Title 38a, Title 38a: Insurance

Sec. 38a-472a. Medical provider indemnification agreements prohibited. No contract between a managed care company, other organization or insurer authorized to do business in this state and a medical provider practicing in this state for the provision of services may require that …

Sec. 38a-472b. Medical provider indemnification contracts. Professional actions and related liability. Notwithstanding the provisions of section 38a-472a, every medical provider participating in a contract pursuant to said section shall be responsible for his professional actions…

Sec. 38a-472c. Dental policies. Estimate of reimbursement. Material adjustments to fee schedules for in-network providers. Notice. (a) For any policy delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for inpatient or outpatient den…

Sec. 38a-472d. Public education outreach program re health insurance availability and eligibility requirements. (a) Not later than January 1, 2006, the Insurance Commissioner, in consultation with the Commissioner of Social Services and the Healthcare Advocate, shall develop a co…

Sec. 38a-472e. Health insurer. Requirements re offer to contract with a school-based health center. Each health insurer licensed to do business in this state shall, at the request of any school-based health center or group of school-based health centers, offer to contract with su…

Sec. 38a-472f. Network adequacy. Health carrier duties and responsibilities. Access plan filing. (a) As used in this section: (1) “Authorized representative” means (A) an individual to whom a covered person has given express written consent to represent the covered person, (B) an…

Sec. 38a-472g. Restrictions applicable to prior authorization or precertification. (a)(1) No insurer, health care center, fraternal benefit society, hospital service corporation or medical service corporation or other entity, delivering, issuing for delivery, renewing, amending o…

Sec. 38a-472h. Fees charged by dentists, optometrists and ophthalmologists for noncovered benefits. Notice and posting required. (a) No insurer, health care center, fraternal benefit society, hospital service corporation, medical service corporation or other entity delivering, is…

Sec. 38a-472i. Payment amount of professional services component of covered colonoscopy or endoscopic services. Each insurer, health care center, hospital service corporation, medical service corporation or fraternal benefit society that delivers, issues for delivery, renews, ame…

Sec. 38a-472j. Restrictions applicable to cost-sharing for covered benefits. Regulations. (a) Notwithstanding any provision of the general statutes and to the maximum extent permitted by federal law, no individual or group health insurance policy delivered, issued for delivery, r…

Sec. 38a-472k. Disability income policies. Discretionary clauses prohibited. Regulations. No insurer, health care center, fraternal benefit society, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, amending or c…

Sec. 38a-472l. Participating dental provider contracts. Third-party access. Restrictions. Exceptions. (a) For the purposes of this section: (1) “Covered person” means a policyholder, subscriber, enrollee or other individual participating in a network dental benefit plan; (2) “Den…

Sec. 38a-473. Medicare supplement expense factors. Age, gender, previous claim or medical history rating prohibited. (a) No insurance company, fraternal benefit society, hospital service corporation, medical service corporation, health care center or other entity that delivers or…

Sec. 38a-474. Medicare supplement policy rate increases: Procedure. Age, gender, previous claim or medical history rating prohibited. (a) Any insurance company, fraternal benefit society, hospital service corporation, medical service corporation, health care center or other entit…

Sec. 38a-475. Precertification of long-term care policies under the Connecticut Partnership for Long-Term Care. Regulations. The Insurance Department shall only precertify long-term care insurance policies that (1) alert the purchaser to the availability of consumer information a…

Sec. 38a-475a. Minimum set of affordable benefit options for long-term care policies. Regulations. (a) For the purposes of this section, “long-term care policy” has the same meaning as provided in section 38a-501 or section 38a-528, as applicable. (b) The commissioner shall, afte…

Sec. 38a-476. Preexisting condition coverage. (a) For the purposes of this section: (1) “Health insurance plan” means any hospital and medical expense incurred policy, hospital or medical service plan contract and health care center subscriber contract. “Health insurance plan” do…

Sec. 38a-476a. Compliance with the Health Insurance Portability and Accountability Act. Guaranteed renewability. Discrimination based on health status, newborns' and mothers' health prohibited. Parity of mental health benefits. Disclosure of information for employers. Constructio…

Sec. 38a-476b. Standards re psychotropic drug availability in health plans. Notwithstanding any provision of the general statutes or the regulations of Connecticut state agencies, no mental health care benefit provided under state law, or with state funds or to state employees ma…

Sec. 38a-476c. Policies and contracts with variable network and enrollee cost-sharing. Approval. Limitations. (a) The Insurance Commissioner shall approve any health insurance policy or contract, including, but not limited to, a policy or contract filed by a health care center, t…

Sec. 38a-477. Standardized claim forms. Information necessary for filing a claim. Regulations. (a) Except where there is an agreement to the contrary between a third-party payer and the health care provider, as defined in section 19a-17b, all health care providers shall submit al…

Sec. 38a-477a. Notification by Insurance Commissioner of required benefits and policy forms. The Insurance Commissioner shall provide written or electronic notification to each insurance company, fraternal benefit society, hospital service corporation, medical service corporation…

Sec. 38a-477aa. Cost-sharing and health care provider reimbursements for emergency services, urgent crisis center services and surprise bills. (a) As used in this section: (1) “Emergency condition” has the same meaning as “emergency medical condition”, as provided in section 38a-…

