Connecticut Chapter 700c — Health Insurance (contains Secs. 38a-469 to 38a-594)
- Sec. 38a-469. Definitions.
- Sec. 38a-470. (Formerly Sec. 38-174n). Lien on workers' compensation awards for insurers. Notice of lien.
- Sec. 38a-471. (Formerly Sec. 38-174o). Third party prescription programs. Notice of cancellation. Applicability of section.
- Sec. 38a-472. (Formerly Sec. 38-174a). Assignment of insurance proceeds to doctor, hospital or state agency. Lien for state care. Notice of lien.
- Sec. 38a-472a. Medical provider indemnification agreements prohibited.
- Sec. 38a-472b. Medical provider indemnification contracts. Professional actions and related liability.
- Sec. 38a-472c. Dental policies. Estimate of reimbursement.
- Sec. 38a-473. Medicare supplement expense factors. Age, gender, previous claim or medical history rating prohibited. Exceptions.
- Sec. 38a-474. Rate increases: Procedure. Age, gender, previous claim or medical history rating prohibited. Exceptions.
- Sec. 38a-475. Precertification of long-term care policies under the Connecticut Partnership for Long-Term Care. Regulations.
- Sec. 38a-476. Preexisting condition coverage.
- 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. Construction. Application. Regulations.
- Sec. 38a-476b. Standards re psychotropic drug availability in health plans.
- Sec. 38a-477. Standardized claim forms. Information necessary for filing a claim. Regulations.
- Sec. 38a-478. Definitions.
- Sec. 38a-478a. Commissioner's report to the Governor and the General Assembly.
- Sec. 38a-478b. Penalty for managed care organization's failure to file data and reports. Commission's report to the Governor and the General Assembly on organizations that fail to file data and reports.
- Sec. 38a-478c. Managed care organization's report to the commissioner: Data, reports and information required.
- Sec. 38a-478d. List of providers required. Notification to enrollee of removal from list of enrollee's primary care physician.
- Sec. 38a-478e. Medical protocols. Procedure prior to change. Physician input. Notification of change.
- Sec. 38a-478f. Provider profile development requirements.
- Sec. 38a-478g. Managed care contract requirements. Plan description requirements.
- Sec. 38a-478h. Removal of providers. Notice requirements. Retaliatory action prohibited.
- Sec. 38a-478i. Limitation on enrollee rights prohibited.
- Sec. 38a-478j. Coinsurance payments based on negotiated discounts.
- Sec. 38a-478k. Gag clauses prohibited.
- Sec. 38a-478l. Consumer report card required. Content.
- Sec. 38a-478m. Internal grievance procedure. Duty to establish and notify enrollees of procedure. Deadline for resolving complaints.
- Sec. 38a-478n. Exhaustion of internal appeal mechanisms. External appeal to commissioner. Fees. Refund of fees. Request for information. Public education outreach program.
- Sec. 38a-478o. Confidentiality and antidiscrimination procedures required.
- Sec. 38a-478p. Expedited utilization review. Standardized form required.
- Sec. 38a-478q. Use of laboratories covered by plan required.
- Sec. 38a-478r. Emergency rooms. Prudent layperson standard. Presenting symptoms or final diagnosis as basis for coverage.
- Sec. 38a-478s. ERISA. Workers' compensation. Nonapplicability.
- Sec. 38a-478t. Commissioner of Public Health to receive data.
- Sec. 38a-478u. Regulations.
- Sec. 38a-478v. Applicability of Unfair and Prohibited Insurance Practices Act. Examination by Insurance Commissioner. Regulations.
- Secs. 38a-479 to 38a-479z.
- Sec. 38a-479aa. Preferred provider networks. Definitions. Licensing. Fees. Requirements.
- Sec. 38a-479bb. Requirements for managed care organizations that contract with preferred provider networks. Requirements for preferred provider networks.
- Sec. 38a-479cc. Duties of a preferred provider network when providing services pursuant to a contract with a managed care organization.
- Sec. 38a-479dd. Preferred provider network examination of outstanding amounts. Notice. Commissioner's duties.
- Sec. 38a-479ee. Violations. Penalties. Investigations and staffing. Grievances. Referrals from Managed Care Ombudsman.
- Sec. 38a-479ff. Adverse action or threat of adverse action against complainant prohibited. Exception. Civil actions by aggrieved persons.
- Sec. 38a-479gg. Regulations.
- Sec. 38a-480. (Formerly Sec. 38-174). Nonapplication to certain policies or contracts.
- Sec. 38a-481. (Formerly Sec. 38-165). Approval of individual health application and policy form by commissioner. Exception re Medicare supplement policy. Filing, form and minimum provisions of loss ratio guarantee. Regulations. Age, gender, previous claim or medical history rating prohibited. Exceptions. Optional life insurance riders. Underwriting classifications.
