Title 38a, Title 38a: Insurance

Sec. 38a-544. Prescription drug coverage. Mail order pharmacies. Step therapy use. (a) No insurance company, hospital service corporation, medical service corporation, health care center or other entity delivering, issuing for delivery, renewing, amending or continuing a group he…

Sec. 38a-544a. Prescription drug coverage. Synchronized refills. No group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this s…

Sec. 38a-544b. Prescription drug coverage. Prior authorization for naloxone hydrochloride or similar drug not required. No group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 delivered, issue…

Sec. 38a-545. (Formerly Sec. 38-262k). Group dental health insurance plans. Alternative coverage option. Any employer or other organization which had twenty-five or more employees or members at all times during the preceding calendar year and which contributes to a group health i…

Sec. 38a-546. (Formerly Sec. 38-379). Discontinuation and replacement of group health insurance policy. Regulations. (a) In any case of the discontinuance of a group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (3), (4), (11) and (12)…

Sec. 38a-547. Termination of policy or contract due to insurer ceasing to offer health insurance in this state; maternity benefits to continue for six weeks following termination of the pregnancy, when. As used in this section, the term “employer” means any individual, partnershi…

Sec. 38a-548. Penalty. Any insurer, hospital service corporation, medical service corporation, health care center or fraternal benefit society, or any officer or agent thereof, delivering or issuing for delivery to any person in this state any policy in violation of any of the pr…

Sec. 38a-549. Coverage for adopted children. (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, amended, renewed or continued in this state shall pro…

Sec. 38a-550. Copayments re in-network imaging services. (a) No health insurer, health care center, hospital service corporation, medical service corporation or fraternal benefit society that provides coverage under a group health insurance policy or contract for magnetic resonan…

Sec. 38a-550a. Copayments re in-network physical therapy services and in-network occupational therapy services. No 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…

Sec. 38a-551. (Formerly Sec. 38-371). Definitions. For the purposes of this section and sections 38a-552 and 38a-556 to 38a-559, inclusive, the following terms have the following meanings: (1) “Health insurance” or “health care plan” means hospital and medical expenses incurred p…

Sec. 38a-552. (Formerly Sec. 38-372). Provision of service to certain low-income individuals. No individual or organization that provides medical advice, diagnosis, care or treatment of a type covered under a special health care plan shall provide such service to any person in th…

Secs. 38a-553 to 38a-555. (Formerly Secs. 38-373 to 38-375). Minimum standard benefits of comprehensive health care plans; optional and excludable benefits; preexisting conditions; use of managed care plans. Additional requirements and eligibility under group comprehensive health…

Sec. 38a-556. (Formerly Sec. 38-376). Health Reinsurance Association. Board of directors. Powers and authority. Rates. Net loss assessment. Immunity from liability. (a) There is hereby created a nonprofit legal entity to be known as the Health Reinsurance Association. All insurer…

Sec. 38a-556a. Connecticut Clearinghouse. Section 38a-556a is repealed, effective June 6, 2024. (P.A. 10-4, S. 3; P.A. 11-44, S. 138; P.A. 13-234, S. 87; P.A. 15-69, S. 40; P.A. 24-138, S. 18.)

Sec. 38a-557. (Formerly Sec. 38-377). Hospital service corporations and medical service corporations. Residual market mechanism. Insurance Commissioner's powers concerning such mechanisms. (a) Hospital service corporations and medical service corporations may participate in the H…

Sec. 38a-558. (Formerly Sec. 38-380). Office of Health Care Access. Section 38a-558 is repealed, effective May 14, 2018. (P.A. 75-616, S. 10, 12; P.A. 77-118; P.A. 95-257, S. 39, 58; P.A. 18-91, S. 80; 18-168, S. 85.)

Sec. 38a-559. (Formerly Sec. 38-381). Commissioner of Social Services. Contract authority concerning Medicaid programs. The Commissioner of Social Services may enter into contractual agreements with any carrier or with the Health Reinsurance Association or a residual market mecha…

Sec. 38a-560. Small employer grouping for health insurance coverage. Small employers, as defined in section 38a-564, may group together solely for the purpose of securing group health insurance coverage. (P.A. 93-69.)

Secs. 38a-561 to 38a-563. Reserved for future use. PART V BLUE RIBBON HEALTH CARE PLANS

Sec. 38a-564. Definitions. As used in this section and sections 38a-566, 38a-567, 38a-569 and 38a-574: (1) “Pool” means the Connecticut Small Employer Health Reinsurance Pool, established under section 38a-569. (2) “Board” means the board of directors of the pool. (3) “Employee” …

Sec. 38a-565. Special health care plans. Section 38a-565 is repealed, effective July 10, 2015. (P.A. 90-134, S. 13, 28; P.A. 91-201, S. 6, 8; P.A. 93-137, S. 2, 6; 93-239, S. 6; P.A. 07-185, S. 20; P.A. 08-33, S. 1; P.A. 15-247, S. 38.)

