that policy or certificate lapsed, when did it lapse?
(3) Are you covered by Medicaid?
(4) Do you intend to replace any of your
			 medical or health insurance coverage with this insurance?
Connecticut Administrative Code › Title 38a - Insurance Department › 528a - Group Short-Term Care Insurance › Section 38a-528a-15 - Reporting requirements

Current through July 10, 2024
(a) Every insurer
			 shall report annually by June 30 the number of certificates lapsed in the
			 previous calendar year, the average total number of certificates in force
			 during the preceding calendar year, and the resulting ratio.
(b) Every insurer shall report annually by
			 June 30 the number of replacement certificates sold in the previous calendar
			 year, the total number of certificates sold during the preceding calendar year,
			 and the resulting ratio.
(c) Every
			 insurer shall report annually by June 30 the number of replacement certificates
			 sold in the previous calendar year, the average total number of certificates in
			 force during the preceding calendar year, and the resulting ratio.
(d) Every insurer shall report annually by
			 June 30 the number of rescissions of certificates, except those voluntarily
			 effectuated by an insured, in the previous calendar year.
(e) For purposes of this section,
			 "certificate" means certificate evidencing coverage under group short-term care
			 policies and "report" means a report on a statewide and national
			 basis.
Connecticut Administrative Code › Title 38a - Insurance Department › 528a - Group Short-Term Care Insurance › Section 38a-528a-16 - Separability

Current through July 10, 2024
If any provision of sections 38a-528a-1 to 38a-528a-16 of the
				Regulations of Connecticut State Agencies or the application thereof to any
				person or circumstance is for any reason held to be invalid, the remainder of
				said regulations and the application of such provision to other persons or
				circumstances shall not be affected thereby.
Connecticut Administrative Code › Title 38a - Insurance Department › 546 - Group Coverage Discontinuance and Replacement › Section 38a-546-1 - Applicability and scope

Current through July 10, 2024
Section 38a-546-1 to
				38a-546-5,
				inclusive, of the Regulations of Connecticut State Agencies, shall apply to all
				group insurance policies in effect, delivered, or issued for delivery in this
				state. The provisions of section
				38a-546-5(a)
				of the Regulations of Connecticut State Agencies shall be effective for all
				covered persons whose group health insurance plan terminates on or after the
				effective date of section 38a-546-1 to
				38a-546-5,
				inclusive, of the Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 38a - Insurance Department › 546 - Group Coverage Discontinuance and Replacement › Section 38a-546-2 - Definitions

Current through July 10, 2024
As used in section
				38a-546-1
				to section
				38a-546-4,
				inclusive, of the Regulations of Connecticut State Agencies:
(1) "Carrier" means a health care center,
			 insurer, hospital and medical service corporation or other entity responsible
			 for the payment of benefits or provision of services under a group
			 contract;
(2) "Commissioner" means
			 the Insurance Commissioner;
(3)
			 "Group disability income protection policy" means a contract for coverage of
			 the type specified in subdivision (5) of section
			 38a-469 of the
			 Connecticut General Statutes that by its terms limits eligibility to members or
			 employees of a specified group;
(4)
			 "Group health insurance policy" means a contract for coverage of the type
			 specified in subdivisions (1), (2), (3), (4), (11) and (12) of section
			 38a-469 of the
			 Connecticut General Statutes that by its terms limits eligibility to members or
			 employees of a specified group;
(5)
			 "Group hospital confinement indemnity policy" means a contract for coverage of
			 the type specified in subdivision (3) of section
			 38a-469 of the
			 Connecticut General Statutes that by its terms limits eligibility to members or
			 employees of a specified group;
(6)
			 "Group insurance policy" means any group health insurance policies, group life
			 plans, group disability income protection policies, and their associated
			 subscriber contracts, certificates, or agreements, if any; and
(7) "Group life plan" means a contract for
			 life insurance issued to members or employees of a specified group as set forth
			 in section
			 38a-431
			 of the Connecticut General Statutes.
Connecticut Administrative Code › Title 38a - Insurance Department › 546 - Group Coverage Discontinuance and Replacement › Section 38a-546-3 - Effective date of discontinuance for nonpayment of premium or subscription charges