Sec. 38a-477b. Postclaims underwriting prohibited unless approval granted. Application for approval of rescission, cancellation or limitation. Decision. Appeals. Regulations. (a) Unless approval is granted pursuant to subsection (b) of this section, no insurer or health care cent…

Sec. 38a-477bb. Cost-sharing re facility fees. (a) As used in this section, “campus”, “facility fee”, “health system”, “hospital” and “hospital-based facility” have the same meanings as provided in section 19a-508c. (b) (1) Each health insurer, health care center or other entity …

Sec. 38a-477c. Disclosure of state and federal medical loss ratio with each health insurance application. An insurer or health care center shall include a written notice with each application for individual or group health insurance coverage that discloses such insurer's or healt…

Sec. 38a-477cc. Contracts for pharmacy services with health carriers or pharmacy benefits managers. (a) No contract for pharmacy services entered into in the state between a health carrier, as defined in section 38a-591a, or pharmacy benefits manager, as defined in section 38a-47…

Sec. 38a-477d. Information to be made available to consumers. Explanations of benefits. Disclosures by health carriers. Specifications by consumers. Restrictions. (a) Each insurer, health care center, hospital service corporation, medical service corporation, fraternal benefit so…

Sec. 38a-477dd. Contracts with health carriers. Certain provisions concerning disclosures to covered persons prohibited. Notwithstanding any provision of the general statutes, and to the maximum extent permitted by applicable law, no contract entered into or amended by a health c…

Sec. 38a-477e. Health carriers to maintain Internet web site and toll-free telephone number. Available information. Exception. (a) On and after January 1, 2017, each health carrier, as defined in section 19a-755b, shall maintain an Internet web site and toll-free telephone number…

Sec. 38a-477ee. Mental health and substance use disorder benefits. Nonquantitative treatment limitations. Reports. Public hearings. Regulations. (a) For the purposes of this section: (1) “Health carrier” has the same meaning as provided in section 38a-1080; (2) “Mental health and…

Sec. 38a-477f. Contract provision prohibiting certain disclosures prohibited. (a) On and after January 1, 2016, no contract entered into or renewed between a health care provider and a health carrier shall contain a provision prohibiting disclosure of (1) billed or allowed amount…

Sec. 38a-477ff. Third-party discounts and payments for covered benefits. Credit required. (a) Each insurer, health care center, hospital service corporation, medical service corporation, fraternal benefit society or other entity that delivers, issues for delivery, renews, amends …

Sec. 38a-477g. Contracts between health carriers and participating providers. (a) As used in this section: (1) “Covered person”, “facility” and “health carrier” have the same meanings as provided in section 38a-591a, (2) “health care provider” has the same meaning as provided in …

Sec. 38a-477gg. Contracts between health carriers and pharmacy benefits managers. Credit required for third-party discounts and payments for covered prescription drug benefits. (a) On and after January 1, 2022, each contract entered into between a health carrier, as defined in se…

Sec. 38a-477h. Participating provider directories. (a) As used in this section: (1) “Covered person”, “facility” and “health carrier” have the same meanings as provided in section 38a-591a, (2) “health care provider” has the same meaning as provided in subsection (a) of section 3…

Sec. 38a-477hh. Denial of coverage for otherwise covered benefits based on measurement of blood oxygen level by pulse oximeter prohibited. No insurer, health care center, hospital service corporation, medical service corporation, fraternal benefit society or other entity deliveri…

Sec. 38a-477i. Contract provisions containing all-or-nothing clauses, anti-steering clauses, anti-tiering clauses or gag clauses prohibited. (a) As used in this section: (1) “All-or-nothing clause” means any provision in a health care contract that: (A) Requires the health carrie…

Sec. 38a-477ii. Pulse oximeter accuracy. Educational materials. Distribution and posting required. (a) For the purposes of this section: (1) “Health carrier” has the same meaning as provided in section 38a-1080; and (2) “Pharmacy benefits manager” has the same meaning as provided…

Sec. 38a-477jj. Prescription drug formularies and lists of covered drugs. Removal or movement to higher cost-sharing tier during plan year prohibited. Exceptions. Study and report. (a) For the purposes of this section: (1) “Affordable Care Act” has the same meaning as provided in…

Sec. 38a-477kk. Proof of coverage to disclose whether coverage is fully insured or self-insured. Regulations. (a) For the purposes of this section: (1) “Health carrier” has the same meaning as provided in section 38a-1080; and (2) “Third-party administrator” has the same meaning …

Sec. 38a-477ll. Coverage for health enhancement programs. (a) For the purposes of this section, “health enhancement program” means a health benefit program that ensures access and removes barriers to essential, high-value clinical services. (b) (1) Not later than January 1, 2024,…

Sec. 38a-477mm. Prohibition on reduction in amount of reimbursement paid to telehealth provider for covered health care or health services that telehealth provider appropriately provided to insured through telehealth. (a) As used in this section: (1) “Health carrier” has the same…

Sec. 38a-477nn. Prohibition on denial of reimbursement or prevention from participating in provider network based solely on health care provider's decision not to maintain specialty certification. (a) For purposes of this section: (1) “Health care provider” has the same meaning a…

Sec. 38a-478. Definitions. As used in this section, sections 38a-478a to 38a-478o, inclusive, subsection (a) of section 38a-478s and section 38a-478w: (1) “Commissioner” means the Insurance Commissioner. (2) “Covered benefit” or “benefit” means a health care service to which an e…

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…