Sec. 38a-566. Health insurance plans or insurance arrangements covering employees of a small employer. Trusts. Trade associations. (a) Any individual or group health insurance plan or any insurance arrangement shall be subject to the provisions of sections 38a-552, 38a-564, 38a-5…

Sec. 38a-567. Provisions of small employer plans and arrangements. Health insurance plans, associations of small employers and other insurance arrangements covering small employers and insurers and producers marketing such plans and arrangements shall be subject to the following …

Sec. 38a-568. Coverage under small employer health care plans and arrangements. Approval by commissioner. Section 38a-568 is repealed, effective July 10, 2015. (P.A. 90-134, S. 19, 28; P.A. 91-201, S. 7, 8; P.A. 93-137, S. 4, 6; 93-239, S. 7; P.A. 00-218, S. 2; P.A. 01-174, S. 3,…

Sec. 38a-569. Connecticut Small Employer Health Reinsurance Pool. (a)(1) There is established a nonprofit entity to be known as the “Connecticut Small Employer Health Reinsurance Pool”. All insurers issuing health insurance in this state and insurance arrangements providing healt…

Secs. 38a-570 to 38a-572. Issuance of special health care plans by the Health Reinsurance Association to small employers. Issuance of individual special health care plans by the Health Reinsurance Association. Requirement to provide service to certain low-income persons. Sections…

Sec. 38a-573. Validity of separate provisions. If any provision of section 38a-564, 38a-566, 38a-567 or 38a-569 is held invalid, the invalidity shall not affect other provisions of said sections that can be given effect without the invalid provisions. (P.A. 90-134, S. 27, 28; P.A…

Sec. 38a-574. Standard family health statement. (a) The board of directors of the Connecticut Small Employer Health Reinsurance Pool shall establish, subject to the approval of the Insurance Commissioner, a standard family health statement for use by small employer carriers to de…

Secs. 38a-575 and 38a-576. Reserved for future use. PART VI CONSUMER DENTAL HEALTH PLANS

Sec. 38a-577. (Formerly Sec. 38-174ii). Consumer dental health plans. Definitions. (a) For the purposes of sections 38a-577 to 38a-590, inclusive: (1) “Capitation” means a payment system in which a dentist or group of dentists earn a fixed monthly fee from an enrolled individual …

Sec. 38a-578. (Formerly Sec. 38-174jj). Certificate of authority. Application requirements. (a) No dentist or group of dentists may establish, operate or administer a dental plan organization, or offer to sell, or solicit offers to purchase, or receive advance or periodic conside…

Sec. 38a-579. (Formerly Sec. 38-174kk). Certificate of authority. Standards for issuance and renewal. (a) The commissioner shall issue a certificate of authority if the commissioner is satisfied that the following conditions are met: (1) The persons responsible for conducting the…

Sec. 38a-580. (Formerly Sec. 38-174ll). General surplus required. The amount of a general surplus that a dental plan organization shall be required to maintain shall be seven hundred fifty thousand dollars or an amount equal to two per cent of premiums written, whichever is great…

Sec. 38a-581. (Formerly Sec. 38-174mm). Evidence of coverage to be provided to enrollees. Approval by commissioner. (a) An enrollee shall be entitled to receive evidence of coverage or a certificate indicating specifically the nature and extent of coverage, and evidence of the to…

Sec. 38a-582. (Formerly Sec. 38-174nn). Schedule of charges. Approval by commissioner. Appeal of disapproval. (a) No schedule of charges for enrollee coverage for dental services, or any amendment thereto, may be used by a dental plan organization until a copy of such schedule or…

Sec. 38a-583. (Formerly Sec. 38-174oo). Records. Commissioner's power to examine; maintenance; preservation. (a) The commissioner or his designee may investigate the business and examine the books, accounts, records and files of any dental plan organization. For such purposes the…

Sec. 38a-584. (Formerly Sec. 38-174pp). Complaint system. (a) A dental plan organization shall establish and maintain a complaint system to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning dental plan services. The dental pl…

Sec. 38a-585. (Formerly Sec. 38-174qq). Requirements re filing of annual reports with commissioner. Every dental plan organization shall, on or before March first in each calendar year, file with the commissioner a report covering its activities for the preceding calendar year. T…

Sec. 38a-586. (Formerly Sec. 38-174rr). False or misleading advertising or solicitation and deceptive evidence of coverage prohibited. (a) No dental plan organization or representative thereof may cause or knowingly permit the use of advertising which is untrue or misleading, sol…

Sec. 38a-587. (Formerly Sec. 38-174ss). Suspension or revocation of certificate of authority. Hearing. Appeal. (a) The commissioner may suspend or revoke any certificate of authority issued to a dental plan organization pursuant to sections 38a-577 to 38a-590, inclusive, if he fi…

Sec. 38a-588. (Formerly Sec. 38-174tt). Penalty. Insolvency. Any dental plan organization that violates any provision of sections 38a-577 to 38a-590, inclusive, or neglects, fails or refuses to comply with any of the requirements of said sections, except the failure to file an an…

Sec. 38a-589. (Formerly Sec. 38-174uu). Confidentiality. (a) Applications, filings and reports required under sections 38a-577 to 38a-590, inclusive, except contracts referred to in subdivisions (4) and (5) of subsection (b) of section 38a-578, shall be public records. (b) Data o…

Sec. 38a-590. (Formerly Sec. 38-174vv). Commissioner's power to adopt regulations. The commissioner may adopt regulations, in accordance with the provisions of chapter 54, as he deems necessary to effect the purposes of sections 38a-577 to 38a-590, inclusive. (P.A. 88-272, S. 14.…

Sec. 38a-591. Compliance with the Patient Protection and Affordable Care Act. Regulations. (a) For purposes of this section, “Affordable Care Act” means the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, and regulations adopted thereunder.…

Sec. 38a-591a. *(See end of section for amended version of subdivision (7) and effective date.) Definitions. As used in this section and sections 38a-591b to 38a-591o, inclusive: (1) “Adverse determination” means: (A) The denial, reduction, termination or failure to provide or ma…