Current through July 10, 2024
(a) If a group
			 insurance policy provides for automatic discontinuance of the policy or
			 contract after a premium or subscription charge has remained unpaid through the
			 grace period allowed for such payment, the carrier shall be liable for valid
			 claims for covered losses incurred prior to the end of the grace
			 period.
(b) If the actions of the
			 carrier after the end of the grace period indicate that it considered the
			 policy or contract as continuing in force beyond the end of the grace period
			 (such as by not denying claims for losses beginning after the end of the grace
			 period), the carrier shall be liable for valid claims for losses beginning
			 prior to the effective date of written notice of discontinuance to the
			 policyholder or other entity responsible for making payments or submitting
			 subscription charges to the carrier. The effective date of discontinuance shall
			 not be prior to midnight at the end of the third scheduled work day after the
			 date upon which the notice is delivered.
Connecticut Administrative Code › Title 38a - Insurance Department › 546 - Group Coverage Discontinuance and Replacement › Section 38a-546-4 - Requirements for notice of discontinuance

Current through July 10, 2024
(a) Any notice of
			 discontinuance so given by the carrier shall include a request to the group
			 policyholder or other entity involved to notify employees or members covered
			 under the policy or subscriber contract of the date as of which the group
			 policy or contract will discontinue and to advise that, unless otherwise
			 provided in the policy or contract, the carrier shall not be liable for claims
			 for losses incurred after such date. Such notice of discontinuance shall also
			 advise, in any instance in which the plan involves employee or member
			 contributions, that if the policyholder or other entity continues to collect
			 contributions for the coverage beyond the date of discontinuance, the
			 policyholder or other entity may be held solely liable for the benefits with
			 respect to which the contributions have been collected.
(b) The carrier will prepare and furnish to
			 the policyholder or other entity at the same time a supply of a notice form to
			 be distributed to the employees or members concerned indicating such
			 discontinuance and the effective date thereof, and urging the employees or
			 members to refer to their certificates or contracts in order to determine what
			 rights, if any, are available to them upon such discontinuance.
Nothing in this section shall relieve the employer from the
				notice of cancellation, discontinuance or substitution of coverage requirements
				in section
				38a-537
				of the General Statutes.
Connecticut Administrative Code › Title 38a - Insurance Department › 554 - Coordination of Benefits › Section 38a-554-2 - Definitions

Current through July 10, 2024
(A) "Plan" means any group policy issued by
			 or reinsured through the Health Reinsurance Association or any subscriber
			 contract issued by a residual market mechanism established by hospital and
			 medical service corporations and providing comprehensive health care coverage
			 as provided in Chapter 700c of the Connecticut General Statutes.
The term "Plan" shall be construed separately with respect to
				each policy, contract, or other arrangement for benefits or services and
				separately with respect to that portion of any such policy, contract, or other
				arrangement which reserves the right to take the benefits or services of other
				Plans into consideration in determining its benefits and that portion which
				does not.
(B) "This Plan"
			 means those portions of the policy which provide the benefits that are subject
			 to this provision.
(C) "Allowable
			 Expense" means any necessary, reasonable, and customary item of expense at
			 least a portion of which is covered under at least one of the Plans covering
			 the person for whom claim is made.
When a Plan provides benefits in the form of services rather
				than cash payments, the reasonable cash value of each service rendered shall be
				deemed to be both an Allowable Expense and a benefit paid.
(D) "Claim Determination Period" means a
			 calendar year, or that portion of a calendar year during which the person for
			 whom claim is made has been covered under this Plan.
Connecticut Administrative Code › Title 38a - Insurance Department › 554 - Coordination of Benefits › Section 38a-554-4 - Right to receive and release necessary information

