Title 38a — Title 38a: Insurance
33 chapters · 1,393 sections in this title.
Conn. Gen. Stat. § 38a-478a Commissioner's report to the Governor and the General Assembly.
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Sec. 38a-478a. Commissioner's report to the Governor and the General Assembly. On March first annually, the Insurance Commissioner shall submit a report to the Governor and to the joint standing committees of the General Assembly having cognizance of matters relating to public he…
Conn. Gen. Stat. § 38a-478b Penalty for managed care organization's failure to file data and reports. Commissioner's report to the Governor and the General Assembly on organizations that fail to file data and reports.
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Sec. 38a-478b. Penalty for managed care organization's failure to file data and reports. Commissioner's report to the Governor and the General Assembly on organizations that fail to file data and reports. (a) Each managed care organization, as defined in section 38a-478, that fai…
Conn. Gen. Stat. § 38a-478c Managed care organization's report to the commissioner: Data, reports and information required.
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Sec. 38a-478c. Managed care organization's report to the commissioner: Data, reports and information required. (a) On or before May first of each year, each managed care organization shall submit to the commissioner: (1) A report on its quality assurance plan that includes, but i…
Conn. Gen. Stat. § 38a-478d Provider directory. Notification to enrollee of termination or withdrawal of enrollee's primary care provider.
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Sec. 38a-478d. Provider directory. Notification to enrollee of termination or withdrawal of enrollee's primary care provider. For any contract delivered, issued for delivery, renewed, amended or continued in this state, each managed care organization shall: (1) Provide at least a…
Conn. Gen. Stat. § 38a-478e Medical protocols. Procedure prior to change. Physician input. Notification of change.
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Sec. 38a-478e. Medical protocols. Procedure prior to change. Physician input. Notification of change. (a) Each managed care organization shall, prior to implementing new medical protocols or substantially or materially altering existing medical protocols, obtain input from physic…
Conn. Gen. Stat. § 38a-478f Provider profile development requirements.
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Sec. 38a-478f. Provider profile development requirements. Each managed care organization, in developing provider profiles or otherwise measuring health care provider performance, shall: (1) Make allowances for the severity of illness or condition of the patient mix; (2) make allo…
Conn. Gen. Stat. § 38a-478g Managed care contract requirements. Plan description requirements.
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Sec. 38a-478g. Managed care contract requirements. Plan description requirements. (a) Each managed care contract delivered, issued for delivery, renewed, amended or continued in this state shall be in writing and a copy thereof furnished to the group contract holder or individual…
Conn. Gen. Stat. § 38a-478h Contract requirements and notice for removal or departure of provider. Retaliatory action prohibited.
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Sec. 38a-478h. Contract requirements and notice for removal or departure of provider. Retaliatory action prohibited. (a) Each contract delivered, issued for delivery, renewed, amended or continued in this state between a managed care organization and a participating provider shal…
Conn. Gen. Stat. § 38a-478i Limitation on enrollee rights prohibited.
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Sec. 38a-478i. Limitation on enrollee rights prohibited. No contract delivered, issued for delivery, renewed, amended or continued in this state between a managed care organization and a participating provider shall prohibit or limit any cause of action or contract rights an enro…
Conn. Gen. Stat. § 38a-478j Coinsurance and deductible payments based on negotiated discounts.
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Sec. 38a-478j. Coinsurance and deductible payments based on negotiated discounts. Each managed care plan that requires a deductible or percentage coinsurance payment by the insured shall calculate the insured's deductible or coinsurance payment on the lesser of the provider's or …
Conn. Gen. Stat. § 38a-478k Gag clauses prohibited.
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Sec. 38a-478k. Gag clauses prohibited. (a) No contract delivered, issued for delivery, renewed, amended or continued in this state between a managed care organization and a participating provider shall prohibit the provider from discussing with an enrollee any treatment options a…
Conn. Gen. Stat. § 38a-478l Consumer report card required. Content. Data analysis by commissioner.
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Sec. 38a-478l. Consumer report card required. Content. Data analysis by commissioner. (a) Not later than October fifteenth of each year, the Insurance Commissioner, after consultation with the Commissioner of Public Health, shall develop and distribute a consumer report card on a…
Conn. Gen. Stat. §§ 38a-478m and 38a-478n Internal grievance procedure; notice re procedure and final resolution; penalties; fines allocated to Office of the Healthcare Advocate. Exhaustion of internal appeal mechanisms; external appeal to commissioner; applicability to health insurers, managed care organizations and utilization review companies; fees; preliminary review; full review; public outreach program; expedited external appeal; requirements for and approval of independent review entities; filing of report.
