reglab/statecodes huggingface dataset:
Connecticut Administrative Code › Title 38a - Insurance Department › 480 - Coordination of Benefits › Approval of Form of Life Insurance, Endowment and Annuity Policies and Contracts Providing Additional Benefits for Accidental Death and Waiver of Premium Benefits › Section 38a-480-13 - Policy form approval

Current through July 10, 2024
(a) Within fifteen
				(15) days of receipt of a form filed with the Commissioner for approval
				pursuant to Section
				38a-480(a)
				(3) of the General Statutes, the Insurance
				Department shall determine a filing to be complete or deficient for purposes of
				submission for review and shall issue written notice to the insurer regarding
				the status of the form.
(1) The written notice
				for a complete filing shall state that the form filing is complete and accepted
				for filing for review as of the date of its receipt. For purposes of this
				section, a form filing is complete upon agency determination that it is in
				compliance with Section
				38a-480-12.
(2) The written notice for a deficient filing
				shall state that the form filing is deficient and not accepted for filing and
				shall set out the specific items that must be corrected to make the form
				complete. In addition to this notice, the Insurance Department may notify the
				insurer, in any manner, of problems with the form.
Connecticut Administrative Code › Title 38a - Insurance Department › 480 - Coordination of Benefits › Approval of Form of Life Insurance, Endowment and Annuity Policies and Contracts Providing Additional Benefits for Accidental Death and Waiver of Premium Benefits › Section 38a-480-13a - Electronic filing

Current through July 10, 2024
(a) Any insurer
				filing a copy of a form with the commissioner in accordance with section
				38a-480-12 of
				the Regulations of Connecticut State Agencies may submit such form
				electronically using software known as the System for Electronic Rate and Form
				Filing (SERFF), Version 2.0 or higher, or any subsequent corresponding system,
				adopted by the National Association of Insurance Commissioners. All such
				filings shall include the information required in section
				38a-480-12 of
				the Regulations of Connecticut State Agencies.
(b) Filings made electronically 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 › 480 - Coordination of Benefits › Approval of Form of Life Insurance, Endowment and Annuity Policies and Contracts Providing Additional Benefits for Accidental Death and Waiver of Premium Benefits › Section 38a-480-14 - 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 › 481 - Approval of Individual Accident and Health Policy Forms › Section 38a-481-1 - Definitions

Current through July 10, 2024
As used in Sections 38a-481-1 to 38a-481-13, inclusive, of the
				Regulations of Connecticut State Agencies, unless the context otherwise
				requires:
(1) "Commissioner" means the
			 Insurance Commissioner of the State of Connecticut.
(2) "Department" means the Connecticut
			 Insurance Department.
(3)
			 "Excessive rate" means the rate is unreasonably high for the "insurance
			 provided.
(4) "Experience period"
			 means the most recent twelve (12) month period from which the insurer
			 accumulates the data to support a rate filing.
(5) "Form" means a policy of insurance
			 against loss or expense from sickness, or from bodily injury or death by
			 accident, or application, rider or endorsement used in connection
			 therewith.
(6) "Formulary" means a
			 list of prescription drugs that are covered by a specific health insurance
			 plan.
(7) "Inadequate rate" means a
			 rate that is unreasonably low for the insurance provided, and continued use of
			 it would endanger solvency of the insurer.
(8) "Insurer" means a health care center, as
			 defined in Section 38a-175 of the Connecticut General Statutes, or an insurance
			 company licensed by the Commissioner to write accident and health
			 insurance.
(9) "Loss ratio" has the
			 same meaning as provided in Section 38a-481(a) of the Connecticut General
			 Statutes.
(10) "Pharmaceutical and
			 therapeutics committee" or "P&T committee" means a group of members that
			 may include physicians, pharmacists, administrators, quality improvement
			 managers, other health care professionals and staff appointed by an insurer to
			 establish policies regarding the use of drugs, therapies and drug-related
			 products, identifying those that are most medically appropriate.
(11) "PPACA" means Patient Protection and
			 Affordable Care Act, PL. 111-148, as amended from time to time, and regulations
			 adopted thereunder.
(12)
			 "Prescription drug tier" means a subset of the drugs covered in a formulary
			 that are covered and subject to a specified level of cost share.
(13) "SERFF" means the National Association
			 of Insurance Commissioners' System for Electronic Rate and Form
			 Filing.
(14) "Specialty drug" means
			 a unique prescription drug that may require special handling, close monitoring
			 or may only be available from limited pharmacies.
(15) "Unfairly discriminatory" means rating
			 practices that reflect differences based on age, disability, race, ethnicity,
			 gender, sexual orientation or health status that are not actuarially justified
			 or otherwise prohibited by law
(16)
			 "Utilization data" means the number of services used by a fixed number of
			 covered persons, as defined in Section 38a-591a of the Connecticut General
			 Statutes, over a fixed length of time.
Connecticut Administrative Code › Title 38a - Insurance Department › 481 - Approval of Individual Accident and Health Policy Forms › Section 38a-481-2 - Filing procedure