Current through July 10, 2024
For the purposes of determining the applicability of and
				implementing the terms of this provision of this plan or any provision of
				similar purpose of any other plan, the company may, without the consent of or
				notice to any person, release to or obtain from any other insurance company or
				other organization or person any information, with respect to any person, which
				the company deems to be necessary for such purposes. Any person claiming
				benefits under this plan shall furnish to the company such information as may
				be necessary to implement this provision.
Connecticut Administrative Code › Title 38a - Insurance Department › 554 - Coordination of Benefits › Section 38a-554-5 - Facility of payment

Current through July 10, 2024
Whenever payments which should have been made under this plan
				in accordance with this provision have been made under any other plans, the
				company shall have the right, exercisable alone and in its sole discretion, to
				pay over to any organizations making such other payments any amounts it shall
				determine to be warranted in order to satisfy the intent of this provision, and
				amounts so paid shall be deemed to be benefits paid under this plan and, to the
				extent of such payments, the company shall be fully discharged from liability
				under this plan.
Connecticut Administrative Code › Title 38a - Insurance Department › 554 - Coordination of Benefits › Section 38a-554-6 - Right of recovery

Current through July 10, 2024
Whenever payments have been made by the company with respect to
				Allowable Expenses in a total amount which is, at any time, in excess of the
				maximum amount of payment necessary at that time to satisfy the intent of this
				provision, the company shall have the right to recover such payments, to the
				extent of such excess, from among one or more of the following, as the company
				shall determine: any persons to or for or with respect to whom such payments
				were made, any other insurance companies, any other
				organizations.
Connecticut Administrative Code › Title 38a - Insurance Department › 591 - Utilization Review, Grievances and External Review › Section 38a-591-1 - Utilization review company licenses

Current through July 10, 2024
(a) No utilization
			 review company shall conduct utilization review in this state unless it has
			 been licensed by the commissioner in accordance with section
			 38a-591j
			 of the Connecticut General Statutes. All requests for licensure shall be made
			 in a manner and on a form prescribed annually by the commissioner.
(b) Applications for licensure shall not be
			 considered complete and eligible for processing until all required information
			 is provided.
(c) The annual license
			 fee shall be submitted in check form made payable to the "Treasurer - State of
			 Connecticut".
(d) All licenses
			 shall be renewed no later than January 1 annually.
(e) The annual license fee shall not be
			 pro-rated if issued for a period less than a full year.
Connecticut Administrative Code › Title 38a - Insurance Department › 591 - Utilization Review, Grievances and External Review › Section 38a-591-2 - Compensation based on certification denials - prohibited

Current through July 10, 2024
(a) No staff member, officer or consultant of
			 a utilization review company or a health carrier shall receive any financial
			 incentive based on the number of denials of certifications made.
(b) No utilization review company or health
			 carrier shall receive any financial incentive based on the number of denials of
			 certifications made.
Connecticut Administrative Code › Title 38a - Insurance Department › 591 - Utilization Review, Grievances and External Review › Section 38a-591-3 - Confidentiality