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Secs. 38a-478m and 38a-478n. Internal grievance procedure; notice re procedure and final resolution; penalties; fines allocated to Office of the Healthcare Advocate. Exhaustion of internal appeal mechanisms; external appeal to commissioner; applicability to health insurers, manag…
Conn. Gen. Stat. § 38a-478o Confidentiality and antidiscrimination procedures required.
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Sec. 38a-478o. Confidentiality and antidiscrimination procedures required. (a) Each managed care organization shall conform to all applicable state and federal antidiscrimination and confidentiality statutes, shall ensure that the confidentiality of specified enrollee patient inf…
Conn. Gen. Stat. § 38a-478p Expedited utilization review. Standardized process required.
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Sec. 38a-478p. Expedited utilization review. Standardized process required. Section 38a-478p is repealed, effective July 1, 2011. (P.A. 97-99, S. 22, 32; P.A. 11-58, S. 89.)
Conn. Gen. Stat. § 38a-478q Use of laboratories covered by plan required.
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Sec. 38a-478q. Use of laboratories covered by plan required. Each provider, as defined in section 38a-478, in utilizing laboratories or testing facilities for enrollees in managed care plans that provide coverage for laboratories and testing facilities, shall utilize laboratories…
Conn. Gen. Stat. § 38a-478r Emergency rooms. Prudent layperson standard. Presenting symptoms or final diagnosis as basis for coverage. Mandatory coverage for medically necessary health care services for emergency medical conditions.
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Sec. 38a-478r. Emergency rooms. Prudent layperson standard. Presenting symptoms or final diagnosis as basis for coverage. Mandatory coverage for medically necessary health care services for emergency medical conditions. (a) Each provider, as defined in section 38a-478, shall code…
Conn. Gen. Stat. § 38a-478s Nonapplicability to self-insured employee welfare benefit plans and workers' compensation plans.
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Sec. 38a-478s. Nonapplicability to self-insured employee welfare benefit plans and workers' compensation plans. (a) Nothing in sections 38a-478 to 38a-478o, inclusive, sections 38a-591a to 38a-591h, inclusive, or section 38a-591n shall be construed to apply to the arrangements of…
Conn. Gen. Stat. § 38a-478t Commissioner of Public Health to receive data.
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Sec. 38a-478t. Commissioner of Public Health to receive data. The Commissioner of Public Health may request and shall receive any data, report or information filed with the Insurance Commissioner pursuant to the provisions of sections 38a-478 to 38a-478u, inclusive, 38a-479aa, 38…
Conn. Gen. Stat. § 38a-478u Regulations.
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Sec. 38a-478u. Regulations. The Insurance Commissioner may adopt regulations in accordance with the provisions of chapter 54 to implement the provisions of sections 38a-478 to 38a-478u, inclusive, 38a-479aa and 38a-993. (P.A. 97-99, S. 29; P.A. 99-284, S. 55, 60; June Sp. Sess. P…
Conn. Gen. Stat. § 38a-478v Applicability of Unfair and Prohibited Insurance Practices Act. Examination by Insurance Commissioner. Regulations.
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Sec. 38a-478v. Applicability of Unfair and Prohibited Insurance Practices Act. Examination by Insurance Commissioner. Regulations. (a) Each managed care organization, as defined in section 38a-478, shall be subject to the provisions of sections 38a-815 to 38a-819, inclusive. (b) …
Conn. Gen. Stat. § 38a-478w Managed care organization's calculation of enrollee liability for covered benefits. Credit required for third-party discounts and payments.
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Sec. 38a-478w. Managed care organization's calculation of enrollee liability for covered benefits. Credit required for third-party discounts and payments. (a) For any contract delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2022,…
Conn. Gen. Stat. § 38a-479 Definitions. Access to fee schedules. Fee information to be confidential.
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Sec. 38a-479. Definitions. Access to fee schedules. Fee information to be confidential. (a) As used in this section and section 38a-479b: (1) “Contracting health organization” means a managed care organization, as defined in section 38a-478, or a preferred provider network, as de…
Conn. Gen. Stat. § 38a-479a Physicians and managed care organizations to discuss issues relative to contracting between such parties.
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Sec. 38a-479a. Physicians and managed care organizations to discuss issues relative to contracting between such parties. The chairpersons and ranking members of the joint standing committee of the General Assembly having cognizance of matters relating to insurance shall convene, …
Conn. Gen. Stat. § 38a-479aa Preferred provider networks. Definitions. Licensing. Fees. Requirements. Exception.
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Sec. 38a-479aa. Preferred provider networks. Definitions. Licensing. Fees. Requirements. Exception. (a) As used in this part and subsection (b) of section 20-138b: (1) “Covered benefits” means health care services to which an enrollee is entitled under the terms of a managed care…
Conn. Gen. Stat. § 38a-479aaa Pharmacy benefits managers. Definitions.
