reglab/statecodes huggingface dataset:
Connecticut Administrative Code › Title 38a - Insurance Department › 465 - Viatical Settlements › Section 38a-465-3 - Verification of license status of providers

Current through July 10, 2024
Each licensed broker shall file on or before March 1 of each
				year, a notarized statement, signed under oath or affirmation, verifying that
				each provider from which such broker receives a commission or other payment or
				benefit is licensed in the State of Connecticut.
Connecticut Administrative Code › Title 38a - Insurance Department › 465 - Viatical Settlements › Section 38a-465-4 - Confidentiality of identity of insured's information

Current through July 10, 2024
Except as otherwise permitted under Section
				38a-465d
				of the Connecticut General Statutes:
(a) No person may submit the report required
			 by Section
			 38a-465-2
			 in such a manner as would identify any insured except with the express written
			 consent of such insured or the insured's estate or representative;
(b) A life insurance producer, broker or
			 provider shall not provide patient identifying information to any person,
			 unless the owner and the insured provide written consent to the release of the
			 information at or before the time of the settlement transaction.
Connecticut Administrative Code › Title 38a - Insurance Department › 465 - Viatical Settlements › Section 38a-465-5 - Evaluation standards for reasonable payments

Current through July 10, 2024
(a) A broker or
			 provider shall not enter into a life settlement contract that provides payment
			 to the owner that is unreasonable, unjust or inequitable. In determining
			 whether a payment is unreasonable, unjust or inequitable, the Commissioner may
			 consider, among other factors, the life expectancy of the insured, the
			 applicable rating of the insurance company that issued the subject policy by a
			 rating service generally recognized by the insurance industry, regulators and
			 consumer groups and the prevailing discount rates in the life settlement
			 contract market in Connecticut, or if sufficient data is unavailable for
			 Connecticut, the prevailing discount rates nationally or in other states that
			 maintain this data; and
(b) A
			 provider shall not use a longer life expectancy than is realistic in order to
			 reduce the payout to which the owner is entitled.
Connecticut Administrative Code › Title 38a - Insurance Department › 465 - Viatical Settlements › Section 38a-465-6 - Amounts payable to owner

Current through July 10, 2024
(a) Payment of the
			 proceeds of a life settlement contract shall be made by means of wire transfer
			 to the account of the owner or by certified check or cashier's check.
(b) Payment of the proceeds to the owner
			 pursuant to a life settlement contract shall be made in a lump sum except where
			 the provider has purchased an annuity or similar financial instrument issued by
			 a licensed insurance company or bank, or an affiliate of either. Retention of a
			 portion of the proceeds by the provider or escrow agents is not
			 permissible.
Connecticut Administrative Code › Title 38a - Insurance Department › 465 - Viatical Settlements › Section 38a-465-7 - Prohibited practices

Current through July 10, 2024
(a) A life
			 insurance producer, broker or provider shall not discriminate in the creation
			 or solicitation of a life settlement contract on the basis of race, color, age,
			 sex, national origin, ancestry, creed, religion, occupation, marital or family
			 status, sexual orientation, gender identity or expression, or based on whether
			 the insured has children.
(b) A
			 life insurance producer, broker or provider shall not pay or offer to pay any
			 finder's fee commission or other compensation to any:
(1) insured's physician, attorney,
			 accountant, or any other person providing financial planning services, legal
			 services or medical services to the insured, or to any other person acting as
			 an agent of the insured with respect to the life settlement contract
			 transaction; and
(2) owner's
			 attorney, accountant or any other person providing financial planning services
			 or legal services to the owner, or to any other person acting as an agent of
			 the owner with respect to the life settlement contract transaction.
Connecticut Administrative Code › Title 38a - Insurance Department › 465 - Viatical Settlements › Section 38a-465-8 - Advertising practices

Current through July 10, 2024
(a) Advertising
			 related to the life settlement contract shall be truthful and not misleading by
			 fact or implication.
(b) If the
			 advertiser references the speed with which the settlement will occur, the
			 advertising shall disclose the average time frame from completed application to
			 the date of offer and from acceptance of the offer to receipt of the funds by
			 the owner.
(c) If the advertising
			 references the dollar amounts available to owners, the advertising shall
			 disclose the average purchase price as a percentage of face value obtained by
			 owners contracting with the advertiser during the past six (6)
			 months.
Connecticut Administrative Code › Title 38a - Insurance Department › 465 - Viatical Settlements › Section 38a-465-9 - Interest retained by owner

