Connecticut Administrative Code

Regulations of Connecticut State AgenciesSec. 38a-480-13. Policy form approval(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 …

Regulations of Connecticut State AgenciesSec. 38a-480-13a. Electronic filing(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 know…

Regulations of Connecticut State AgenciesSec. 38a-480-14. SeverabilityIf 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 pers…

Regulations of Connecticut State AgenciesSec. 38a-480-2. Applicability(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 consis…

Regulations of Connecticut State AgenciesSec. 38a-480-3. Definitions(a) Plan.(1) A “Plan” is a form of coverage with which coordination is allowed. The definition of Plan in the group contract shall state the types of coverage which will be considered in applying the COB provisio…

Regulations of Connecticut State AgenciesSec. 38a-480-4. COB contract provision(a) General. Subsection (d) of this section contains a COB Provision for use in group contracts. That use is subject to the provisions of subsections (b) and (c) of this section and to the provisions o…

Regulations of Connecticut State AgenciesSec. 38a-480-5. Rules for coordination of benefits(a) Order of Benefits.(1) General. (A) The Primary Plan shall pay or provide its benefits as if the Secondary Plan or Plans did not exist.(B) A Secondary Plan may take the benefits of anoth…

Regulations of Connecticut State AgenciesSec. 38a-480-6. Effect on mandated benefits; spouse coverage(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 b…

Regulations of Connecticut State AgenciesSec. 38a-480-7. Effective date; existing contractsThis 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 hea…

Regulations of Connecticut State AgenciesSec. 38a-480-8. DefinitionsAs 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 f…

Regulations of Connecticut State AgenciesSec. 38a-480-9. Filing procedureAny 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…

Regulations of Connecticut State AgenciesSec. 38a-481-1. DefinitionsAs used in Sections 38a-481-1 to 38a-481-12, inclusive, of the Regulations of Connecticut State Agencies, unless the context otherwise requires:(1) \"Commissioner\" means the Insurance Commissioner of the State o…

Regulations of Connecticut State AgenciesSec. 38a-481-10. Formulary annual filing requirementsInsurers 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 …

Regulations of Connecticut State AgenciesSec. 38a-481-11. Minimum standards for formularies 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 no…

Regulations of Connecticut State AgenciesSec. 38a-481-12. Minimum standards for pharmaceutical and therapeutics committees(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 physici…

Regulations of Connecticut State AgenciesSec. 38a-481-13. Notice to insureds regarding formulary changes (Repealed) Repealed December 12, 2024.(Effective December 3, 2018; Repealed December 12, 2024) AUTHORITY: Conn. Gen. Stat. § 38a-481 AUTHORITY: Conn. Gen. Stat. § 38a-481

Regulations of Connecticut State AgenciesSec. 38a-481-2. Filing procedureAny 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) Fi…

Regulations of Connecticut State AgenciesSec. 38a-481-3. Policy form approval(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 I…

Regulations of Connecticut State AgenciesSec. 38a-481-3a. Electronic filingFilings 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 elec…

Regulations of Connecticut State AgenciesSec. 38a-481-4. SeverabilityIf 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 perso…

Regulations of Connecticut State AgenciesSec. 38a-481-5. Timing for rate filings(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 f…

Regulations of Connecticut State AgenciesSec. 38a-481-6. Transparency of rate filingsThe 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…

Regulations of Connecticut State AgenciesSec. 38a-481-7. Rate filing process(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 Hu…

Regulations of Connecticut State AgenciesSec. 38a-481-8. Minimum rate filing requirements(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 o…

Regulations of Connecticut State AgenciesSec. 38a-481-9. Additional rate filing requirements(a) All rate filings for individual health insurance providing coverage of the types specified in Connecticut General Statutes Section 38a-469 (1), (2), (4), (11) and (12) shall include: (…

Regulations of Connecticut State AgenciesSec. 38a-495-1. Applicability and scopeExcept 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 i…

Regulations of Connecticut State AgenciesSec. 38a-495-10. Required disclosure provisions(a) General Rules.(1) Medicare supplement policies shall include a renewal or continuation provision. The language or specifications of such provision must be consistent with the type of contr…

Regulations of Connecticut State AgenciesSec. 38a-495-11. Requirements for application forms and replacement coverage(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 anot…

Regulations of Connecticut State AgenciesSec. 38a-495-12. Filing requirements for advertisingEvery 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 int…

Regulations of Connecticut State AgenciesSec. 38a-495-13. Standards for marketing(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 procedure…

Regulations of Connecticut State AgenciesSec. 38a-495-14. Appropriateness of recommended purchase and excessive insurance(a) In recommending the purchase or replacement of any Medicare supplement policy or certificate an agent shall make reasonable efforts to determine the approp…

Regulations of Connecticut State AgenciesSec. 38a-495-15. Reporting of multiple policiesOn 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 …

Regulations of Connecticut State AgenciesSec. 38a-495-16. Prohibition against preexisting conditions, waiting periods, elimination periods and probationary periods in replacement policies or certificatesIf a Medicare supplement policy or certificate replaces another Medicare supp…

Regulations of Connecticut State AgenciesSec. 38a-495-17. SeparabilityIf 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 …

Regulations of Connecticut State AgenciesSec. 38a-495-2. DefinitionsAs 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 b…

Regulations of Connecticut State AgenciesSec. 38a-495-3. Policy definitions and termsNo 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 def…

Regulations of Connecticut State AgenciesSec. 38a-495-4. Prohibited policy provisions(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…

Regulations of Connecticut State AgenciesSec. 38a-495-5. Minimum benefit standards(a) No insurance policy or subscriber contract which provides benefits to any resident of this State may be advertised, solicited or issued for delivery in this State who is eligible for Medicare wh…

Regulations of Connecticut State AgenciesSec. 38a-495-6. Standard for claims payment(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) Complianc…

Regulations of Connecticut State AgenciesSec. 38a-495-7. Loss ratio standards(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 …

Regulations of Connecticut State AgenciesSec. 38a-495-8. Filing requirements for out-of-state group policiesEvery 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 b…

Regulations of Connecticut State AgenciesSec. 38a-495-9. Permitted compensation arrangements(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 firs…

Regulations of Connecticut State AgenciesSec. 38a-495a-1. Applicability and scope(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 del…

Regulations of Connecticut State AgenciesSec. 38a-495a-10. Loss ratio standards and refund or credit of premium(a) Loss Ratio Standards(1) A Medicare Supplement policy form or certificate form shall not be delivered or issued for delivery unless the policy form or certificate for…

Regulations of Connecticut State AgenciesSec. 38a-495a-11. Filing and approval of policies and certificates and premium rates(a) An issuer shall not deliver or issue for delivery a policy or certificate to a resident of this state unless the policy form or certificate form has be…

Regulations of Connecticut State AgenciesSec. 38a-495a-12. Permitted compensation arrangements(a) An issuer 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 fir…

Regulations of Connecticut State AgenciesSec. 38a-495a-13. Required disclosure provisions(a) General Rules. (1) Medicare supplement policies and certificates shall include a renewal or continuation provision. The language or specifications of such provision shall be consistent wi…