Current through July 10, 2024
Any insurer required pursuant to Section
				38a-481
				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.
Connecticut Administrative Code › Title 38a - Insurance Department › 481 - Approval of Individual Accident and Health Policy Forms › Section 38a-481-3 - 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-481
			 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.
(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 insurer is necessary
			 in order to ascertain whether the form is contrary to law or is unfair,
			 deceptive or may encourage misrepresentation of the policy, the Department
			 shall make such request to the insurer. The insurer 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 insurer 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 insurer fails to comply with such request within the allotted time, such
			 applicant 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, or if it contains a provision or provisions which are
			 unfair or deceptive or which encourage misrepresentation of the policy. Any
			 such order 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 › 481 - Approval of Individual Accident and Health Policy Forms › Section 38a-481-3a - 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 › 481 - Approval of Individual Accident and Health Policy Forms › Section 38a-481-4 - 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 › 481 - Approval of Individual Accident and Health Policy Forms › Section 38a-481-5 - Timing for rate filings

Current through July 10, 2024
(a) Rate filings
			 shall be made no later than ninety (90) days prior to the date an insurer
			 intends to market such plans.
(b)
			 For plans subject to the requirements of the PPACA, rate filings shall be filed
			 annually no later than a date prescribed by the Commissioner. The Commissioner
			 shall provide notice to insurers no later than thirty (30) days prior to the
			 prescribed date each year.
Connecticut Administrative Code › Title 38a - Insurance Department › 481 - Approval of Individual Accident and Health Policy Forms › Section 38a-481-6 - Transparency of rate filings

Current through July 10, 2024
The information supplied to the Department to fulfill its
				statutory rate review requirement is not confidential. Complete rate filings
				including all correspondence and documentation are available through SERFF and
				may be posted on the Department website for review and comment by the public.
				All public comments shall be reviewed by the Department and considered as an
				additional element of the review determination.
Connecticut Administrative Code › Title 38a - Insurance Department › 481 - Approval of Individual Accident and Health Policy Forms › Section 38a-481-7 - Rate filing process

Current through July 10, 2024
(a) All rate
			 filings shall be submitted via SERFF.
(b) For filings subject to the requirements
			 of the PPACA, all fields in SERFF added for reporting requirements to the
			 federal Department of Health and Human Services in accordance with PPACA shall
			 be populated.
(c) All rate filings
			 shall be made in accordance with Department bulletins, notifications, and other
			 written guidance.
(d) Incomplete
			 submissions may be rejected.
(e) No
			 rate filing shall be approved if the Department determines that it is
			 excessive, inadequate or unfairly discriminatory.
(f) Rates shall not be approved unless the
			 policy forms to which they apply are approved.
(g) No rate may be marketed until the rates
			 are approved. The Commissioner may grant conditional approval to enhance the
			 fairness and efficiency of the marketplace.
Connecticut Administrative Code › Title 38a - Insurance Department › 481 - Approval of Individual Accident and Health Policy Forms › Section 38a-481-8 - Minimum rate filing requirements

