Title 38a, Title 38a: Insurance

Sec. 38a-518t. Mandatory coverage for prosthetic devices. (a) As used in this section, “prosthetic device” means an artificial limb device to replace, in whole or in part, an arm or a leg, including a device that contains a microprocessor if such microprocessor-equipped device is…

Sec. 38a-518u. Coverage for psychotropic drugs. Standards re availability. Notwithstanding any provision of the general statutes, no group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 delive…

Sec. 38a-518v. Mandatory coverage for hospice services in the home through a hospice care program to the extent provided for inpatient hospice services. (a) As used in this section, “hospice care program” has the same meaning as provided in section 19a-122e. (b) Each group health…

Sec. 38a-518w. Medically necessary wheelchair repairs, replacements. Coverage requirements. (a) As used in this section, (1) “complex rehabilitation technology wheelchair” has the same meaning as provided in section 42-337, and (2) “medically necessary” means a written determinat…

Sec. 38a-518x. Mandatory coverage of coronary calcium scans. (a) As used in this section, “coronary calcium scan” means a computed tomography scan of the heart that looks for calcium deposits in the heart arteries. (b) Each group health insurance policy providing coverage of the …

Sec. 38a-519. (Formerly Sec. 38-174j). Offset proviso prohibited in certain policies. Required disclosures for group long-term disability policies. (a) No group health insurance policy that provides disability income protection coverage, delivered, issued for delivery, renewed, a…

Sec. 38a-520. Mandatory coverage for home health care. Deductibles. Exception from deductible limits for medical savings accounts. Archer MSAs and health savings accounts. (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4…

Sec. 38a-521. Home health care by recognized nonmedical systems. Notwithstanding the provisions of section 38a-520, no insurer, health care center or issuer of any service plan contract for hospital or medical expense delivered, issued for delivery or renewed in this state shall …

Sec. 38a-522. Medicare supplement policies. Coverage of home health aide service. (a) As used in this section, “Medicare” means the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as amended (Title I, Part I of P.L. 89-97); “Medicare supp…

Sec. 38a-523. (Formerly Sec. 38-174p). Group hospital or medical insurance coverage for comprehensive rehabilitation services. (a) For the purposes of this section: (1) “Comprehensive rehabilitation services” shall consist of the following when provided in a comprehensive rehabil…

Sec. 38a-524. Coverage for occupational therapy. (a) For the purposes of this section: (1) “Occupational therapy” means services provided by a licensed occupational therapist in accordance with a plan of care established and approved in writing by a physician licensed in accordan…

Sec. 38a-525. Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider. (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6), (11) and (12) of section 38a-469 delivered, issue…

Sec. 38a-525a. Prior authorization prohibited for certain 9-1-1 emergency calls or transporting enrollee to a hospital by ambulance when medically necessary. Denial of payment to ambulance provider responding to 9-1-1 local prehospital emergency medical service system call prohib…

Sec. 38a-525b. Mandatory coverage for mobile field hospital. Each group health insurance policy providing coverage of the type specified in subdivisions (1) to (13), inclusive, of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state shall pr…

Sec. 38a-525c. Denial of coverage prohibited for health care services rendered to persons with an elevated blood alcohol content. No group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, i…

Sec. 38a-526. Coverage for services of physician assistants and certain nurses. (a) For the purposes of this section: (1) “Certified nurse practitioner” means any registered nurse licensed under chapter 378 who has completed a formal educational nurse practitioner program and is …

Sec. 38a-526a. Coverage for telehealth services. (a) As used in this section, (1) “telehealth” has the same meaning as provided in section 19a-906, and (2) “telehealth provider” means any physician licensed under chapter 370, physical therapist licensed under chapter 376, chiropr…

Sec. 38a-527. Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries. (a) Notwithstanding any other provision of the general statutes, no group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (…

Sec. 38a-528. Group long-term care policies. Insurers authorized. Disclosures. Premium rate increases of twenty per cent or more. Disclosure of premium rate increase and minimum set of affordable benefit options. (a)(1) As used in this section and section 38a-475a, “long-term car…

Sec. 38a-528a. Group short-term care policies. Approval of rates and forms. Disclosures. Regulations. (a) As used in this section, “short-term care policy” means any group health insurance policy or certificate delivered or issued for delivery to any resident of this state that i…

Sec. 38a-529. Mandatory coverage for services provided by the Healthcare Center maintained by the Department of Veterans Affairs. No group health insurance policy delivered, issued for delivery or renewed in this state on or after October 1, 1988, may exclude coverage for service…

Sec. 38a-530. Mandatory coverage for diagnostic and screening mammography, diagnostic and screening breast ultrasound, diagnostic and screening magnetic resonance imaging, breast biopsies, prophylactic mastectomies and breast reconstructive surgery. Breast density information inc…

Sec. 38a-530a. Mandatory coverage for breast cancer survivors. Section 38a-530a is repealed, effective January 1, 2020. (P.A. 96-177, S. 3; P.A. 17-15, S. 68; P.A. 19-134, S. 3.)

