Connecticut Administrative Code

Regulations of Connecticut State AgenciesSec. 38a-528a-11. Non-forfeiture of benefitsAn insurer may offer the option to purchase a certificate that provides a non-forfeiture benefit in the form of a return of premium, full benefits for a reduced benefit period, reduced benefits f…

Regulations of Connecticut State AgenciesSec. 38a-528a-12. Inflation protection(a) An insurer shall offer the option to purchase a certificate that provides for meaningful periodic benefit level increases to account for reasonably anticipated increases in the costs of short-term …

Regulations of Connecticut State AgenciesSec. 38a-528a-13. Standard format outline of coverage(a) No group short-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 in th…

Regulations of Connecticut State AgenciesSec. 38a-528a-14. 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 group or individual short-term care or long…

Regulations of Connecticut State AgenciesSec. 38a-528a-15. 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 yea…

Regulations of Connecticut State AgenciesSec. 38a-528a-16. SeparabilityIf any provision of sections 38a-528a-1 to 38a-528a-16 of the Regulations of Connecticut State Agencies or the application thereof to any person or circumstance is for any reason held to be invalid, the remain…

Regulations of Connecticut State AgenciesSec. 38a-528a-2. DefinitionsAs used in Sections 38a-528a-1 to 38a-528a-16, inclusive, of the Regulations of Connecticut State Agencies: (1) “Applicant” means the proposed certificate holder. (2) “Insurer” means an insurance company, frater…

Regulations of Connecticut State AgenciesSec. 38a-528a-3. Policy definitions and termsNo insurance policy or certificate may be advertised, solicited or issued for delivery to any resident of this state as a short-term care policy unless the terms used in such policy or certifica…

Regulations of Connecticut State AgenciesSec. 38a-528a-4. Minimum standardsNo group insurance policy or certificate shall be advertised, solicited or issued for delivery in this state as a group short-term care policy or certificate that does not meet the minimum standards set fo…

Regulations of Connecticut State AgenciesSec. 38a-528a-5. Prohibition against pre-existing conditions and probationary periods in replacement policiesIf a group short-term care certificate replaces another group or individual short-term care or long-term care policy or certificat…

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

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

Regulations of Connecticut State AgenciesSec. 38a-528a-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 sixty…

Regulations of Connecticut State AgenciesSec. 38a-528a-9. Standards for marketing(a) Every insurer marketing group short-term care insurance coverage in this state, directly or through producers, shall: (1) Establish marketing procedures to assure that any comparison of policies …

Regulations of Connecticut State AgenciesSec. 38a-53-1. DefinitionsAs used in Sections 38a-53-1 to 38a-53-4, inclusive of the Regulations of Connecticut State Agencies: (a) \"Qualified Actuary\" and \"Qualified Loss Reserve Specialist\" means a person who is either: (1) A member …

Regulations of Connecticut State AgenciesSec. 38a-53-2. Statement of actuarial opinion(a) Each insurer shall include as an attachment to page one of its Annual Statement an opinion of a Qualified Actuary or qualified reserve specialist, entitled \"Statement of Actuarial Opinion,\…

Regulations of Connecticut State AgenciesSec. 38a-53-3. Availability of workpapers and confidentiality(a) Every insurer required to file a Statement of Actuarial Opinion with its Annual Statement pursuant to this regulation, shall make available all workpapers for review by the C…

Regulations of Connecticut State AgenciesSec. 38a-53-4. Exemptions(a) Upon written application of an insurer, the Commissioner may issue an exemption from compliance with the provisions of this regulation in the following instances: (1) An insurer that has less than $1,000,000 to…

Regulations of Connecticut State AgenciesSec. 38a-54-1. Purpose and scope(a) Sections 38a-54-1 to 38a-54-14, inclusive, of the Regulations of Connecticut State Agencies are intended to improve the Insurance Department’s surveillance of the financial condition of insurance compani…

Regulations of Connecticut State AgenciesSec. 38a-54-10. Accountant's letter of qualificationsThe accountant shall furnish the insurer in connection with, and for inclusion in, the filing of the annual audited financial report, a letter which states all of the following: (1) That…

Regulations of Connecticut State AgenciesSec. 38a-54-11. Availability and maintenance of independent CPA work-papers(a) Every insurer required to file an audited financial report pursuant to Section 38a-54-3 of the Regulations of Connecticut State Agencies, shall require the acco…

Regulations of Connecticut State AgenciesSec. 38a-54-11a. Requirements for audit committees(a) This section shall not apply to foreign or alien insurers licensed in this state or an insurer that is a SOX compliant entity or a direct or indirect wholly-owned subsidiary of a SOX co…

Regulations of Connecticut State AgenciesSec. 38a-54-11b. Conduct of insurer in connection with the preparation of required reports and documents(a) No director or officer of an insurer shall, directly or indirectly: (1) Make or cause to be made a materially false or misleading s…

Regulations of Connecticut State AgenciesSec. 38a-54-11c. Management’s report of internal control over financial reporting(a) Each insurer required to file an audited financial report pursuant to Sections 38a-54-1 through 38a-54-14, inclusive, of the Regulations of the Connecticu…

Regulations of Connecticut State AgenciesSec. 38a-54-11d. Internal audit function requirementsThe requirements of this section shall be effective January 1, 2017.(a) (1) Exemption. An insurer is exempt from the requirement of this section if: (A) The insurer has annual direct wri…