Current through July 10, 2024
(a) All rate
			 filings shall include, at a minimum, the following:
(1) A cover letter describing all policy
			 forms affected by the requested rates or rate changes as well as the effective
			 date of the requested rates or rate changes.
(2) The detailed development for the initial
			 rate or rate increase.
(3)
			 Historical experience from inception-to-date including earned premium, paid
			 claims, incurred claims, membership, actual loss ratios and expected loss
			 ratios.
(A) Both state-specific and
			 nationwide experience shall be provided.
(B) Annual experience shall be provided for
			 all years.
(4) A
			 certification by a member of the American Academy of Actuaries that the rate
			 filing is in compliance with this section. Such certification shall include a
			 statement by a member of the American Academy of Actuaries that the rates are
			 reasonable in relation to the benefits provided, and that they are not
			 excessive, inadequate or unfairly discriminatory.
(5) Claim lag triangles.
(6) Cost for each newly mandated benefit that
			 applies to the type of insurance for which the rate filing has been
			 submitted.
(7) Any additional
			 information the Commissioner deems necessary to review the rate
			 filing.
Connecticut Administrative Code › Title 38a - Insurance Department › 481 - Approval of Individual Accident and Health Policy Forms › Section 38a-481-10 - Formulary annual filing requirements

Current through July 10, 2024
Insurers that deliver, issue for delivery, renew, amend or
				continue any individual health insurance policy that includes prescription drug
				coverage and utilizes a formulary shall submit an annual report to the
				Commissioner regarding the development and use of formularies and P&T
				committees. Such report shall be in a form prescribed by the commissioner and
				shall be submitted with the annual form filing.
Connecticut Administrative Code › Title 38a - Insurance Department › 481 - Approval of Individual Accident and Health Policy Forms › Section 38a-481-11 - Minimum standards for formularies

Current through July 10, 2024
No individual health insurance policy that offers prescription
				drug coverage that is subject to a formulary shall be delivered or issued for
				delivery in this state if the formulary does not meet the following required
				minimum standards:
(1) The formulary
			 shall be easily searchable and posted online, accessible to members and
			 non-members.
(2) The medications
			 within the formulary shall be grouped in alphabetical order by therapeutic
			 class.
(3) Definitions or
			 explanations, or both, of each prescription drug tier, including specialty drug
			 tiers, shall be clearly stated.
(4)
			 Definitions for utilization controls, including, but not limited to, quantity
			 or dosage controls, prior authorization, and step therapy shall be clearly
			 stated.
(5) Tier coverage and
			 utilization controls for each medication (by dosage, if applicable) shall be
			 clearly stated.
(6) The formulary
			 shall include information on how to obtain drugs that are off
			 formulary.
(7) The formulary shall
			 specify if and how drugs may be obtained through mail order pharmacy.
(8) The formulary shall clearly state when it
			 was created, when it was last updated, and when the next anticipated update
			 will be.
(9) The formulary shall
			 provide customer service contact information.
(10) The formulary shall meet all additional
			 requirements as set by the Commissioner.
Connecticut Administrative Code › Title 38a - Insurance Department › 481 - Approval of Individual Accident and Health Policy Forms › Section 38a-481-12 - Minimum standards for pharmaceutical and therapeutics committees

Current through July 10, 2024
(a)
(1) No
			 insurer shall utilize a P&T committee that does not have appropriate
			 membership.
(A) A majority of P&T
			 committee members shall be practicing physicians, pharmacists, and other
			 professionals who are licensed to prescribe drugs.
(B) P&T committee members shall represent
			 a sufficient number of clinical specialties to adequately meet the needs of
			 enrollees.
Connecticut Administrative Code › Title 38a - Insurance Department › 481 - Approval of Individual Accident and Health Policy Forms › Section 38a-481-13 - Notice to insureds regarding formulary changes

Current through July 10, 2024
Insurers that deliver, issue for delivery, renew, amend or
				continue any individual health insurance policy that includes prescription drug
				coverage and utilizes a formulary shall provide at least sixty (60) days'
				advance notice to each insured and to each participating provider under the
				policy utilizing a prescription drug within the formulary before the insurer
				may remove such prescription drug from the formulary or make any change to the
				structure of prescription drug benefits under such policy
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-1 - Applicability and scope