Current through July 10, 2024
(a) If a provider
			 enters a life settlement contract that allows the owner to retain an interest
			 in the policy, the life settlement contract shall contain the following
			 provisions:
(1) A provision that the provider
			 will effect the transfer of the amount of the death benefit only to the extent
			 or portion of the amount settled. Benefits in excess of the amount settled
			 shall be paid directly to the owner or the owner's beneficiary by the insurance
			 company;
(2) a provision that the
			 provider will, upon acknowledgment of the perfection of the transfer, either
(A) advise the insured, in writing that the
			 insurance company has confirmed the owner's interest in the policy or
(B) send a copy of the instrument sent from
			 the insurance company to the provider that acknowledges the owner's interest in
			 the policy; and
(3) a
			 provision that apportions the premiums to be paid by the provider and the
			 owner. It is permissible for the life settlement contract to specify that all
			 premiums shall be paid by the provider. The contract may also require that the
			 owner reimburse the provider for the premiums attributable to the retained
			 interest.
Connecticut Administrative Code › Title 38a - Insurance Department › 465 - Viatical Settlements › Section 38a-465-10 - Disclosure requirements

Current through July 10, 2024
A disclosure document containing the disclosures required in
				section
				38a-465f of
				the Connecticut General Statutes and sections
				38a-465-2
				to 38a-465-10, inclusive, of the Regulations of Connecticut State Agencies
				shall be provided before or concurrent with taking an application for a life
				settlement contract.
Connecticut Administrative Code › Title 38a - Insurance Department › 472f - Network Adequacy › Section 38a-472f-1 - Policy Definitions

Current through July 10, 2024
For purposes of sections 38a-472f-2 to 38a-472f-5, inclusive,
				of the Regulations of Connecticut State Agencies:
(1) "Ancillary service" means a health care
			 service that is not provided as part of an office visit, outpatient procedure
			 or hospital admission, but for which a patient presents at a separate facility
			 or site of service.
(2) "Primary
			 care physician" means a participating health care provider designated by a
			 health carrier to supervise, coordinate or provide initial health care services
			 or continuing health care services to a covered person, and who may be required
			 by the health carrier to initiate a referral for specialty care and maintain
			 supervision of health care services provided to the covered person.
(3)
(A)
			 "Specialist" means a health care provider who (i) focuses on a specific area of
			 physical, mental or behavioral health or a specific group of patients, and (ii)
			 has successfully completed required training and is recognized by this state to
			 provide specialty care.
(B)
			 "Specialist" includes a subspecialist who has additional training and
			 recognition beyond that required for a specialist.
Connecticut Administrative Code › Title 38a - Insurance Department › 472f - Network Adequacy › Section 38a-472f-2 - Health insurance carrier standards and responsibilities

Current through July 10, 2024
Each health carrier that delivers, issues for delivery, renews,
				amends or continues any individual or group health insurance policy or
				certificate in this state that uses a provider network shall:
(1) Contract with the appropriate type and
			 number of health care providers to ensure that each person covered by such
			 health carrier under such a plan or certificate has reasonable access to
			 participating providers located near such covered person's place of residence
			 or employment. Reasonable access includes maintaining a sufficient number and
			 appropriate types of participating providers that predominately serve, without
			 unreasonable travel or delay:
(A) Low income
			 individuals;
(B) Medically
			 underserved individuals;
(C)
			 Individuals with serious, chronic or complex illnesses; and
(D) Individuals with physical or mental
			 disabilities.
Connecticut Administrative Code › Title 38a - Insurance Department › 472f - Network Adequacy › Section 38a-472f-3 - Minimum Standards for Network Adequacy

Current through July 10, 2024
(a) Each health
			 carrier that delivers, issues for delivery, renews, amends or continues any
			 individual or group health insurance policy or certificate in this state that
			 uses a provider network shall:
(1) Establish
			 and monitor the provider network to ensure that a person covered under the
			 policy or certificate has access to health care services within the maximum
			 time and distance standards.
(2)
			 Ensure that the provider network has at least one primary care physician per
			 two thousand (2,000) covered persons.
(3) Ensure that the percentage of providers
			 participating in the network that accept new patients is at least seventy
			 percent (70%).
(4) Establish
			 reasonable wait times for access to primary care, urgent care, specialist care,
			 mental health, ancillary services and any other categories of service, and
			 monitor provider compliance with the requirements established pursuant to this
			 subdivision.
(5) Demonstrate a good
			 faith effort to contract with centers of excellence, mobile clinics, walk-in
			 clinics, urgent care facilities and providers of technological or specialty
			 care services, to the extent available.
(6) Have an adequate process in place to
			 provide in-network levels of coverage from nonparticipating providers, without
			 unreasonable travel or delay or unreasonable wait time for an appointment, when
			 a participating provider is not available.
(7) Demonstrate a good faith effort to
			 contract with hospital-based providers.
(8) Ensure that covered persons:
(A) Have access to emergency services, as
			 defined in section 38a-477aa of the Connecticut General Statutes, twenty-four
			 (24) hours a day, seven (7) days a week.
(B) Have reasonable access to participating
			 providers within normal business hours.
(9) Ensure that participating providers shall
			 have admitting rights to at least one participating hospital, where
			 appropriate.
Connecticut Administrative Code › Title 38a - Insurance Department › 472f - Network Adequacy › Section 38a-472f-4 - Minimum Standards for Provider Directories

