Title 38a — Title 38a: Insurance
33 chapters · 1,393 sections in this title.
Conn. Gen. Stat. § 38a-472h Fees charged by dentists, optometrists and ophthalmologists for noncovered benefits. Notice and posting required.
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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…
Conn. Gen. Stat. § 38a-472i Payment amount of professional services component of covered colonoscopy or endoscopic services.
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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…
Conn. Gen. Stat. § 38a-472j Restrictions applicable to cost-sharing for covered benefits. Regulations.
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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…
Conn. Gen. Stat. § 38a-472k Disability income policies. Discretionary clauses prohibited. Regulations.
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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…
Conn. Gen. Stat. § 38a-472l Participating dental provider contracts. Third-party access. Restrictions. Exceptions.
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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…
Conn. Gen. Stat. § 38a-473 Medicare supplement expense factors. Age, gender, previous claim or medical history rating prohibited.
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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…
Conn. Gen. Stat. § 38a-474 Medicare supplement policy rate increases: Procedure. Age, gender, previous claim or medical history rating prohibited.
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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…
Conn. Gen. Stat. § 38a-475 Precertification of long-term care policies under the Connecticut Partnership for Long-Term Care. Regulations.
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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…
Conn. Gen. Stat. § 38a-475a Minimum set of affordable benefit options for long-term care policies. Regulations.
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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…
Conn. Gen. Stat. § 38a-476 Preexisting condition coverage.
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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…
Conn. Gen. Stat. § 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. Construction. Application. Regulations.
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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…
Conn. Gen. Stat. § 38a-476b Standards re psychotropic drug availability in health plans.
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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…
Conn. Gen. Stat. § 38a-476c Policies and contracts with variable network and enrollee cost-sharing. Approval. Limitations.
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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…
Conn. Gen. Stat. § 38a-477 Standardized claim forms. Information necessary for filing a claim. Regulations.
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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…
Conn. Gen. Stat. § 38a-477a Notification by Insurance Commissioner of required benefits and policy forms.
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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…
Conn. Gen. Stat. § 38a-477aa Cost-sharing and health care provider reimbursements for emergency services, urgent crisis center services and surprise bills.
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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-…
Conn. Gen. Stat. § 38a-477b Postclaims underwriting prohibited unless approval granted. Application for approval of rescission, cancellation or limitation. Decision. Appeals. Regulations.
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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…
Conn. Gen. Stat. § 38a-477bb Cost-sharing re facility fees.
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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 …
Conn. Gen. Stat. § 38a-477c Disclosure of state and federal medical loss ratio with each health insurance application.
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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…
Conn. Gen. Stat. § 38a-477cc Contracts for pharmacy services with health carriers or pharmacy benefits managers.
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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…
Conn. Gen. Stat. § 38a-477d Information to be made available to consumers. Explanations of benefits. Disclosures by health carriers. Specifications by consumers. Restrictions.
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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…
Conn. Gen. Stat. § 38a-477dd Contracts with health carriers. Certain provisions concerning disclosures to covered persons prohibited.
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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…
Conn. Gen. Stat. § 38a-477e Health carriers to maintain Internet web site and toll-free telephone number. Available information. Exception.
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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…
Conn. Gen. Stat. § 38a-477ee Mental health and substance use disorder benefits. Nonquantitative treatment limitations. Reports. Public hearings. Regulations.
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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…
Conn. Gen. Stat. § 38a-477f Contract provision prohibiting certain disclosures prohibited.
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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…
Conn. Gen. Stat. § 38a-477ff Third-party discounts and payments for covered benefits. Credit required.
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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 …
Conn. Gen. Stat. § 38a-477g Contracts between health carriers and participating providers.
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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 …
Conn. Gen. Stat. § 38a-477gg Contracts between health carriers and pharmacy benefits managers. Credit required for third-party discounts and payments for covered prescription drug benefits.
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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…
Conn. Gen. Stat. § 38a-477h Participating provider directories.
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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…
Conn. Gen. Stat. § 38a-477hh Denial of coverage for otherwise covered benefits based on measurement of blood oxygen level by pulse oximeter prohibited.
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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…
Conn. Gen. Stat. § 38a-477i Contract provisions containing all-or-nothing clauses, anti-steering clauses, anti-tiering clauses or gag clauses prohibited.
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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…
Conn. Gen. Stat. § 38a-477ii Pulse oximeter accuracy. Educational materials. Distribution and posting required.
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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…
Conn. Gen. Stat. §§ 38a-477j to 38a-477z 38a-477j to 38a-477z
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Secs. 38a-477j to 38a-477z. Reserved for future use.
Conn. Gen. Stat. § 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.
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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…
Conn. Gen. Stat. § 38a-477kk Proof of coverage to disclose whether coverage is fully insured or self-insured. Regulations.
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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 …
Conn. Gen. Stat. § 38a-477ll Coverage for health enhancement programs.
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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,…
Conn. Gen. Stat. § 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.
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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…
Conn. Gen. Stat. § 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.
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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…
Conn. Gen. Stat. § 38a-478 Definitions.
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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…
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…