Current through July 10, 2024
Except as otherwise specifically provided, Sections 38a-495-1
				to
				38a-495-13,
				inclusive, shall apply to:
(a) All
			 Medicare supplement policies and subscriber contracts delivered or issued for
			 delivery in this State on or after the effective date hereof, and
(b) All certificates issued under group
			 Medicare supplement policies or subscriber contracts, which certificates have
			 been delivered or issued for delivery in this State.
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-2 - Definitions

Current through July 10, 2024
As used in Sections
				38a-495-1
				to
				38a-495-13,
				inclusive:
(a) "Applicant" means:
(1) in the case of an individual Medicare
			 supplement policy or subscriber contract, the person who seeks to contract for
			 insurance benefits, and
(2) in the
			 case of a group Medicare supplement policy or subscriber contract, the proposed
			 certificateholder;
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-3 - Policy definitions and terms

Current through July 10, 2024
No Medicare Supplement policy may be advertised, solicited or
				issued for delivery to any resident in this State who is eligible for Medicare
				unless such policy or subscriber contract contains definitions or terms which
				conform to the requirements of this section.
(a) "Accident," "Accidental Injury," or
			 "Accidental Means" shall be defined to employ "result" language and shall not
			 include words which establish an accidental means test or use words such as
			 "external, violent, visible wounds" or similar words of description or
			 characterization.
(1) The definition shall not
			 be more restrictive than the following: "Injury or injuries for which benefits
			 are provided means accidental bodily injury sustained by the insured person
			 which is the direct result of an accident, independent of disease or bodily
			 infirmity or any other cause, and occurs while insurance coverage is in
			 force."
(2) Such definition may
			 provide that injuries shall not include injuries for which benefits are
			 provided or available under any workers compensation, employer's liability or
			 similar law, or motor vehicle no-fault plan, unless prohibited by
			 law.
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-4 - Prohibited policy provisions

Current through July 10, 2024
(a) No insurance
			 policy or subscriber contract which provides benefits to any resident of this
			 State who is eligible for Medicare may be advertised, solicited or issued for
			 delivery in this State if such policy or subscriber contract limits or excludes
			 coverage by type of illness, accident, treatment or medical condition, except
			 as follows:
(1) foot care in connection with
			 corns, calluses, flat feet, fallen arches, weak feet, chronic foot strain, or
			 symptomatic complaints of the feet;
(2) mental or emotional disorders, alcoholism
			 and drug addiction;
(3) illness,
			 treatment or medical condition arising out of:
(A) war or act of war (whether declared or
			 undeclared); participation in a felony, riot or insurrection; service in the
			 armed forces or units auxiliary thereto;
(B) suicide (sane or insane), attempted
			 suicide or intentionally self-inflicted injury;
(C) aviation;
(4) cosmetic surgery, except that "cosmetic
			 surgery" shall not include reconstructive surgery when such service is
			 incidental to or follows surgery resulting from trauma, infection or other
			 diseases of the involved part;
(5)
			 Care in connection with the detection and correction by manual or mechanical
			 means of structural imbalance, distortion, or subluxation in the human body for
			 purposes of removing nerve interference and the effect thereof, where such
			 interference is the result of or related to distortion, misalignment or
			 subluxation of or in the vertebral column;
(6) treatment provided in a governmental
			 hospital; benefits provided under Medicare or other governmental program
			 (except Medicaid), any state or federal workers' compensation, employer's
			 liability or occupational disease law, or any motor vehicle no-fault law;
			 services rendered by employees of hospitals, laboratories or other
			 institutions; services performed by a member of the covered person's immediate
			 family and services for which no charge is normally made in the absence of
			 insurance;
(7) dental care or
			 treatment;
(8) eye glasses, hearing
			 aids and examination for the prescription or fitting thereof;
(9) rest cures, custodial care,
			 transportation and routine physical examinations;
(10) territorial limitations outside the
			 United States; provided, however, supplemental policies may not contain, when
			 issued, limitations or exclusions of the type enumerated in Subsections (1),
			 (5), (9), or (10) above that are more restrictive than those of Medicare.
			 Medicare supplement policies may exclude coverage for any expense to the extent
			 of any benefit available to the insured under Medicare.
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-6 - Standard for claims payment