Regulations of Connecticut State AgenciesSec. 38a-54-12. Exemptions and compliance dates(a) Upon written application of any insurer, the Commissioner may grant an exemption from compliance with Sections 38a-54-1 to 38a-54-14, inclusive, of the Regulations of Connecticut State Age…

Regulations of Connecticut State AgenciesSec. 38a-54-13. Canadian and British companies(a) In the case of Canadian and British insurers, the annual audited financial report shall be defined as the annual statement of total business on the form filed by such companies with their s…

Regulations of Connecticut State AgenciesSec. 38a-54-14. SeverabilityIf any provision of Sections 38a-54-1 to 38a-54-13, inclusive, of the Regulations of Connecticut State Agencies or the applicability thereof to any person or circumstance is held to be invalid, the remainder of …

Regulations of Connecticut State AgenciesSec. 38a-54-2. DefinitionsAs used in Sections 38a-54-1 to 38a-54-13, inclusive, of the Regulations of Connecticut State Agencies: (a) \"Accountant\" or \"independent certified public accountant\" means an independent certified public accou…

Regulations of Connecticut State AgenciesSec. 38a-54-3. General requirements related to filing and extension for filing of annual audited financial reports and audit committee appointment(a) All insurers shall have an annual audit by an independent certified public accountant and…

Regulations of Connecticut State AgenciesSec. 38a-54-4. Contents of annual audited financial report(a) The annual audited financial report shall report the financial position of the insurer as of the end of the most recent calendar year and the results of its operations, cash flo…

Regulations of Connecticut State AgenciesSec. 38a-54-5. Designation of independent certified public accountant(a) Each insurer required to file an annual audited financial report pursuant to Section 38a-54-3 of the Regulations of Connecticut State Agencies shall within sixty (60)…

Regulations of Connecticut State AgenciesSec. 38a-54-6. Qualifications of independent certified public accountant(a) The Commissioner shall not recognize any person or firm as a qualified independent certified public accountant if the person or firm: (1) is not in good standing w…

Regulations of Connecticut State AgenciesSec. 38a-54-7. Consolidated or combined auditsAn insurance company may make written application to the Commissioner for approval to file audited consolidated or combined financial statements in lieu of separate annual audited financial sta…

Regulations of Connecticut State AgenciesSec. 38a-54-8. Scope of audit and report of independent certified public accountantFinancial statements furnished pursuant to Section 38a-54-4 of the Regulations of Connecticut State Agencies shall be examined by the independent certified …

Regulations of Connecticut State AgenciesSec. 38a-54-9. Notification of adverse financial condition(a) The insurer required to furnish the annual audited financial report shall require the independent certified public accountant to notify in writing within five (5) business days …

Regulations of Connecticut State AgenciesSec. 38a-54-9a. Communication of internal control related matters noted in an audit(a) In addition to the annual audited financial report, each insurer shall furnish the Commissioner with a written communication as to any unremediated mate…

Regulations of Connecticut State AgenciesSec. 38a-546-1. Applicability and scopeSection 38a-546-1 to 38a-546-5, inclusive, of the Regulations of Connecticut State Agencies, shall apply to all group insurance policies in effect, delivered, or issued for delivery in this state. The…

Regulations of Connecticut State AgenciesSec. 38a-546-2. DefinitionsAs used in section 38a-546-1 to section 38a-546-4, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Carrier\" means a health care center, insurer, hospital and medical service corporation or oth…

Regulations of Connecticut State AgenciesSec. 38a-546-3. Effective date of discontinuance for nonpayment of premium or subscription charges(a) If a group insurance policy provides for automatic discontinuance of the policy or contract after a premium or subscription charge has re…

Regulations of Connecticut State AgenciesSec. 38a-546-4. Requirements for notice of discontinuance(a) Any notice of discontinuance so given by the carrier shall include a request to the group policyholder or other entity involved to notify employees or members covered under the p…

Regulations of Connecticut State AgenciesSec. 38a-546-5. Group extension of benefits, continuation of benefits, conversion, and pre-existing conditions(a) Extension of benefits. In accordance with section 38a-546 of the Connecticut General Statutes, every group insurance policy s…

Regulations of Connecticut State AgenciesSec. 38a-546-6. (Repealed) Repealed August 30, 2004. AUTHORITY: Conn. Gen. Stat. § 38a-546 AUTHORITY: Conn. Gen. Stat. § 38a-546

Regulations of Connecticut State AgenciesSec. 38a-554-1. AuthorityThe following regulations are promulgated under the authority set forth in Section 38a-554 of the Connecticut General Statutes. (Effective September 25, 1992) AUTHORITY: Conn. Gen. Stat. § 38a-554 AUTHORITY: Conn. …

Regulations of Connecticut State AgenciesSec. 38a-554-2. Definitions(A) \"Plan\" means any group policy issued by or reinsured through the Health Reinsurance Association or any subscriber contract issued by a residual market mechanism established by hospital and medical service c…

Regulations of Connecticut State AgenciesSec. 38a-554-3. Effect on benefits(A) This provision shall apply in determining the benefits as to a person covered under this Plan for any Claim Determination Period if, for the Allowable Expenses incurred as to such person during such Cl…

Regulations of Connecticut State AgenciesSec. 38a-554-4. Right to receive and release necessary informationFor the purposes of determining the applicability of and implementing the terms of this provision of this plan or any provision of similar purpose of any other plan, the com…