Current through July 10, 2024
(a) Each utilization review company shall
			 comply with the provisions of this section as well as all applicable federal
			 and state laws to protect the confidentiality of patient medical records. Each
			 utilization review company shall:
(1) Secure
			 each case file by assigning case identification numbers to all utilization
			 review requests, and use such numbers in lieu of personally identifiable
			 information, whenever feasible.
(2)
			 Ensure that all paper copies of files are reasonably secured in appropriate
			 storage facilities.
(3) Maintain
			 appropriate written procedures for the requesting, maintenance, and disposition
			 of patient medical records.
(4)
			 Develop and maintain specifications indicating when and by whom the release of
			 patient medical records is permitted.
(5) Ensure that all utilization review
			 business operations are reasonably secured during non-business hours.
(6) Require all employees with access to
			 patient medical records to sign a confidentiality statement, to be maintained
			 on file by the company, in which the employee acknowledges the confidential
			 nature of such information.
(7)
			 Maintain a written policy stipulating sanctions for an employee's unauthorized
			 disclosure of patient medical records, up to and including termination of
			 employment.
(8) Maintain procedures
			 for limiting access to computer files containing patient medical records
			 through passwords, restricted functions and computer terminal
			 security.
(9) Develop and maintain
			 procedures to address the security of all patient medical records that are
			 transferred by facsimile, which shall include:
(i) A statement in all facsimile transmission
			 cover sheets that such data is confidential and is limited specifically for use
			 by the company in making a utilization review determination; and
(ii) Security procedures governing the use of
			 facsimile transmissions, specifying restricted access to such transmissions,
			 the extent of such information that may be released, and the placement of the
			 facsimile machine in a reasonably secured or isolated area.
Connecticut Administrative Code › Title 38a - Insurance Department › 591 - Utilization Review, Grievances and External Review › Section 38a-591-4 - Recordkeeping

Current through July 10, 2024
With respect to all utilization reviews, urgent care or
				expedited utilization reviews, grievances of adverse determinations, and
				expedited reviews of adverse determinations, each utilization review company
				shall maintain an audit trail, through a written control log or computer
				report, clearly evidencing:
(1) the
			 date that a request or grievance was received;
(2) the dates and reasons for any subsequent
			 requests for additional information required to complete any such review or
			 grievance;
(3) the dates of the
			 receipt of the additional information; and
(4) the date of notification to the provider
			 of record or the covered person or the covered person's authorized
			 representative.
Connecticut Administrative Code › Title 38a - Insurance Department › 591 - Utilization Review, Grievances and External Review › Section 38a-591-5 - Statistical reporting to the commissioner

Current through July 10, 2024
(a) Each health
			 carrier shall file annually with the commissioner, on or before March 1, a
			 summary report of its utilization review program activities in the calendar
			 year immediately preceding and a report that includes for each type of health
			 benefit plan offered by the health carrier the required information set forth
			 in subsection (e)(1)(B) of section
			 38a-591b
			 of the Connecticut General Statutes.
(b) Each health carrier shall report the
			 information indicated in a format as specified annually by the commissioner and
			 shall maintain source records adequate to support the accuracy of the
			 information filed.
Connecticut Administrative Code › Title 38a - Insurance Department › 591 - Utilization Review, Grievances and External Review › Section 38a-591-6 - Examinations

Current through July 10, 2024
(a) The commissioner may undertake a
			 compliance examination of any utilization review company licensed and
			 conducting business in this state. In conducting the examination, the
			 commissioner or his designee may examine the offices of such utilization review
			 company, its books, records, procedures and any other information deemed to be
			 relevant to the examination.
(b)
			 Upon completing the compliance examination, the commissioner or his designee
			 shall issue a report of the examination. The report shall include any
			 corrective or remedial actions deemed necessary to be taken by the utilization
			 review company in order to assure compliance with the requirements of
			 Connecticut law.
Connecticut Administrative Code › Title 38a - Insurance Department › 591 - Utilization Review, Grievances and External Review › Section 38a-591-7 - Grievance procedures

Current through July 10, 2024
(a) Each health
			 carrier shall file with the commissioner a copy of the written procedures,
			 including all forms used to process requests, for (1) the review of grievances
			 of adverse determinations that were based, in whole or in part, on medical
			 necessity, (2) the expedited review of grievances of adverse determinations of
			 urgent care requests, including concurrent review urgent care requests
			 involving an admission, availability of care, continued stay or health care
			 service for a covered person who has received emergency services but has not
			 been discharged from a facility, and (3) notifying covered persons or covered
			 persons' authorized representatives of such adverse determinations.
(b) Each health carrier shall file with the
			 commissioner an initial copy of such procedures, including all forms used to
			 process requests, no later than September 1, 2012 and any subsequent material
			 modifications to such procedures no later than one month following
			 implementation of the modification.
Connecticut Administrative Code › Title 38a - Insurance Department › 591 - Utilization Review, Grievances and External Review › Section 38a-591-8 - Notice to enrollees