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Sec. 38a-479aaa. Pharmacy benefits managers. Definitions. As used in this section and sections 38a-479bbb to 38a-479iii, inclusive: (1) “Commissioner” means the Insurance Commissioner; (2) “Department” means the Insurance Department; (3) “Drug” has the same meaning as provided in…
Conn. Gen. Stat. § 38a-479b Material changes to fee schedules. Return of payment by provider. Appeals. Filing of claim by provider under other applicable insurance coverage. Certain clauses, covenants and agreements prohibited. Exception.
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Sec. 38a-479b. Material changes to fee schedules. Return of payment by provider. Appeals. Filing of claim by provider under other applicable insurance coverage. Certain clauses, covenants and agreements prohibited. Exception. (a) No contracting health organization shall make mate…
Conn. Gen. Stat. § 38a-479bb Requirements for managed care organizations that contract with preferred provider networks. Requirements for preferred provider networks.
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Sec. 38a-479bb. Requirements for managed care organizations that contract with preferred provider networks. Requirements for preferred provider networks. (a) On and after May 1, 2004, no managed care organization may enter into or renew a contractual relationship with a preferred…
Conn. Gen. Stat. § 38a-479bbb Registration of pharmacy benefits managers required. Application for registration. Fee. Surety bond. Exemption from registration.
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Sec. 38a-479bbb. Registration of pharmacy benefits managers required. Application for registration. Fee. Surety bond. Exemption from registration. (a) Except as provided in subsection (d) of this section, no person shall act as a pharmacy benefits manager in this state without fi…
Conn. Gen. Stat. §§ 38a-479c to 38a-479z 38a-479c to 38a-479z
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Secs. 38a-479c to 38a-479z. Reserved for future use. PART Ib HEALTH INSURANCE: PREFERRED PROVIDER NETWORKS
Conn. Gen. Stat. § 38a-479cc Duties of a preferred provider network when providing services pursuant to a contract with a managed care organization.
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Sec. 38a-479cc. Duties of a preferred provider network when providing services pursuant to a contract with a managed care organization. (a) Whenever a preferred provider network is providing services pursuant to a contract with a managed care organization, the preferred provider …
Conn. Gen. Stat. § 38a-479ccc Certificate of registration; when issued or refused. Suspension, revocation or refusal to issue or renew registration; grounds.
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Sec. 38a-479ccc. Certificate of registration; when issued or refused. Suspension, revocation or refusal to issue or renew registration; grounds. (a) Upon receipt of a completed application, evidence of a surety bond and fee, the commissioner shall: (1) Issue and deliver to the ap…
Conn. Gen. Stat. § 38a-479dd Preferred provider network examination of outstanding amounts. Notice. Commissioner's duties.
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Sec. 38a-479dd. Preferred provider network examination of outstanding amounts. Notice. Commissioner's duties. Each preferred provider network shall examine its outstanding amounts in each quarter and if the preferred provider network determines that the outstanding amounts in a q…
Conn. Gen. Stat. § 38a-479ddd Hearing on denial of certificate. Subsequent application.
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Sec. 38a-479ddd. Hearing on denial of certificate. Subsequent application. (a) Upon refusal to issue or renew a certificate, the commissioner shall notify the applicant of the denial and of the applicant's right to request a hearing within ten days from the date of receipt of the…
Conn. Gen. Stat. § 38a-479ee Violations. Penalties. Investigations and staffing. Grievances. Referrals from Healthcare Advocate.
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Sec. 38a-479ee. Violations. Penalties. Investigations and staffing. Grievances. Referrals from Healthcare Advocate. (a) If the Insurance Commissioner determines that a preferred provider network or managed care organization, or both, has not complied with any applicable provision…
Conn. Gen. Stat. § 38a-479eee Claims payment to be made by electronic funds transfer upon written request.
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Sec. 38a-479eee. Claims payment to be made by electronic funds transfer upon written request. Upon written request from a pharmacy, a pharmacy benefits manager shall pay claims to such pharmacy by electronic funds transfer. Any such payments shall be made within the time periods …
Conn. Gen. Stat. § 38a-479ff Adverse action or threat of adverse action against complainant prohibited. Exception. Civil actions by aggrieved persons.
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Sec. 38a-479ff. Adverse action or threat of adverse action against complainant prohibited. Exception. Civil actions by aggrieved persons. No health insurer, health care center, utilization review company, as defined in section 38a-591a, or preferred provider network, as defined i…
Conn. Gen. Stat. § 38a-479fff Expiration of certificates of registration. Renewal. Fees.