Sec. 38a-530b. Carriers to permit direct access to obstetrician-gynecologist. (a) As used in this section, “carrier” means each insurer, health care center, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, amend…

Sec. 38a-530c. Mandatory coverage for maternity care. Interhospital transfer of newborn infant and mother. (a) As used in this section, “carrier” means each insurer, health care center, hospital service corporation, medical service corporation or other entity delivering, issuing …

Sec. 38a-530d. Mandatory coverage for mastectomy care. Termination of provider contract prohibited. (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (10), (11) and (12) of section 38a-469 delivered, issued for delivery…

Sec. 38a-530e. Mandatory coverage for contraceptives and sterilization. (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in…

Sec. 38a-530f. Mandatory coverage for certain health benefits and services for women, infants, children and adolescents and certain evidence-based items or services for individuals. (a)(1) Except as provided in subdivision (2) of this subsection, each group health insurance polic…

Sec. 38a-530g. Mandatory coverage for ovarian cancer screening and monitoring. (a) For purposes of this section: (1) “At risk for ovarian cancer” means: (A) Having a family history: (i) With one or more first degree blood relatives, including a parent, sibling or child, or one or…

Sec. 38a-531. (Formerly Sec. 38-174hh). Mandatory coverage for employees of certain employers. Approval of policy forms. (a) For purposes of this section: (1) “Employer” means any person, firm, corporation, limited liability company, partnership or association engaged in business…

Sec. 38a-532. (Formerly Sec. 38-262a). Assignment of incidents of ownership under group life, health or accident policy. Any person who is insured under any policy of group health insurance may make an assignment of all or any part of such insured's incidents of ownership in such…

Sec. 38a-533. (Formerly Sec. 38-262b). Mandatory coverage for the treatment of medical complications of alcoholism. (a) Except as provided in subsection (c) of this section, each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4),…

Sec. 38a-534. Coverage for services performed by chiropractors. Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6) and (11) of section 38a-469, delivered, issued for delivery, renewed, amended or continued in this state …

Sec. 38a-535. Mandatory coverage for preventive pediatric care and blood lead screening and risk assessment. (a) For purposes of this section, “preventive pediatric care” means the periodic review of a child's physical and emotional health from birth through six years of age by o…

Sec. 38a-535a. Notification of individual coverage and benefits of a noncustodial parent to a custodial parent, when. Regulations. Section 38a-535a is repealed, effective July 1, 1995. (May Sp. Sess. P.A. 94-5, S. 5, 30; P.A. 95-305, S. 5, 6.)

Sec. 38a-536. Mandatory coverage for infertility diagnosis and treatment. Limitations. (a) Subject to the limitations set forth in subsection (b) of this section and except as provided in subsection (c) of this section, each group health insurance policy providing coverage of the…

Sec. 38a-537. (Formerly Sec. 38-262c). Notice of cancellation or discontinuation to covered employees. Fine. Notice of transfer of coverage. Failure to procure coverage. (a) Any individual, partnership, corporation or unincorporated association providing group health insurance co…

Sec. 38a-538. (Formerly Sec. 38-262d). Continuation of benefits under group employee health plans. Section 38a-538 is repealed, effective July 10, 2015. (P.A. 75-417; P.A. 82-340; P.A. 87-274, S. 1; P.A. 90-243, S. 119; P.A. 92-158; May Sp. Sess. P.A. 92-11, S. 69, 70; P.A. 97-26…

Sec. 38a-539. (Formerly Sec. 38-262f). Group hospital or medical expense insurance policy coverage for treatment of alcoholism on an outpatient basis. Section 38a-539 is repealed, effective January 1, 2000. (P.A. 77-237; 77-614, S. 323, 610; P.A. 79-610, S. 32; P.A. 90-102, S. 2;…

Sec. 38a-540. (Formerly Sec. 38-262g). Duplication of coverage under group health insurance policies. In any case in which spouses are employed by the same employer and, by reason of their employment, are both eligible for coverage under the terms of any health insurance policy i…

Sec. 38a-541. (Formerly Sec. 38-262h). Group health policy to allow spouse coverage as both employee and dependent, when. Effect of collective bargaining agreements. Every health insurance policy issued under a group insurance plan and by an insurance company, hospital service co…

Sec. 38a-542. Mandatory coverage for treatment of tumors and leukemia. Mandatory coverage for reconstructive surgery, prosthesis, chemotherapy and wigs. Orally administered anticancer medications. (a) Each insurance company, hospital service corporation, medical service corporati…

Sec. 38a-542a. Coverage for routine patient care costs associated with certain clinical trials. Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, ame…

Sec. 38a-542b. Clinical trial criteria. A clinical trial for the prevention of cancer shall be eligible for coverage only if it involves a therapeutic intervention, is a phase III clinical trial approved by one of the entities identified in this section, and is conducted at multi…

Sec. 38a-542c. Evidence and information re eligibility for clinical trial. No coverage required for otherwise reimbursable costs. In order to be eligible for coverage of routine patient care costs, as defined in section 38a-542d, the insurer, health care center or plan administra…

Sec. 38a-542d. Clinical trials: Routine patient care costs. (a) For purposes of sections 38a-542a to 38a-542g, inclusive, “routine patient care costs” means: (1) Medically necessary health care services that are incurred as a result of the treatment being provided to the insured …