Current through July 10, 2024
Each health carrier that delivers, issues for delivery, renews,
				amends or continues any individual or group health insurance policy or
				certificate in this state that uses a provider network shall:
(1) Post an on-line provider directory in
			 searchable format for each provider network that is made available in the
			 state;
(2) Clearly label the
			 provider network so it may be linked to a specific plan offered;
(3) Update the on-line provider directory no
			 less than monthly;
(4) Make the
			 provider directory accessible to both members and non-members;
(5) State the date the provider directory was
			 last updated;
(6) Make a hard copy
			 of the provider directory, that is updated no less than annually, available
			 upon request;
(7) Provide an e-mail
			 address and telephone number to report inaccurate information;
(8) Indicate whether each participating
			 provider listed in the provider directory accepts new patients, and whether
			 such health care provider is accepting new patients on an outpatient services
			 basis;
(9) Indicate the languages
			 spoken in each participating provider's office or facility;
(10) Indicate whether each participating
			 provider's office or facility is handicapped accessible;
(11) Indicate the participating providers for
			 each different tier of benefits, if applicable;
(12) Establish and maintain an audit process
			 to ensure accuracy of provider directories;
(13) Ensure the provider directory
			 accommodates the communication needs of individuals with disabilities or
			 limited English proficiency and provides information on how to receive
			 assistance;
(14) Provide by type,
			 for participating facilities other than hospitals, the facility name, the type,
			 the types of health care services performed at the facility and the facility's
			 location and telephone number;
(15)
			 Provide, for each participating facility that is a hospital, the hospital name,
			 the type (such as acute, rehabilitation, children's or cancer), location and
			 telephone number;
(16) Provide, for
			 each participating health care provider, the health care provider's name,
			 contact information, specialty (if applicable) and participating office
			 location or locations;
(17)
			 Indicate whether participating health care providers are authorized to admit
			 patients to hospitals participating in the network; and
(18) Indicate whether hospital-based health
			 care providers are participating providers and see patients on an outpatient
			 service basis.
Connecticut Administrative Code › Title 38a - Insurance Department › 472f - Network Adequacy › Section 38a-472f-5 - Annual Filing Requirements

Current through July 10, 2024
Each health carrier that delivers, issues for delivery, renews,
				amends or continues any individual or group health insurance policy or
				certificate in this state that uses a provider network shall submit an annual
				report, in the form of a survey response, to the Commissioner regarding the
				adequacy of the network. Each health carrier shall submit a separate report for
				each provider network used by the health carrier, and each report shall be in a
				form prescribed by the commissioner. The commissioner shall provide at least
				sixty (60) days' advance notice to a health carrier of the due date of the
				report required by this section.
Connecticut Administrative Code › Title 38a - Insurance Department › 472f - Network Adequacy › Section 38a-472f-6 - Separability

Current through July 10, 2024
If any provision of sections 38a-472f-1 to 38a-472f-5,
				inclusive, of the Regulations of Connecticut State Agencies or the application
				thereof to any person or circumstances, is for any reason held to be invalid,
				the remainder of said sections, and the application of such provision to other
				persons or circumstances shall not be affected thereby.
Connecticut Administrative Code › Title 38a - Insurance Department › 474 - Submission and Review of Rates for Medicare Supplement Insurance › Section 38a-474-1 - Definitions

Current through July 10, 2024
As used in Sections 38a-474-1 to
				38a-474-4,
				inclusive, of the regulations of Connecticut state agencies:
(1) "Commissioner" means the Insurance
			 Commissioner.
(2) "Insurer" means
			 insurance company, fraternal benefit society, hospital service corporation,
			 medical service corporation, or health care center.
(3) "Medicare supplement policy" means any
			 Medicare supplement policy or certificate, as defined in Sections
			 38a-495,
			 38a-495a
			 and
			 38a-522
			 of the general statutes, delivered, issued for delivery, continued or renewed
			 in this state on or after October 1, 1990 by any insurer.
Connecticut Administrative Code › Title 38a - Insurance Department › 474 - Submission and Review of Rates for Medicare Supplement Insurance › Section 38a-474-2a - Electronic filing

Current through July 10, 2024
(a) Any insurer
			 filing rates with the commissioner in accordance with section
			 38a-474-2
			 of the Regulations of Connecticut State Agencies may submit such filing
			 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-474-2
			 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 › 474 - Submission and Review of Rates for Medicare Supplement Insurance › Section 38a-474-3 - Rate review standards

