Connecticut Administrative Code

Regulations of Connecticut State AgenciesSec. 38a-501a-5. Prohibition against pre-existing conditions and probationary periods in replacement policiesIf a short term care policy replaces another short term care or long term care policy or certificate, the replacing insurer shall …

Regulations of Connecticut State AgenciesSec. 38a-501a-6. Required disclosure provisions(a) Renewability. Individual short term care policies shall contain a renewability provision. Such provision shall be appropriately captioned, shall appear on the first page of the policy, and…

Regulations of Connecticut State AgenciesSec. 38a-501a-7. Prohibition against post claims underwriting(a) All applications for short term care policies except those that are guaranteed issue shall contain clear and unambiguous questions designed to ascertain the health condition …

Regulations of Connecticut State AgenciesSec. 38a-501a-8. Filing requirements(a) All filings of rates and rating schedules shall be accompanied by an actuarial certification demonstrating that expected claims in relation to premiums comply with a loss ratio of not less than fifty…

Regulations of Connecticut State AgenciesSec. 38a-501a-9. Standards for marketing(a) Every insurer marketing short term care insurance coverage in this state, directly or through producers shall: (1) Establish marketing procedures to assure that any comparison of policies by its …

Regulations of Connecticut State AgenciesSec. 38a-504a-1—38a-504a-2. (Repealed) Repealed July 2, 2012. AUTHORITY: Conn. Gen. Stat. § 38a-504a

Regulations of Connecticut State AgenciesSec. 38a-504a-3. Request for authorization of coverageStandardized form to request authorization for coverage of routine patient care costs associated with clinical trials required by sections 38a-504f and 38a-542f of the Connecticut Gener…

Regulations of Connecticut State AgenciesSec. 38a-505-1. PurposeThe purpose of this regulation is to implement Section 38a-505 of the Connecticut General Statutes so as to provide reasonable standardization and simplification of terms and coverages of individual accident and sick…

Regulations of Connecticut State AgenciesSec. 38a-505-10. Required disclosure provisions(A) General Rules.(1) Each individual policy of accident and sickness insurance or fraternal benefit society certificate shall include a renewal, continuation, or non-renewal provision. The la…

Regulations of Connecticut State AgenciesSec. 38a-505-11. Requirements for replacement(A) Application forms shall include a question designed to elicit information as to whether the insurance to be issued is intended to replace any other accident and sickness insurance presently …

Regulations of Connecticut State AgenciesSec. 38a-505-12. SeparabilityIf any provision of this regulation (Secs. 38a-505-9—38a-505-11) or the application thereof to any person or circumstances is for any reason held to be invalid, the remainder of the regulation and the applicati…

Regulations of Connecticut State AgenciesSec. 38a-505-13. Specified disease policies(a) A \"specified disease policy\" means an individual health insurance policy delivered or issued for delivery in this state which pays benefits for the diagnosis or treatment of one or more spec…

Regulations of Connecticut State AgenciesSec. 38a-505-2. AuthorityThis regulation is issued pursuant to the authority vested in the Commissioner under Section 38a-505 of the Connecticut General Statutes. (Effective September 25, 1992) AUTHORITY: Conn. Gen. Stat. § 38a-505 AUTHORI…

Regulations of Connecticut State AgenciesSec. 38a-505-3. Applicability and scopeThis regulation shall apply to all individual accident and sickness insurance policies and fraternal benefit society certificates delivered or issued for delivery in this State on and after the effect…

Regulations of Connecticut State AgenciesSec. 38a-505-4. Effective dateThis regulation shall be effective on January 1, 1979 or 180 days after the date of adoption of the regulation, whichever is later, and shall be applicable to all individual accident and sickness insurance pol…

Regulations of Connecticut State AgenciesSec. 38a-505-5. Policy definitionsExcept as provided hereafter, no individual accident or sickness insurance policy or fraternal benefit society certificate delivered or issued for delivery to any person in this State shall contain definit…

Regulations of Connecticut State AgenciesSec. 38a-505-6. SeparabilityIf any provision of this regulation (Secs. 38a-505-1—38a-505-5) or the application thereof to any person or circumstances is for any reason held to be invalid, the remainder of the regulation and the application…

Regulations of Connecticut State AgenciesSec. 38a-505-7. Prohibited policy provisions(A) Except as provided in Section 38a-505-5(E), no policy shall contain provisions establishing a probationary or waiting period during which no coverage is provided under the policy subject to t…

Regulations of Connecticut State AgenciesSec. 38a-505-8. SeparabilityIf any provision of this regulation (Sec. 38a-505-7) or the application thereof to any person or circumstances is for any reason held to be invalid, the remainder of the regulation and the application of such pr…

Regulations of Connecticut State AgenciesSec. 38a-505-9. Accident and sickness minimum standards for benefitsThe following minimum standards for benefits are prescribed for the categories of coverage noted in the following subsections. No individual policy of accident and sicknes…

Regulations of Connecticut State AgenciesSec. 38a-513-1. Definitions As used in sections 38a-513-1 to 38a-513-13, inclusive, of the Regulations of Connecticut State Agencies, unless otherwise provided: (1) \"Activities of daily living\" means activities such as bathing, dressing,…

Regulations of Connecticut State AgenciesSec. 38a-513-10. 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 availabl…

Regulations of Connecticut State AgenciesSec. 38a-513-11. 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 …

Regulations of Connecticut State AgenciesSec. 38a-513-12. 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…

Regulations of Connecticut State AgenciesSec. 38a-513-13. Additional rate filing requirements (a) All rate filings for small group 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-513-14. SeparabilityIf any provision of sections 38a-513-1 to 38a-513-13, 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, …