- Sec. 38a-482. (Formerly Sec. 38-166). Form of policy.
- Sec. 38a-483. (Formerly Sec. 38-167). Standard provisions of individual health policy.
- Sec. 38a-483a. Exclusionary riders for individual health insurance policies. Regulations.
- Sec. 38a-483b. Time limits for coverage determinations. Notice requirements.
- Sec. 38a-483c. Coverage and notice re experimental treatments. Appeals.
- Sec. 38a-484. (Formerly Sec. 38-168). Policy provisions not to be less favorable than standard. Validity of policy issued in violation of law.
- Sec. 38a-485. (Formerly Sec. 38-169). Copy of application to be part of new policy or to be furnished with renewal. Alteration of application.
- Sec. 38a-486. (Formerly Sec. 38-170). Certain acts not to operate as waiver of rights.
- Sec. 38a-487. (Formerly Sec. 38-171). Coverage after termination date of policy.
- Sec. 38a-488. (Formerly Sec. 38-172). Discrimination.
- Sec. 38a-488a. Mandatory coverage for the diagnosis and treatment of mental or nervous conditions. Exceptions. Benefits payable re type of provider or facility. State's claim against proceeds.
- Sec. 38a-489. (Formerly Sec. 38-174e). Continuation of coverage of mentally or physically handicapped children.
- Sec. 38a-490. (Formerly Sec. 38-174g). Coverage for newborn infants in health insurance policies. Notice. Application.
- Sec. 38a-490a. Coverage for birth-to-three program.
- Sec. 38a-490b. Coverage for hearing aids for children twelve and under.
- Sec. 38a-490c. Coverage for craniofacial disorders.
- Sec. 38a-491. (Formerly Sec. 38-174h). Coverage for services performed by dentists in certain instances.
- Sec. 38a-491a. Coverage for in-patient, outpatient or one-day dental services in certain instances.
- Sec. 38a-491b. Assignment of benefits to a dentist or oral surgeon.
- Sec. 38a-492. (Formerly Sec. 38-174i). Coverage for accidental ingestion or consumption of controlled drugs. Benefits prescribed.
- Sec. 38a-492a. Mandatory coverage for hypodermic needles and syringes.
- Sec. 38a-492b. Coverage for off-label drug prescriptions.
- Sec. 38a-492c. Coverage for low protein modified food products, amino acid modified preparations and specialized formulas.
- Sec. 38a-492d. Mandatory coverage for diabetes testing and treatment.
- Sec. 38a-492e. Mandatory coverage for diabetes outpatient self-management training.
- Sec. 38a-492f. Mandatory coverage for certain prescription drugs removed from formulary.
- Sec. 38a-492g. Mandatory coverage for prostate cancer screening.
- Sec. 38a-492h. Mandatory coverage for certain Lyme disease treatments.
- Sec. 38a-492i. Mandatory coverage for pain management.
- Sec. 38a-492j. Mandatory coverage for ostomy-related supplies.
- Sec. 38a-492k. Mandatory coverage for colorectal cancer screening.
- Sec. 38a-493. (Formerly Sec. 38-174k). Mandatory coverage for home health care. Deductibles. Exception from deductible limits for medical savings accounts, Archer MSAs and health savings accounts.
- Sec. 38a-494. (Formerly Sec. 38-174l). Home health care by recognized nonmedical systems.
- Sec. 38a-495. (Formerly Sec. 38-174m). Medicare supplement policies. Coverage of home health aid services and mammography. Prescription drug riders.
- Sec. 38a-495a. Medicare supplement policies and certificates. Minimum required policy benefits and standards. Regulations.
- Sec. 38a-495b. Medicare supplement policies and certificates. Definitions.
- Sec. 38a-495c. Premium rates charged on a community rate basis. Age, gender, previous claim or medical history rating prohibited. Exceptions. Medicare supplement policies for the disabled.
- Sec. 38a-496. (Formerly Sec. 38-174q). Coverage for occupational therapy. Definitions. Benefits.
- Sec. 38a-497. (Formerly Sec. 38-174r). Termination of coverage of children in individual policies.
- Sec. 38a-497a. Group coverage and benefits of a noncustodial parent. National Medical Support Notice. Notification of new employer by IV-D agency. Notification to custodial parent. Enrollment of child.
- Sec. 38a-498. (Formerly Sec. 38-174t). Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider.
- Sec. 38a-498a. Preauthorization prohibited for certain 9-1-1 emergency calls.
- Sec. 38a-499. (Formerly Sec. 38-174v). Mandatory coverage for services of physician assistants and certain nurses.
- Sec. 38a-500. (Formerly Sec. 38-174w). Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries. Subrogation rights.
- Sec. 38a-501. (Formerly Sec. 38-174x). Long-term care policies.