Current through July 10, 2024
(a) Every entity
			 providing Medicare supplement policies or contracts shall comply with all
			 provisions of Section 4081 of the Omnibus Budget Reconciliation Act of 1987 (
			 P.L.
			 100-203 ).
(b) Compliance with the requirements set
			 forth in Subsection (a) must be certified on the Medicare supplement insurance
			 experience reporting form.
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-7 - Loss ratio standards

Current through July 10, 2024
(a) Medicare
			 supplement policies shall return to policyholders in the form of aggregate
			 benefits under the policy, for the entire period for which rates are computed
			 to provide coverage, on the basis of incurred claims experience or incurred
			 health care expenses where coverage is provided by a health maintenance
			 organization on a service rather than reimbursement basis and earned premiums
			 for such period and in accordance with accepted actuarial principles and
			 practices:
(1) At least 70 percent of the
			 aggregate amount of premiums earned in the case of group policies;
			 and
(2) At least 75 percent of the
			 aggregate amount of premiums earned in the case of group policies defined in
			 Section 1882 (g) of Title XVIII of the Social Security Act,
			 42
			 U.S.C. 1395ss(g), as
			 amended; and
(3) At least 65
			 percent of the aggregate amount of premiums earned in the case of individual
			 policies.
All filings of rates and rating schedules shall demonstrate
				that actual and expected losses in relation to premiums comply with the
				requirements of this section.
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-8 - Filing requirements for out-of-state group policies

Current through July 10, 2024
Every insurer providing group Medicare supplement insurance
				benefits to a resident of this State shall submit a copy of the master policy
				and any certificate and rates to be used in this State for approval prior to
				being issued in this State in accordance with the filing requirements and
				procedures applicable to group Medicare supplement policies issued in this
				State.
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-9 - Permitted compensation arrangements

Current through July 10, 2024
(a) An insurer or
			 other entity may provide commission or other compensation to an agent or other
			 representative for the sale of a Medicare supplement policy or certificate only
			 if the first year commission or other first year compensation is no more than
			 200 percent (200%) of the commission or other compensation paid for selling or
			 servicing the policy or certificate in the second year or period.
(b) The commission or other compensation
			 provided in subsequent (renewal) years must be the same as that provided in the
			 second year or period and must be provided for a reasonable number of renewal
			 years.
(c) No entity shall provide
			 compensation to its agents or other producers and no agent or producer shall
			 receive compensation greater than the renewal compensation payable by the
			 replacing insurer on renewal policies or certificates if an existing policy or
			 certificate is replaced unless benefits of the new policy or certificate are
			 clearly and substantially greater than the benefits under the replaced
			 policy.
(d) For purposes of this
			 section, "compensation" includes pecuniary or non-pecuniary remuneration of any
			 kind relating to the sale or renewal of the policy or certificate including but
			 not limited to bonuses, gifts, prizes, awards and finders fees.
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-11 - Requirements for application forms and replacement coverage

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 Medicare supplement
			 insurance policy or certificate in force or whether a Medicare supplement
			 policy or certificate is intended to replace any other accident and sickness
			 policy or certificate presently in force. A supplementary application or other
			 form to be signed by the applicant and agent, except where the coverage is sold
			 without an agent, containing such questions may be used.
(1) Do you have another Medicare supplement
			 insurance policy or certificate in force (including health care service
			 contract, health maintenance organization contract)?
(2) Did you have another Medicare supplement
			 policy or certificate in force during the last twelve (12) months?
(A) If so, with which company?
(B) If that policy 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
			 policy [certificate]?
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-12 - Filing requirements for advertising

Current through July 10, 2024
Every insurer, health care service plan or other entity
				providing Medicare supplement insurance or benefits in this State shall provide
				a copy of any Medicare supplement advertisement intended for use in this State
				whether through written, radio or television medium to the Commissioner for
				review or approval by the Commissioner to the extent it may be required under
				state law.
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-13 - Standards for marketing