Current through July 10, 2024
(a) The
			 commissioner shall not approve a rate for a Medicare supplement policy that is
			 excessive, inadequate, unreasonable in relation to the benefits provided or
			 unfairly discriminatory.
(b) Rates
			 for Medicare supplement policy or certificate forms shall not be approved
			 unless the form can be expected, as estimated for the entire period for which
			 rates are computed to provide coverage, to return to policyholders or
			 certificate holders in the form of aggregate benefits (not including
			 anticipated refunds or credits) provided under the policy form or certificate
			 form:
(1) at least seventy-five (75%) of the
			 aggregate amount of premiums earned in the case of group policies, or
(2) at least sixty-five percent (65%) of the
			 aggregate amount of premiums earned in the case of individual policies,
			 calculated on the basis of incurred claims experience, or incurred health care
			 expenses where coverage is provided by a health care center, and earned
			 premiums for such period and in accordance with accepted actuarial principles
			 and practices. All rate filings shall demonstrate that expected claims in
			 relation to premiums comply with these loss ratio requirements 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 appropriate required loss ratio.
Connecticut Administrative Code › Title 38a - Insurance Department › 474 - Submission and Review of Rates for Medicare Supplement Insurance › Section 38a-474-4 - Separability

Current through July 10, 2024
If any provision of sections
				38a-474-1 to
				38a-474-3,
				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 this regulation and the application of such provision to other
				persons or circumstances shall not be affected thereby.
Connecticut Administrative Code › Title 38a - Insurance Department › 475 - Connecticut Partnership For Long Term Care › Section 38a-475-1 - Applicability and scope

Current through July 10, 2024
Sections 38a-475-1 to
				38a-475-6,
				inclusive, apply to any long-term care insurance policy or certificate form
				which the insurance department is requested to precertify in accordance with
				section
				38a-475
				of the general statutes.
Connecticut Administrative Code › Title 38a - Insurance Department › 475 - Connecticut Partnership For Long Term Care › Section 38a-475-3 - Partnership-approval of long-term care policies

Current through July 10, 2024
No long-term care insurance policy shall be precertified as
				partnership-approved for purposes of the Connecticut Partnership for Long-Term
				Care, unless the requirements of sections
				38a-475-1
				to
				38a-475-6,
				inclusive, of the regulations of Connecticut state agencies are complied
				with.
Connecticut Administrative Code › Title 38a - Insurance Department › 475 - Connecticut Partnership For Long Term Care › Section 38a-475-6 - Separability

Current through July 10, 2024
If any provision of sections
				38a-475-1
				to 38a-475-6, inclusive, or the application thereof to any person or
				circumstance is for any reason held to be invalid, the remainder of these
				regulations and the application of such provision to other persons or
				circumstances shall not be affected thereby.
Connecticut Administrative Code › Title 38a - Insurance Department › 478u - Managed Care › Section 38a-478u-1 - Applicability and scope

Current through July 10, 2024
Nothing in Sections 38a-478u-1 to
				38a-478u-7,
				inclusive, shall be construed to apply to the arrangements of managed care
				organizations offered to individuals covered under self-insured employee
				welfare benefit plans established pursuant to the federal Employee Retirement
				Income Security Act of 1974, or to any plan providing health care solely for
				workers' compensation benefits.
Connecticut Administrative Code › Title 38a - Insurance Department › 478u - Managed Care › Section 38a-478u-2 - Definitions

Current through July 10, 2024
As used in Sections
				38a-478u-1
				to
				38a-478u-7,
				inclusive, of the Regulations of
Connecticut State Agencies:
(1) "Commissioner" means the Insurance
			 Commissioner of the State of Connecticut;
(2) "Enrollee" means a person who has
			 contracted for or who participates in a managed care plan for himself or his
			 eligible dependents who participate in a managed care plan;
(3) "Managed care organization" means
			 "managed care organization" as defined in Section
			 38a-478 of the
			 Connecticut General Statutes;
(4)
			 "Managed care plan" means "managed care plan" as defined in Section
			 38a-478 of the
			 Connecticut General Statutes;
(5)
			 "Provider" means "provider" as defined in Section
			 38a-478 of the
			 Connecticut General Statutes; and
(6) "Utilization review" means "utilization
			 review" as defined in Section
			 38a-591a of the
			 Connecticut General Statutes.
Connecticut Administrative Code › Title 38a - Insurance Department › 478u - Managed Care › Section 38a-478u-3 - Annual filing requirements