- Sec. 38a-502. (Formerly Sec. 38-174ff). Mandatory coverage for services provided by the Veterans' Home.
- Sec. 38a-503. (Formerly Sec. 38-174gg). Mandatory coverage for mammography.
- Sec. 38a-503a. Mandatory coverage for breast cancer survivors.
- Sec. 38a-503b. Carriers to permit direct access to obstetrician-gynecologist.
- Sec. 38a-503c. Mandatory coverage for maternity care. Notice required.
- Sec. 38a-503d. Mandatory coverage for mastectomy care. Termination of provider contract prohibited.
- Sec. 38a-503e. Mandatory coverage for prescription contraceptives.
- Sec. 38a-504. (Formerly Sec. 38-262i). Mandatory coverage for treatment of tumors and leukemia. Mandatory coverage for reconstructive surgery, prosthesis, chemotherapy and wigs. Mandatory coverage for breast reconstruction after mastectomy.
- Sec. 38a-504a. Coverage for certain cancer clinical trials.
- Sec. 38a-504b. Cancer clinical trials that are eligible for coverage.
- Sec. 38a-504c. Evidence and information re eligibility for cancer clinical trial. No coverage required for otherwise reimbursable costs.
- Sec. 38a-504d. Cancer clinical trials: Routine patient care costs.
- Sec. 38a-504e. Cancer clinical trials: Billing. Payments. Appeals.
- Sec. 38a-504f. Cancer clinical trials: Standardized forms. Time frames for coverage determinations. Appeals. Regulations.
- Sec. 38a-504g. Cancer clinical trials: Submission and certification of policy forms.
- Sec. 38a-505. (Formerly Sec. 38-378). Insurance Commissioner's powers concerning comprehensive health care plans. Notification to purchasers of policy.
- Sec. 38a-506. (Formerly Sec. 38-173). Penalty.
- Sec. 38a-507. Coverage for services performed by chiropractors.
- Sec. 38a-508. Coverage for adopted children.
- Secs. 38a-509 to 38a-511.
- Sec. 38a-512. Applicability of statutes to certain major medical expense policies.
- Sec. 38a-513. Approval of group health insurance policy forms. Age, gender, previous claim or medical history rating prohibited. Exceptions. Optional life insurance riders.
- Sec. 38a-513a. Time limits for coverage determinations. Notice requirements.
- Sec. 38a-513b. Coverage and notice re experimental treatments. Appeals.
- Sec. 38a-514. (Formerly Sec. 38-174d). Mandatory coverage for the diagnosis and treatment of mental or nervous conditions. Exceptions. Benefits payable re type of provider or facility. State's claim against proceeds.
- Sec. 38a-514a. Biologically-based mental illness. Coverage required.
- Sec. 38a-515. Continuation of coverage of mentally retarded or physically handicapped dependent children.
- Sec. 38a-516. Coverage for newborn infants in health insurance policies. Notice. Application.
- Sec. 38a-516a. Coverage for birth-to-three program.
- Sec. 38a-516b. Coverage for hearing aids for children twelve and under.
- Sec. 38a-516c. Coverage for craniofacial disorders.
- Sec. 38a-517. Coverage for services performed by dentist in certain instances.
- Sec. 38a-517a. Coverage for in-patient, outpatient or one-day dental services in certain instances.
- Sec. 38a-517b. Assignment of benefits to a dentist or oral surgeon.
- Sec. 38a-518. Coverage for accidental ingestion or consumption of controlled drugs. Benefits prescribed.
- Sec. 38a-518a. Mandatory coverage for hypodermic needles and syringes.
- Sec. 38a-518b. Coverage for off-label drug prescriptions.
- Sec. 38a-518c. Coverage for low protein modified food products, amino acid modified preparations and specialized formulas.
- Sec. 38a-518d. Mandatory coverage for diabetes testing and treatment.
- Sec. 38a-518e. Mandatory coverage for diabetes outpatient self-management training.
- Sec. 38a-518f. Mandatory coverage for certain prescription drugs removed from formulary.
- Sec. 38a-518g. Mandatory coverage for prostate cancer screening.
- Sec. 38a-518h. Mandatory coverage for certain Lyme disease treatments.
- Sec. 38a-518i. Mandatory coverage for pain management.
- Sec. 38a-518j. Mandatory coverage for ostomy-related supplies.
- Sec. 38a-518k. Mandatory coverage for colorectal cancer screening.
- Sec. 38a-519. (Formerly Sec. 38-174j). Offset proviso prohibited in certain policies.
- Sec. 38a-520. Mandatory coverage for home health care. Deductibles. Exception from deductible limits for medical savings accounts. Archer MSAs and health savings accounts.
- Sec. 38a-521. Home health care by recognized nonmedical systems.
- Sec. 38a-522. Medicare supplement policies. Coverage of home health aide service.