Current through July 10, 2024
(a) Each health
			 carrier that submits notices to a covered person or the covered person's
			 authorized representative pursuant to section
			 38a-591d
			 of the Connecticut General Statutes, including adverse determinations that
			 involve a rescission, shall include with the Notice of Adverse Determination a
			 description of the health carrier's procedures for initiating an internal
			 grievance of an adverse determination including the procedures for requesting
			 an expedited review. Such notification shall also include the procedures for
			 filing an external review and an expedited external review.
(b) Each health carrier that submits a notice
			 to a covered person or the covered person's authorized representative pursuant
			 to section
			 38a-591e
			 of the Connecticut General Statutes shall include with the Notice of a
			 Grievance Decision that upholds the adverse determination a description of the
			 health carrier's procedures for initiating any remaining internal grievance
			 rights including the procedures for requesting an expedited review. If the
			 Notice of a Grievance Decision that upholds the adverse determination is the
			 final adverse determination, or if the notice is issued due to the health
			 carrier's failure to strictly adhere to the requirements of section
			 38a-591e(f)(1)
			 of the Connecticut General Statutes, the notice shall also include a statement
			 that all internal appeals have been exhausted. Such notice shall include the
			 procedure for filing an external review and an expedited external review, as
			 well as a copy of the external review application and a consumer guide to the
			 external review process. The commissioner shall develop and make available to
			 health carriers the external review application and consumer guide to the
			 external review process. A copy of the external review application and consumer
			 guide shall also be made available from the health carrier to a covered person
			 or the covered person's authorized representative, upon request.
(c) For purposes of triggering the filing
			 period for an external review request or an expedited external review request
			 under section
			 38a-591g(e)
			 of the Connecticut General Statutes, notice of an adverse determination or a
			 final adverse determination shall be deemed to have been received by the
			 covered person or the covered person's authorized representative five (5)
			 calendar days after the notice is mailed.
Connecticut Administrative Code › Title 38a - Insurance Department › 591 - Utilization Review, Grievances and External Review › Section 38a-591-9 - Rescission notice

Current through July 10, 2024
Health carriers shall provide advance written notice,
				consistent with 45 C.F.R. 136, to each covered person who would be affected
				before coverage may be rescinded regardless of whether the rescission applies
				to an entire group or only to an individual within the group.
Connecticut Administrative Code › Title 38a - Insurance Department › 591 - Utilization Review, Grievances and External Review › Section 38a-591-10 - Independent review organizations

Current through July 10, 2024
(a) The
			 commissioner shall enter into agreements for external review services with as
			 many independent review organizations as he deems necessary. The agreements
			 shall set forth all terms which the commissioner deems necessary to assure a
			 full and fair review.
(b) After
			 entering into an agreement with the commissioner, an independent review
			 organization shall report changes in its ownership, or its operational or
			 administrative status to the commissioner not later than thirty (30) days after
			 the effective date of such change. If the commissioner determines that the
			 reported change(s) may negatively impact the effectiveness or objectivity of
			 the independent review organization, the commissioner may terminate the
			 agreement.
Connecticut Administrative Code › Title 38a - Insurance Department › 591 - Utilization Review, Grievances and External Review › Section 38a-591-11 - Severability