Current through July 10, 2024
(a) Every insurer,
			 health care service plan or other entity marketing Medicare supplement
			 insurance coverage in this state, directly or through its producers, shall:
(1) Establish marketing procedures to assure
			 that any comparison of policies 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 or the outline of
			 coverage and policy the following:
"NOTICE TO BUYER: This policy may not cover all of the
						  costs associated with medical care incurred by the buyer during the period of
						  coverage. The buyer is advised to review carefully all policy limitations."
(4)
			 Inquire and otherwise make every reasonable effort to identify whether a
			 prospective applicant or enrollee for Medicare supplement insurance already has
			 accident and sickness insurance and the types and amounts of any such
			 insurance.
(5) Every insurer or
			 entity marketing Medicare supplement insurance shall establish auditable
			 procedures for verifying compliance with this subsection.
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-14 - Appropriateness of recommended purchase and excessive insurance

Current through July 10, 2024
(a) In recommending the purchase or
			 replacement of any Medicare supplement policy or certificate an agent shall
			 make reasonable efforts to determine the appropriateness of a recommended
			 purchase or replacement.
(b) Any
			 sale of Medicare supplement coverage which will provide an individual more than
			 one Medicare supplement policy or certificate is prohibited; provided however,
			 that additional Medicare supplement coverage may be sold if, when combined with
			 that individual's health coverage already in force, it would insure no more
			 than 100% of the individual's actual medical expenses covered under the
			 combined policies.
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-15 - Reporting of multiple policies

Current through July 10, 2024
On or before March 1, every insurer or other entity providing
				Medicare supplement insurance coverage in this State shall report the following
				information for every individual resident of this State for which the insurer
				or entity has in force more than one Medicare supplement insurance policy or
				certificate:
(1) policy and
			 certificate number, and
(2) date of
			 issuance. This information shall be grouped by individual
			 policyholder.
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-16 - Prohibition against preexisting conditions, waiting periods, elimination periods and probationary periods in replacement policies or certificates

Current through July 10, 2024
If a Medicare supplement policy or certificate replaces another
				Medicare supplement policy or certificate, the replacing insurer shall waive
				any time periods applicable to preexisting conditions, waiting periods,
				elimination periods and probationary periods in the new Medicare supplement
				policy for similar benefits to the extent such time was spent under the
				original policy.
Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-17 - Separability

Current through July 10, 2024
If any provision of this regulation or the 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 › 495 - Medicare Supplement Insurance Minimum Standards › Appendix A

Current through July 10, 2024
[Company Name]
Notice of Changes in Medicare and your Medicare
Supplement Coverage-199X
The following chart briefly describes the modifications in
				Medicare and in your medicare supplement coverage. PLEASE READ THIS
				CAREFULLY!
[A brief description of the revisions to Medicare Parts A &
				B with a parallel description of supplemental benefits with subsequent changes,
				including dollar amounts, provided by the Medicare supplement coverage in
				substantially the following format.]
SERVICES
MEDICARE BENEFITS
Effective January 1, 199X,
Medicare Will Pay
YOUR MEDICARE
SUPPLEMENT COVERAGE
Effective January 1, 199X,
Your Coverage Will Pay
MEDICARE PART A
SERVICE AND SUPPLIES
Inpatient Hospital
Services
Semi-Private Room &
Board
Misc. Hospital Servivces
& Supplies, such as
Drugs, X-Rays, Lab
Tests & Operating
Rooom
BLOOD
SKILLED NURSING
FACILITY CARE
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-1 - Applicability and scope

Current through July 10, 2024
(a) Except as
			 otherwise specifically provided, sections 38a-495a-1 to
			 38a-495a-21,
			 inclusive, of the Regulations of Connecticut State Agencies shall apply to:
(1) All Medicare supplement policies
			 delivered or issued for delivery in this state on or after the effective date
			 hereof, and
(2) All certificates
			 issued under group Medicare supplement policies which certificates have been
			 delivered or issued for delivery in this state on or after the effective date
			 hereof.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-2 - Definitions

Current through July 10, 2024
As used in sections
				38a-495a-1
				to
				38a-495a-20,
				inclusive, of the Regulations of Connecticut State Agencies:
(1)"Applicant" means:
(A) In the case of an individual Medicare
			 supplement policy, the person who seeks to contract for insurance benefits;
			 and
(B) In the case of a group
			 Medicare supplement policy, the proposed certificate holder.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-3 - Policy definitions and terms