Current through July 10, 2024
Each managed care organization shall file annually the
				information specified below.
(1)
			 Quality Assurance Reports
(A) A summary report
			 on its quality assurance plan inclusive of, but not limited to, information on
			 complaints relating to providers and quality of care, decisions related to
			 patient requests for coverage and prior authorization statistics. All
			 information provided shall be as of the prior calendar year and shall pertain
			 to Connecticut business only. In order for the statistical information to be
			 provided in a manner permitting comparison across plans, each managed care
			 organization shall be required to complete a form provided by the Insurance
			 Department.
(B) Where Health Plan
			 Employer Data and Information Set (HEDIS) data is required for the summary
			 report, managed care organizations who do not provide HEDIS information to the
			 National Committee for Quality Assurance shall have provided equivalent data
			 upon submission of a completed consumer report card survey as required by
			 subsection (2).
Connecticut Administrative Code › Title 38a - Insurance Department › 478u - Managed Care › Section 38a-478u-5 - Medical loss ratio

Current through July 10, 2024
For the purposes of reporting and disclosure in accordance with
				Sections 4 and 8 of Public Act 97-99 as amended by Public Act 97-8, June 18
				Special Session, "medical loss ratio" means the ratio of incurred claims to
				earned premium for the prior calendar year for managed care plans issued in
				Connecticut. Claims shall be limited to medical expenses for services and
				supplies provided to enrollees and shall not include expenses for stop loss,
				reinsurance, enrollee educational programs or other cost containment programs
				or features.
Connecticut Administrative Code › Title 38a - Insurance Department › 478u - Managed Care › Section 38a-478u-6 - Prior certification

Current through July 10, 2024
Each managed care plan that requires preauthorization
				procedures may require enrollees to obtain prior certification or
				preauthorization for covered services provided (1) such services are clearly
				identified in the policy or certificate, and (2) the maximum penalty assessed
				to the enrollee if the enrollee fails to obtain the required prior
				certification or preauthorization for services ultimately determined to be
				medically necessary is limited to the lesser of five hundred dollars or fifty
				percent of the scheduled benefit in the policy or
				certificate.
Connecticut Administrative Code › Title 38a - Insurance Department › 478u - Managed Care › Section 38a-478u-7 - Separability

Current through July 10, 2024
If any provision of sections
				38a-478u-1
				to 38a-478u-7, 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 sections
				38a-478u-1
				to 38a-478u-7, inclusive, of the Regulations of Connecticut State Agencies, and
				the application of such provision to other persons or circumstances shall not
				be affected thereby.
Connecticut Administrative Code › Title 38a - Insurance Department › 479aaa - Requirements for Pharmacy Benefits Managers Applying for a Certificate of Registration to do Business in the State of Connecticut › Section 38a-479aaa-1 - Definitions

Current through July 10, 2024
As used in section 38a-479aaa-1 to Section 38a-479aaa-5,
				inclusive, of the Regulations of Connecticut State Agencies:
(1) "Commissioner" means the Insurance
			 Commissioner;
(2) "Material
			 modification" means a change in the information provided under section
			 38a-479aaa-3(a)(1)(A) through (G), inclusive, and under section
			 38a-479aaa-3(a)(2)(D) of the Regulations of Connecticut State
			 Agencies;
(3) "Person" means
			 person, as defined in section
			 38a-1
			 of the general statutes;
(4)
			 "Pharmacy benefits manager" means a person as defined in section
			 38a-479aaa
			 of the Connecticut General Statutes.
Connecticut Administrative Code › Title 38a - Insurance Department › 479aaa - Requirements for Pharmacy Benefits Managers Applying for a Certificate of Registration to do Business in the State of Connecticut › Section 38a-479aaa-2 - Timing of application and registration

Current through July 10, 2024
(a) Each person
			 acting as a pharmacy benefits manager on January 1, 2008 shall obtain a
			 certificate of registration from the commissioner on or before April 1, 2008,
			 after completion of an application form containing the information described in
			 section 38a-479aaa-3 of the Regulations of Connecticut State Agencies and
			 approval of the application by the commissioner. All certificates of
			 registration shall expire annually on December 31st
			 of each year. A pharmacy benefits manager that continues to do business in the
			 State after January 1, 2008 shall renew its certificate of registration
			 annually and submit a renewal application to the commissioner by November first
			 annually for a January first effective date of renewal of the certificate of
			 registration.
(b) A person seeking
			 to commence activity as a pharmacy benefits manager in the state after January
			 1, 2008, shall first apply for, and receive, a certificate of registration from
			 the commissioner as a pharmacy benefits manager, before commencing such
			 activity. Upon receipt of a certificate of registration, such person may
			 perform the business of a pharmacy benefits manager from the effective date of
			 the certificate of registration through December 31 of that year. Thereafter,
			 the pharmacy benefits manager shall renew its certificate of registration on an
			 annual basis as set forth in subsection (a) of this section.
Connecticut Administrative Code › Title 38a - Insurance Department › 479aaa - Requirements for Pharmacy Benefits Managers Applying for a Certificate of Registration to do Business in the State of Connecticut › Section 38a-479aaa-3 - Contents of application