Regulations of Connecticut State AgenciesSec. 38a-513-2. Group health prohibited policy provisions(a) Except as provided in section 38a-513-4(g)(4), no policy or certificate shall contain provisions establishing a probationary or waiting period during which no coverage is provide…

Regulations of Connecticut State AgenciesSec. 38a-513-3. Minimum standards for group health insurance benefitsThe following minimum standards for benefits are prescribed for the categories of coverage noted in subsections (a) to (g), inclusive, of this section. No such group poli…

Regulations of Connecticut State AgenciesSec. 38a-513-4. Required provisions for group health insurance benefits(a) General Rules.(1) Each group policy or certificate of accident and sickness insurance shall include a renewal, continuation, or non-renewal provision. The language …

Regulations of Connecticut State AgenciesSec. 38a-513-5. Drug formulary annual filing requirementsInsurers that deliver, issue for delivery, renew, amend or continue any group health insurance policy or certificate that includes prescription drug coverage and utilizes a formulary…

Regulations of Connecticut State AgenciesSec. 38a-513-6. Minimum standards for drug formulariesNo individual or group health insurance plan or certificate that offers prescription drug coverage that is subject to a formulary shall be delivered or issued for delivery in this state…

Regulations of Connecticut State AgenciesSec. 38a-513-7. Minimum standards for pharmaceutical and therapeutics committees(a) (1) No insurer shall utilize a P&T committee that does not have appropriate membership.(A) The majority of P&T committee members shall be practicing physic…

Regulations of Connecticut State AgenciesSec. 38a-513-8. Notice to insureds regarding formulary changes (Repealed) Repealed December 12, 2024.(Effective December 3, 2018; Repealed December 12, 2024) AUTHORITY: Conn. Gen. Stat. § 38a-513

Regulations of Connecticut State AgenciesSec. 38a-513-9. Timing for rate filings (a) Rate filings for health insurance plans sold to small employers 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 th…

Regulations of Connecticut State AgenciesSec. 38a-528-1. Applicability and scopeExcept as otherwise specifically provided, Sections 38a-528-1 to 38a-528-17, inclusive, apply to all group long-term care insurance policies, subscriber contracts or certificates delivered or issued f…

Regulations of Connecticut State AgenciesSec. 38a-528-10. Suitability of recommended purchase(a) An agent who recommends the purchase or replacement of a long-term care policy or certificate shall have reasonable grounds for believing that the recommendation is suitable for the a…

Regulations of Connecticut State AgenciesSec. 38a-528-11. Requirement to deliver shopper's guideA long-term care insurance shopper's guide approved by the Commissioner shall be provided to all prospective applicants for a long-term care insurance certificate. (a) In the case of a…

Regulations of Connecticut State AgenciesSec. 38a-528-12. Requirement to offer a non-forfeiture benefitNo insurer shall offer for sale a long-term care insurance certificate unless the insurer also offers the applicant the option to purchase a certificate that provides a non-forf…

Regulations of Connecticut State AgenciesSec. 38a-528-13. Requirement to offer inflation protection(a) No insurer shall offer for sale a long-term care insurance certificate unless the insurer also offers the applicant the option to purchase a certificate that provides for meanin…

Regulations of Connecticut State AgenciesSec. 38a-528-14. Standard format outline of coverage(a) No long-term care certificate shall be delivered or issued for delivery to any resident of this state unless an appropriate outline of coverage in the format prescribed herein is comp…

Regulations of Connecticut State AgenciesSec. 38a-528-15. Replacement(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 long-term care insurance policy or certifica…

Regulations of Connecticut State AgenciesSec. 38a-528-16. Reporting requirements(a) Every insurer shall report annually by June 30 the number of certificates lapsed in the previous calendar year, the average total number of certificates in force during the preceding calendar year…

Regulations of Connecticut State AgenciesSec. 38a-528-17. Effective date; separability(a) The effective date of Sections 38a-528-1 to 38a-528-17, inclusive, shall be September 30, 1994. (b) If any provision of Sections 38a-528-1 to 38a-528-17, inclusive, or the application thereo…

Regulations of Connecticut State AgenciesSec. 38a-528-2. DefinitionsAs used in Sections 38a-528-1 to 38a-528-17, inclusive:(a) \"Long-term care policy\" means any group health insurance policy or subscriber contract or certificate, or any amendment, endorsement or rider to any su…

Regulations of Connecticut State AgenciesSec. 38a-528-3. Policy definitions and termsNo insurance policy or subscriber contract or certificate may be advertised, solicited or issued for delivery to any resident of this state as a long-term care policy or certificate unless the te…

Regulations of Connecticut State AgenciesSec. 38a-528-4. Minimum standardsNo group insurance policy or subscriber contract or certificate shall be advertised, solicited or issued for delivery in this state as a long-term care policy or certificate which does not meet the followin…

Regulations of Connecticut State AgenciesSec. 38a-528-5. Prohibition against pre-existing conditions and probationary periods in replacement coverageIf a long-term care certificate replaces another long-term care certificate or individual policy, the replacing insurer shall waive…

Regulations of Connecticut State AgenciesSec. 38a-528-6. Required disclosure provisions(a) Continuation. Group long-term care certificates shall contain a provision, appropriately captioned, which describes how the coverage may be continued or converted. (b) Riders and Endorsemen…

Regulations of Connecticut State AgenciesSec. 38a-528-7. Prohibition against post claims underwriting(a) All applications for long-term care insurance certificates except those which are guaranteed issue shall contain clear and unambiguous questions designed to ascertain the heal…

Regulations of Connecticut State AgenciesSec. 38a-528-8. Filing requirements(a) All filings of rates and rating schedules shall be accompanied by an actuarial certification demonstrating that expected claims in relation to premiums comply with the loss ratio required by subsectio…