Current through July 10, 2024
No policy or certificate may be advertised, solicited or issued
				for delivery in this state as a Medicare supplement policy or certificate
				unless such policy or certificate contains definitions or terms which conform
				to the requirements of this section.
(a) "Accident," "Accidental Injury," or
			 "Accidental Means" shall be defined to employ "result" language and shall not
			 include words which establish an accidental means test or use words such as
			 "external, violent, visible wounds" or similar words of description or
			 characterization.
(1) The definition shall not
			 be more restrictive than the following: "Injury or injuries for which benefits
			 are provided means accidental bodily injury sustained by the insured person
			 which is the direct result of an accident, independent of disease or bodily
			 infirmity or any other cause, and occurs while insurance coverage is in
			 force."
(2) Such definition may
			 provide that injuries shall not include injuries for which benefits are
			 provided or available under any workers' compensation, employer's liability or
			 similar law, or motor vehicle no-fault plan, unless prohibited by
			 law.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-4 - Policy provisions

Current through July 10, 2024
(a) Except for
			 permitted preexisting condition clauses as described in sections 38a-495a-4
			 a(a)(1), 38a-495a-5(a) (1), and 38a-495a-5a(a)(1) of the Regulations of
			 Connecticut State Agencies, no policy or certificate may be advertised,
			 solicited or issued for delivery in this state as a Medicare supplement policy
			 if such policy or certificate contains limitations or exclusions on coverage
			 that are more restrictive than those of Medicare.
(b) No Medicare supplement policy or
			 certificate may use waivers to exclude, limit or reduce coverage or benefits
			 for specifically named or described preexisting diseases or physical
			 conditions.
(c) No Medicare
			 supplement policy or certificate in force in the state shall contain benefits
			 which duplicate benefits provided by Medicare.
(d)
(1)
			 Subject to sections
			 38a-495a-5(a)(4),
			 38a-495a-5(a)(5)
			 and
			 38a-495a-5(a)(7)
			 of the Regulations of Connecticut State Agencies, a Medicare supplement policy
			 with benefits for outpatient prescription drugs in existence as of December 31,
			 2005 shall be renewed for current policyholders who do not enroll in Medicare
			 Part D at the option of the policyholder.
(2) A Medicare supplement policy with
			 benefits for outpatient prescription drugs shall not be issued after December
			 31, 2005.
(3) After December 31,
			 2005, a Medicare Supplement policy with benefits for outpatient prescription
			 drugs may not be renewed after the policyholder enrolls in Medicare Part D
			 unless:
(A) The policy is modified to
			 eliminate outpatient prescription coverage for expenses of outpatient
			 prescription drugs incurred after the effective date of the individual's
			 coverage under a Medicare Part D plan; and
(B) Premiums are adjusted to reflect the
			 elimination of outpatient prescription drug coverage at the time of Medicare
			 Part D enrollment, accounting for any claims paid, if applicable.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-6a - Standard Medicare supplement benefit plans for 2010 standardized Medicare supplement benefit plan policies or certificates with an effective date for coverage on or after June 1, 2010

Current through July 10, 2024
(a) The following
			 standards are applicable to all Medicare supplement policies or certificates
			 delivered or issued for delivery in this state with an effective date for
			 coverage on or after June 1, 2010. No policy or certificate may be advertised,
			 solicited, delivered or issued for delivery in this state as a Medicare
			 supplement policy or certificate on or after June 1, 2010 unless it complies
			 with these benefit plan standards. Benefit plan standards applicable to
			 Medicare supplement policies and certificates with an effective date for
			 coverage on or after July 30, 1992, and before June 1, 2010, remain subject to
			 the requirements of sections
			 38a-495a-5
			 and
			 38a-495a-6
			 of the Regulations of Connecticut State Agencies.
(1)
(A) An
			 issuer shall make available to each prospective policyholder and
			 certificateholder a policy form or certificate form containing only the basic
			 core benefits, as defined in section
			 38a-495a-5
			 a of the Regulations of Connecticut State Agencies.
(B) If an issuer makes available any of the
			 additional benefits set forth in section
			 38a-495a-5
			 a(c) of the Regulations of Connecticut State Agencies or offers standardized
			 benefit plan K or L as set forth in this section, the issuer shall also make
			 available to each prospective policyholder and certificateholder standardized
			 benefit plan C or F, as set forth in this section, in addition to the basic
			 core benefit plan required under subparagraph (A) of this
			 subdivision.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-7 - Medicare select policies and certificates