Current through July 10, 2024
If any provision of sections
				38a-591-1
				to 38a-591-11, inclusive, of the Regulations of Connecticut State Agencies or
				the application thereof to any person or circumstance is for any reason held to
				be invalid, the remainder of the provisions of said regulations, and the
				application of such provision to other persons or circumstances shall not be
				affected thereby.
Connecticut Administrative Code › Title 38a - Insurance Department › 640 - Approval of Form of Fraternal Benefit Society Policies and Contracts › Section 38a-640-1 - Definitions

Current through July 10, 2024
As used in Sections 38a-640-1 to
				38a-640-4,
				inclusive, of the Regulations of Connecticut State Agencies:
(a) "Commissioner" means the Insurance
			 Commissioner of the State of Connecticut.
(b) "Form" means a certificate or other
			 evidence of a contract of accident insurance or health insurance or of a total
			 and permanent disability contract, or application, rider or endorsement used in
			 connection therewith.
(c) "Society"
			 means a fraternal benefit society as defined in Section
			 38a-595
			 of the Connecticut General Statutes.
(d) "SERFF" means National Association of
			 Insurance Commissioners System for Electronic Rate and Form Filing.
Connecticut Administrative Code › Title 38a - Insurance Department › 640 - Approval of Form of Fraternal Benefit Society Policies and Contracts › Section 38a-640-2 - Filing procedure

Current through July 10, 2024
Any society required pursuant to Section
				38a-640
				of the Connecticut General Statutes to file a copy of a form with the
				Commissioner for approval, shall comply with the following standards:
(a)
Filing
.
(1) Filing shall be done electronically
			 through SERFF or any subsequent corresponding system adopted by the National
			 Association of Insurance Commissioners or the Commissioner. All fields in SERFF
			 shall be filled out appropriately and accurately for each filing.
(2) The electronic filing shall contain a
			 descriptive caption. The caption shall identify the society and include a brief
			 description of the type of filing, and any applicable form identification
			 number. All subsequent correspondence to the Insurance Department on the filing
			 shall include the caption in the identical format as it was displayed in the
			 original electronic filing and a reference to the previous filing's State
			 tracking number, in addition to the date of the original filing transmittal
			 document and the Department's file number, if known.
(3) All SERFF submissions shall include the
			 following information in the filing description:
(A) A list of the documents submitted
			 therewith;
(B) A brief outline of
			 proposed changes;
(C) The approval
			 sought;
(D) The proposed effective
			 date; and
(E) Whether the form
			 sought to be approved by the Commissioner is subject to the requirements of the
			 Insurance Plain Language Act, Chapter 699a of the Connecticut General
			 Statutes.
Connecticut Administrative Code › Title 38a - Insurance Department › 640 - Approval of Form of Fraternal Benefit Society Policies and Contracts › Section 38a-640-3 - Policy form approval

Current through July 10, 2024
(a) Each filing
			 shall be state specific. Only filings with state specific language will be
			 approved.
(b) Unless otherwise
			 provided by law, the Insurance Department shall review all forms filed with the
			 Insurance Commissioner for approval pursuant to Section
			 38a-640
			 of the Connecticut General Statutes in the order in which they are received by
			 the Department; provided, however, that in appropriate circumstances the
			 Commissioner may waive this requirement and direct the immediate review of a
			 form filing. The Department shall employ a chronological logging system to
			 facilitate the chronological review of such forms.
(c) Within ninety (90) days after a form is
			 accepted for review, the Insurance Department shall review the form and either
			 approve it or disapprove it. If, upon such review of the form, the Insurance
			 Department determines that additional information from the society is necessary
			 in order to ascertain whether the form is contrary to law, the Department shall
			 make such request to the society. The society will then have ten (10) days from
			 the date of the request to provide the Department with the additional
			 information; provided that during such time, the society may request in writing
			 that the period for responding to the request for information be extended for
			 an additional period of time, not to exceed thirty (30) days. The request for
			 extension shall be considered granted upon its receipt by the Insurance
			 Department. During the pendency of the Insurance Department's request for
			 information, the ninety (90) day period for Department action shall be tolled.
			 If the society fails to comply with such request within the allotted time, the
			 society shall be deemed to have voluntarily withdrawn its filing and the
			 Department shall close its file without further action.
(d) The Commissioner shall issue a decision
			 disapproving the use of any such form if it does not comply with the
			 requirements of law. Any such decision shall specify the reason for disapproval
			 of the form.
(e) Forms that are
			 approved by the Commissioner shall have the form labeled "Approved," together
			 with the name and signature of the staff member who acted upon the filing and
			 the date of the approval.
Connecticut Administrative Code › Title 38a - Insurance Department › 640 - Approval of Form of Fraternal Benefit Society Policies and Contracts › Section 38a-640-3a - Electronic filing