Current through July 10, 2024
(a) The filing
			 required from a pharmacy benefits manager shall include the following
			 information:
(1) The identity of the pharmacy
			 benefits manager and any company or organization controlling the operation of
			 the pharmacy benefits manager, including the name, business address, and
			 contact person, for the pharmacy benefits manager and the controlling entity,
			 and, where applicable, the following:
(A) a
			 certificate from the Secretary of the State regarding the pharmacy benefits
			 manager's and the controlling company's or organization's, if applicable, good
			 standing to do business in the state;
(B) the name, address, official position and
			 professional qualifications of each individual responsible for the conduct of
			 the affairs of the pharmacy benefits manager, including all members of the
			 board of directors, board of trustees, executive committee, other governing
			 board or committee, the principal officers in the case of a corporation, the
			 partners or members in the case of a partnership or association, and any other
			 person who exercises control or influence over the affairs of the pharmacy
			 benefits manager;
(C) the name,
			 address, official position and professional qualifications of each individual
			 who is a member of the controlling company's or organization's board of
			 directors or other policy-making body and of those executive officers who are
			 responsible for the controlling company's or organization's activities with
			 respect to the pharmacy benefits services;
(D) a list of the pharmacy benefits manager's
			 principal owners;
(E) in the case
			 of an out-of-state pharmacy benefit manager, controlling company or
			 organization, a certificate that such pharmacy benefits manager, company, or
			 organization is in good standing in its state of organization;
(F) a report of the details of any
			 suspension, sanction or other disciplinary action relating to the pharmacy
			 benefits manager, or controlling company or organization, in this state or in
			 any other state; and
(G) the name
			 and address of the agent for service of process for the pharmacy benefits
			 manager in the state.
Connecticut Administrative Code › Title 38a - Insurance Department › 479aaa - Requirements for Pharmacy Benefits Managers Applying for a Certificate of Registration to do Business in the State of Connecticut › Section 38a-479aaa-4 - Contents of exemption form

Current through July 10, 2024
A pharmacy benefits manager seeking exemption from registration
				pursuant to section
				38a-479bbb
				of the Connecticut General Statutes shall notify the commissioner and include
				the following information in the notification:
(1) the name and address of the pharmacy
			 benefits manager, including the name, address, phone number, and email address
			 of a contact person at the pharmacy benefits manager;
(2) the name and address of the health
			 insurer, health care center, hospital service corporation, medical service
			 corporation, or fraternal benefit society for which entity the pharmacy
			 benefits manager is operating as a line of business or is an affiliate, and the
			 name, address, phone number, and email address of a contact person at such
			 entity; and
(3) certification by
			 the Chief Executive Officer of the health insurer, health care center, hospital
			 service corporation, medical service corporation, or fraternal benefit society
			 that the pharmacy benefits manager is operating as a line of business under, or
			 affiliate or subsidiary of, such entity.
Connecticut Administrative Code › Title 38a - Insurance Department › 479aaa - Requirements for Pharmacy Benefits Managers Applying for a Certificate of Registration to do Business in the State of Connecticut › Section 38a-479aaa-5 - Timing of exemption request

Current through July 10, 2024
(a) For pharmacy
			 benefits managers doing business on January 1, 2008, as set forth in subsection
			 (d) of section
			 38a-479bbb
			 of the Connecticut General Statutes, the health insurer, health care center,
			 hospital service corporation, medical service corporation, or fraternal benefit
			 society shall make the filing described in section 38a-479aaa-4 of the
			 Regulations of Connecticut State Agencies before April 1, 2008, and thereafter
			 prior to January 1 of each subsequent year, for so long as the pharmacy
			 benefits manager continues to do business in the state, and for so long as the
			 pharmacy benefits manager remains a line of business of, or affiliate or
			 subsidiary of, the entity filing for exemption.
(b) For pharmacy benefits managers commencing
			 business after January 1, 2008, the entity claiming exemption shall file an
			 exemption form as set forth in section 38a-479aaa-4 of the Regulations of
			 Connecticut State Agencies before commencing business in the state, and
			 thereafter prior to January 1st of each subsequent year, under the
			 circumstances set forth in subsection (a) of this section.
Connecticut Administrative Code › Title 38a - Insurance Department › 480 - Coordination of Benefits › Section 38a-480-1 - Purpose and scope