Current through July 10, 2024
(a)
(1) This section shall apply to Medicare
			 Select policies and certificates, as defined in this section.
(2) No policy or certificate may be
			 advertised as a Medicare Select policy or certificate unless it meets the
			 requirements of this section.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-8 - Open enrollment

Current through July 10, 2024
(a) No issuer shall
			 deny or condition the issuance or effectiveness of any Medicare supplement
			 policy or certificate available for sale in this state, nor discriminate in the
			 pricing of such a policy or certificate because of the health status, claims
			 experience, receipt of health care, or medical condition of an applicant in the
			 case of an application for a policy or certificate that is submitted prior to
			 or during the six (6) month period beginning with the first day of the first
			 month in which an individual is both 65 years of age or older and is enrolled
			 for benefits under Medicare Part B. Each Medicare supplement policy and
			 certificate currently available from an issuer shall be made available to all
			 applicants who qualify under this subsection without regard to age.
(b)
(1) If
			 an applicant qualifies under subsection (a) of this section and submits an
			 application during the time period referenced in subsection (a) and, as of the
			 date of application, has had a continuous period of creditable coverage of at
			 least six (6) months, the issuer shall not exclude benefits based on a
			 preexisting condition.
(2) If the
			 applicant qualifies under subsection (a) of this section and submits an
			 application during the time period referenced in subsection (a) and, as of the
			 date of application, has had a continuous period of creditable coverage that is
			 less than six (6) months, the issuer shall reduce the period of any preexisting
			 condition exclusion by the aggregate of the period of creditable coverage
			 applicable to the applicant as of the enrollment date. The secretary shall
			 specify the manner of the reduction under this subsection.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-8a - Guaranteed issue for eligible persons

Current through July 10, 2024
(a)
Guaranteed Issue
(1) Eligible
			 persons are those individuals described in subsection (b) of this section who
			 seek to enroll under the policy during the period specified in subsection (c)
			 of this section, and who submit evidence of the date of termination,
			 disenrollment, or Medicare Part D enrollment with the application for a
			 Medicare supplement policy.
(2)
			 With respect to eligible persons, an issuer shall not deny or condition the
			 issuance or effectiveness of a Medicare supplement policy described in
			 subsection (e) of this section that is offered and is available for issuance to
			 new enrollees by the issuer, shall not discriminate in the pricing of such a
			 Medicare supplement policy because of health status, claims experience, receipt
			 of health care, or medical condition, and shall not impose an exclusion of
			 benefits based on a preexisting condition under such a Medicare supplement
			 policy.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-9 - Standards for claims payment

Current through July 10, 2024
(a) An issuer shall
			 comply with section 1882(c) (3) of the Social Security Act (as enacted by
			 section 4081(b) (2) (C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA)
			 1987, Pub. L. No. 100-203 ) by:
(1) Accepting a notice from a Medicare
			 carrier on dually assigned claims submitted by participating physicians and
			 suppliers as a claim for benefits in place of any other claim form otherwise
			 required and making a payment determination on the basis of the information
			 contained in that notice;
(2)
			 Notifying the participating physician or supplier and the beneficiary of the
			 payment determination;
(3) Paying
			 the participating physician or supplier directly;
(4) Furnishing, at the time of enrollment,
			 each enrollee with a card listing the policy name, number and a central mailing
			 address to which notices from a Medicare carrier may be sent;
(5) Paying user fees for claim notices that
			 are transmitted electronically or otherwise; and
(6) Providing to the secretary, at least
			 annually, a central mailing address to which all claims may be sent by Medicare
			 carriers.