Current through July 10, 2024
Filings shall be considered received by the Commissioner when
				received at the Insurance Department. Filings received on a weekend or legal
				holiday shall be deemed received on the next business day. An electronic
				communication from the Insurance Department concerning a filing shall be deemed
				received by the person to whom the communication is addressed when the
				communication is sent to that person.
Connecticut Administrative Code › Title 38a - Insurance Department › 640 - Approval of Form of Fraternal Benefit Society Policies and Contracts › Section 38a-640-4 - Severability

Current through July 10, 2024
If any provision of this regulation or application thereof to
				any person or circumstance is for any reason held to be invalid, the remainder
				of the regulation and the application of such provision to other persons or
				circumstances shall not be affected thereby.
Connecticut Administrative Code › Title 38a - Insurance Department › 651 - Approval of Credit Life Insurance and Credit Accident and Health Insurance Policy Forms › Section 38a-651-1 - Definitions

Current through July 10, 2024
As used in Sections 38a-651-1 to
				38a-651-4,
				inclusive, of the Regulations of Connecticut State Agencies:
(a) "Commissioner" means the Insurance
			 Commissioner of the State of Connecticut.
(b) "Form" means a credit life insurance or
			 credit accident and health insurance, policy or application, certificate,
			 notice of proposed insurance rider or endorsement used in connection
			 therewith.
(c) "Insurer" means an
			 insurance company licensed by the Commissioner to write credit life insurance
			 or credit accident and health insurance.
(d) "SERFF" means National Association of
			 Insurance Commissioners System for Electronic Rate and Form Filing.
Connecticut Administrative Code › Title 38a - Insurance Department › 651 - Approval of Credit Life Insurance and Credit Accident and Health Insurance Policy Forms › Section 38a-651-2 - Filing procedure

Current through July 10, 2024
Any insurer required pursuant to Section
				38a-651
				of the Connecticut General Statutes to file a copy of a form with the
				Commissioner for approval, shall comply with the following standards:
(a)
Filing
.
(1) Filing shall be done electronically
			 through SERFF or any subsequent corresponding system adopted by the National
			 Association of Insurance Commissioners or the Commissioner. All fields in SERFF
			 shall be filled out appropriately and accurately for each filing.
(2) If one or more elements within a filing
			 vary by member company within a group of companies, the filer shall file
			 separately for each insurer within the group.
(3) The electronic filing shall contain a
			 descriptive caption. The caption shall include a brief description of the type
			 of filing, and any applicable form identification number. All subsequent
			 correspondence to the Insurance Department on the filing shall include the
			 caption in the identical format as it was displayed in the original electronic
			 filing and a reference to the previous filing's State tracking number, in
			 addition to the date of the original filing transmittal document and the
			 Department's file number, if known.
(4) All SERFF submissions shall include the
			 following information in the filing description:
(A) A list of the documents submitted
			 therewith;
(B) A brief outline of
			 proposed changes;
(C) The approval
			 sought;
(D) The proposed effective
			 date; and
(E) Whether the form
			 sought to be approved by the Commissioner is subject to the requirements of the
			 Insurance Plain Language Act, Chapter 699a of the Connecticut General
			 Statutes.