Current through July 10, 2024
(a)
Purpose.
The purpose of this regulation is to adopt a group
			 coordination of benefits regulation. This regulation is intended to establish
			 uniformity in the permissive use of overinsurance provisions and to avoid claim
			 delays and misunderstandings that could otherwise result from the use of
			 inconsistent or incompatible provisions among plans.
(b)
Coordination of Benefits.
A
			 Coordination of Benefits (COB) provision is one that is intended to avoid
			 claims payment delays and duplication of benefits when a person is covered by
			 two or more Plans providing benefits or services for medical, dental or other
			 care or treatment. It avoids claims payment delays by establishing an order in
			 which Plans pay their claims and providing the authority for the orderly
			 transfer of information needed to pay claims promptly. It avoids duplication of
			 benefits by permitting a reduction of the benefits of a Plan when, by the rules
			 established by this regulation, it does not have to pay its benefits
			 first.
Connecticut Administrative Code › Title 38a - Insurance Department › 480 - Coordination of Benefits › Section 38a-480-2 - Applicability

Current through July 10, 2024
(a)
Coordination Permissive.
This regulation permits, but does not require, Plans to include COB
			 provisions.
(b)
Consistency
			 with this Regulation.
If a group contract includes a COB provision, it
			 must be consistent with this regulation. A Plan that does not include such a
			 provision may not take the benefits of another Plan as defined in Section
			 38a-480-3 Definitions
			 into account when it determines its benefits. There is one exception: a
			 contract holder's coverage that is designed to supplement a part of a basic
			 package of benefits may provide that the supplementary coverage shall be excess
			 to any other parts of the plan provided by the contract holder.
Connecticut Administrative Code › Title 38a - Insurance Department › 480 - Coordination of Benefits › Section 38a-480-4 - COB contract provision

Current through July 10, 2024
(a)
General.
Subsection
			 38a-480-4(d)
			 contains a COB Provision for use in group contracts. That use is subject to the
			 provision of subsections
			 38a-480-4(b)
			 and
			 38a-480-4(c)
			 and to the provisions of Section
			 38a-480-3,
			 Definitions, and Section
			 38a-480-5,
			 Rules for Coordination of Benefits. The bracketed references in the COB
			 Provision to those rules are not to be included in a group contract.
(b)
Flexibility.
A group
			 contract's COB provision does not have to use the words and format shown in
			 this regulation. Changes may be made to fit the language and style of the rest
			 of the group contract or to reflect the difference among Plans:
(1) which provides services;
(2) which pay benefits for expenses incurred;
			 and
(3) which indemnify.
Substantive changes are allowed only as set forth in this
				regulation.
Connecticut Administrative Code › Title 38a - Insurance Department › 480 - Coordination of Benefits › Section 38a-480-5 - Rules for coordination of benefits

Current through July 10, 2024
(a)
Order of
			 Benefits
.
(1) General.
(A) The Primary Plan must pay or provide its
			 benefits as if the Secondary Plan or Plans did not exist.
(B) A Secondary Plan may take the benefits of
			 another Plan into account only when, under these rules, it is Secondary to that
			 other Plan.
(Reference: subsections
				38a-480-4(c)
				and
				38a-480-4(d)
				(2) (C) above.)
Connecticut Administrative Code › Title 38a - Insurance Department › 480 - Coordination of Benefits › Section 38a-480-6 - Effect on mandated benefits; spouse coverage

Current through July 10, 2024
(a)
Mandated Benefits.
Nothing in this regulation may be used so as to
			 diminish the benefits due under a Primary Plan or Secondary Plan with regard to
			 benefits that are mandated by any statute or public act of the State of
			 Connecticut.
(b)
Spouse
			 Coverage.
Nothing in this regulation may be used to negate the
			 provisions of Connecticut General Statutes Section
			 38a-541.
Connecticut Administrative Code › Title 38a - Insurance Department › 480 - Coordination of Benefits › Section 38a-480-7 - Effective date; existing contracts

Current through July 10, 2024
This regulation takes effect on April 1, 1988.
It applies to every group contract which provides health care
				benefits and is issued on or after that date.
A group contract which provides health care benefits and was
				issued before that date shall be brought into compliance with this regulation
				by the later of:
(a) the next
			 anniversary date or renewal date of the group contract; or
(b) the expiration of any applicable
			 collectively bargained contract pursuant to which it was written.
Connecticut Administrative Code › Title 38a - Insurance Department › 480 - Coordination of Benefits › Approval of Group Accident, Group Health, and Group Accident and Health Policy Forms › Section 38a-480-8 - Definitions

Current through July 10, 2024
As used in Sections 38a-480-8 through
				  38a-480-10,
				  inclusive:
(a) "Commissioner" means
				the Insurance Commissioner of this state.
(b) "Form" means a policy of insurance
				against loss or expense from sickness, or from bodily injury or death by
				accident, issued upon a group plan, or application, certificate, rider or
				endorsement used in connection therewith.
(c) "Insurer" means an insurance company
				licensed by the Commissioner to write accident and health insurance.
Connecticut Administrative Code › Title 38a - Insurance Department › 480 - Coordination of Benefits › Approval of Group Accident, Group Health, and Group Accident and Health Policy Forms › Section 38a-480-9 - Filing procedure