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Sec. 38a-479fff. Expiration of certificates of registration. Renewal. Fees. (a) All certificates of registration issued under section 38a-479ccc shall expire annually on December thirty-first. (b) Any person seeking to renew a certificate of registration shall apply to the commis…
Conn. Gen. Stat. § 38a-479gg Regulations.
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Sec. 38a-479gg. Regulations. The Insurance Commissioner may adopt regulations, in accordance with chapter 54, to implement the provisions of this part. (P.A. 03-169, S. 7.)
Conn. Gen. Stat. § 38a-479ggg Regulations.
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Sec. 38a-479ggg. Regulations. The commissioner shall adopt regulations, in accordance with chapter 54, to implement the provisions of sections 38a-479aaa to 38a-479hhh, inclusive. Such regulations shall specify the contents of the application form and any other form or report req…
Conn. Gen. Stat. §§ 38a-479hh to 38a-479pp 38a-479hh to 38a-479pp
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Secs. 38a-479hh to 38a-479pp. Reserved for future use. PART Ic HEALTH INSURANCE: MEDICAL DISCOUNT PLANS
Conn. Gen. Stat. § 38a-479hhh Investigations and hearings. Powers of commissioner. Appeals.
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Sec. 38a-479hhh. Investigations and hearings. Powers of commissioner. Appeals. (a) The commissioner may conduct investigations and hold hearings on any matter under the provisions of sections 38a-479aaa to 38a-479iii, inclusive. The commissioner may issue subpoenas, administer oa…
Conn. Gen. Stat. § 38a-479iii Pharmacy audits.
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Sec. 38a-479iii. Pharmacy audits. (a) As used in this section: (1) “Extrapolation” means the practice of inferring a frequency of dollar amount of overpayments, underpayments, nonvalid claims or other errors on any portion of claims submitted, based on the frequency or dollar amo…
Conn. Gen. Stat. § 38a-479jjj Contract with 340B covered entity. Prohibited provisions. Reimbursement rates. Regulations.
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Sec. 38a-479jjj. Contract with 340B covered entity. Prohibited provisions. Reimbursement rates. Regulations. (a) For purposes of this section and section 19a-649: (1) “340B covered entity” means an entity authorized to participate in the federal 340B Drug Pricing Program under 42…
Conn. Gen. Stat. §§ 38a-479kkk to 38a-479nnn 38a-479kkk to 38a-479nnn
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Secs. 38a-479kkk to 38a-479nnn. Reserved for future use. PART Ie HEALTH INSURANCE: PRESCRIPTION DRUG COSTS
Conn. Gen. Stat. § 38a-479ooo Definitions.
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Sec. 38a-479ooo. Definitions. For the purposes of this part: (1) “Commissioner” means the Insurance Commissioner. (2) “Department” means the Insurance Department. (3) “Drug” has the same meaning as provided in section 21a-92. (4) “Health care plan” means an individual or a group …
Conn. Gen. Stat. § 38a-479ppp Annual report by pharmacy benefits managers. Standardized form. Confidentiality of information. Penalty. Regulations. Commissioner's report to the General Assembly.
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Sec. 38a-479ppp. Annual report by pharmacy benefits managers. Standardized form. Confidentiality of information. Penalty. Regulations. Commissioner's report to the General Assembly. (a) Not later than February 1, 2025, and annually thereafter, each pharmacy benefits manager shall…
Conn. Gen. Stat. § 38a-479qq Medical discount plans: Definitions, prohibited sales practices, penalties.
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Sec. 38a-479qq. Medical discount plans: Definitions, prohibited sales practices, penalties. (a) As used in this section and section 38a-479rr: (1) “Affiliate” means a person that directly or indirectly through one or more intermediaries, controls, or is controlled by, or is under…
Conn. Gen. Stat. § 38a-479qqq Annual report by health carriers. Regulations.
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Sec. 38a-479qqq. Annual report by health carriers. Regulations. (a) Each health carrier that delivers, issues for delivery, renews, amends or continues a health care plan on or after January 1, 2021, shall submit the following information and data to the commissioner, for such he…
Conn. Gen. Stat. § 38a-479rr Medical discount plan organizations: Licensure. List of authorized marketers. Provider agreements. Minimum net worth. Suspension of authority and revocation or nonrenewal of license. Reinstatement of license. Maintenance of information. Regulations. Penalties. Advertising and marketing materials. Investigations.
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Sec. 38a-479rr. Medical discount plan organizations: Licensure. List of authorized marketers. Provider agreements. Minimum net worth. Suspension of authority and revocation or nonrenewal of license. Reinstatement of license. Maintenance of information. Regulations. Penalties. Adv…