Current through July 10, 2024
Any insurer required pursuant to Section
				  38a-480(a)
				  (2) of the General Statutes to file a copy of
				  a form with the Commissioner for approval, shall comply with the following
				  standards:
(a)
Filing
				Transmittal Letter
.
(1) The filing
				transmittal letter should be sent to the attention of the Life and Health
				Division of the Insurance Department.
(2) If one or more elements within a filing
				vary by member company within a group of companies, the filer shall send a
				separate filing transmittal letter for each insurer within the group.
(3) The filer shall enclose a return copy of
				the transmittal letter(s) along with a stamped self-addressed return envelope
				of a size sufficient to return the duplicate copies of the filing to the
				insurer, and one letter size self-addressed stamped envelope to provide the
				notice required by Section
				38a-480-10(a).
(4) The filing transmittal letter shall
				contain a descriptive caption. The caption shall identify the insurer when the
				insurer is a member of an affiliated group of insurers using generic
				letterhead. The caption shall also 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 filing
				transmittal letter, in addition to the date of the original filing transmittal
				letter (and the Department's file number, if known).
(5) The body of the filing transmittal letter
				shall list the documents submitted therewith, briefly outline proposed changes,
				the approval sought, and specify the proposed effective date. When the form(s)
				sought to be approved by the Commissioner are not subject to the requirements
				of the Insurance Plain Language Act, Chapter 699a of the General Statutes, the
				filing transmittal letter shall so state such fact.
(6) The insurer shall provide in the filing
				transmittal letter a telephone number for readily contacting the person
				responsible for submitting the filing.
Connecticut Administrative Code › Title 38a - Insurance Department › 480 - Coordination of Benefits › Approval of Group Accident, Group Health, and Group Accident and Health Policy Forms › Section 38a-480-10 - 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)
				(2) 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-480-9.
(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 Group Accident, Group Health, and Group Accident and Health Policy Forms › Section 38a-480-10a - Electronic filing

Current through July 10, 2024
(a) Any insurer
				filing a copy of a form with the commissioner in accordance with section
				38a-480-9 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-480-9 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.
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-480-11 - Definitions

Current through July 10, 2024
As used in Section 38a-480-11 through
				  38a-480-14,
				  inclusive:
(a) "Commissioner" means
				the Insurance Commissioner of this state.
(b) "Form" means a life insurance, endowment
				or annuity contract or contracts supplemental thereto which contain only such
				provisions relating to accident and health insurance as (1) provide additional
				benefits in case of death by accidental means and (2) operate to safeguard such
				contracts against lapse, or to give a special surrender value or special
				benefit or an annuity in the event that the insured or annuitant become totally
				and permanently disabled as defined by the contract or supplemental
				contract.
(c) "Insurer" means an
				insurance company licensed by the Commissioner to write life
				insurance.
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-480-12 - Filing procedure

Current through July 10, 2024
Any insurer required pursuant to Section
				  38a-480(a)
				  (3) of the General Statutes to file a copy of
				  a form with the Commissioner for approval, shall comply with the following
				  standards:
(a)
Filing
				Transmittal Letter
.
(1) The filing
				transmittal letter should be sent to the attention of the Life and Health
				Division of the Insurance Department.
(2) If one or more elements within a filing
				vary by member company within a group of companies, the filer shall send a
				separate filing transmittal letter for each insurer within the group.
(3) The filer shall enclose a return copy of
				the transmittal letter(s) along with a stamped self-addressed return envelope
				of a size sufficient to return the duplicate copies of the filing to the
				insurer, and one letter size self-addressed stamped envelope to provide the
				notice required by Section
				38a-480-13(a).
(4) The filing transmittal letter shall
				contain a descriptive caption. The caption shall identify the insurer when the
				insurer is a member of an affiliated group of insurers using generic
				letterhead. The caption shall also 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 form as it was displayed in the original filing
				transmittal letter, in addition to the date of the original filing transmittal
				letter (and the Department's file number, if known).
(5) The body of the filing transmittal letter
				shall list the documents submitted therewith, briefly outline proposed changes,
				the approval sought, and specify the proposed effective date. When the form(s)
				sought to be approved by the Commissioner are not subject to the requirements
				of the Insurance Plain Language Act, Chapter 699a of the General Statutes, the
				filing transmittal letter shall so state such fact.
(6) The insurer shall provide in the filing
				transmittal letter a telephone number for readily contacting the person
				responsible for submitting the filing.