- Sec. 38a-523. (Formerly Sec. 38-174p). Group hospital or medical insurance coverage for comprehensive rehabilitation services.
- Sec. 38a-524. Coverage for occupational therapy. Definitions. Benefits.
- Sec. 38a-525. Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider.
- Sec. 38a-525a. Preauthorization prohibited for certain 9-1-1 emergency calls.
- Sec. 38a-526. Mandatory coverage for services of physician assistants and certain nurses.
- Sec. 38a-527. Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries.
- Sec. 38a-528. Long-term care policies.
- Sec. 38a-529. Mandatory coverage for services provided by the Veterans' Home.
- Sec. 38a-530. Mandatory coverage for mammography.
- Sec. 38a-530a. Mandatory coverage for breast cancer survivors.
- Sec. 38a-530b. Carriers to permit direct access to obstetrician-gynecologist.
- Sec. 38a-530c. Mandatory coverage for maternity care. Notice required.
- Sec. 38a-530d. Mandatory coverage for mastectomy care. Termination of provider contract prohibited.
- Sec. 38a-530e. Mandatory coverage for prescription contraceptives.
- Sec. 38a-531. (Formerly Sec. 38-174hh). Mandatory coverage for employees of certain employers. Approval of policy forms.
- Sec. 38a-532. (Formerly Sec. 38-262a). Assignment of incidents of ownership under group life, health or accident policy.
- Sec. 38a-533. (Formerly Sec. 38-262b). Mandatory coverage for the treatment of medical complications of alcoholism.
- Sec. 38a-534. Mandatory coverage for chiropractic services.
- Sec. 38a-535. Mandatory coverage for preventive pediatric care.
- Sec. 38a-535a. Notification of individual coverage and benefits of a noncustodial parent to a custodial parent, when. Regulations.
- Sec. 38a-536. Group hospital or medical expense insurance policy coverage for infertility.
- 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. Retroactive coverage.
- Sec. 38a-538. (Formerly Sec. 38-262d). Continuation of benefits under group employee health plans.
- Sec. 38a-539. (Formerly Sec. 38-262f). Group hospital or medical expense insurance policy coverage for treatment of alcoholism on an outpatient basis.
- Sec. 38a-540. (Formerly Sec. 38-262g). Duplication of coverage under group health insurance policies.
- 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.
- Sec. 38a-542. Mandatory coverage for treatment of tumors and leukemia. Mandatory coverage for reconstructive surgery, prothesis, chemotherapy and wigs. Mandatory coverage for breast reconstruction after mastectomy.
- Sec. 38a-542a. Cancer clinical trials: Coverage for routine patient care costs.
- Sec. 38a-542b. Cancer clinical trials: When eligible for coverage.
- Sec. 38a-542c. Cancer clinical trials: Evidence and information re eligibility for. No coverage required for otherwise reimbursable costs.
- Sec. 38a-542d. Cancer clinical trials: Routine patient care costs.
- Sec. 38a-542e. Cancer clinical trials: Billing. Payments. Appeals.
- Sec. 38a-542f. Cancer clinical trials: Standardized forms. Time frames for coverage determinations. Appeals. Regulations.
- Sec. 38a-542g. Cancer clinical trials: Submission and certification of policy forms.
- Sec. 38a-543. (Formerly Sec. 38-262j). Age discrimination in group insurance coverage prohibited.
- Sec. 38a-544. Prescription drug coverage. Mail order pharmacies.
- Sec. 38a-545. (Formerly Sec. 38-262k). Group dental health insurance plans. Alternative coverage option.
- Sec. 38a-546. (Formerly Sec. 38-379). Continuation of benefits under group health policies.
- 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.
- Sec. 38a-548. Penalty.
- Sec. 38a-549. Coverage for adopted children.
- Sec. 38a-550.
- Sec. 38a-551. (Formerly Sec. 38-371). Definitions.
- Sec. 38a-552. (Formerly Sec. 38-372). Applicability. Individual and group comprehensive health care plans.
- Sec. 38a-553. (Formerly Sec. 38-373). Minimum standard benefits of comprehensive health care plans. Optional and excludable benefits. Managed care plans.
- Sec. 38a-554. (Formerly Sec. 38-374). Additional requirements and eligibility under group comprehensive health care plans. Continuation of benefits under group plans. Insurance Commissioner's authority to coordinate benefits.
- Sec. 38a-555. (Formerly Sec. 38-375). Additional requirements for individual comprehensive health care plans. Carrier obligations concerning termination of coverage.
- Sec. 38a-556. (Formerly Sec. 38-376). Health Reinsurance Association. Classes of risk. Audits. Insurance Commissioner's powers. Qualification as an acceptable alternative mechanism.
- Sec. 38a-557. (Formerly Sec. 38-377). Hospital and medical service corporations. Residual market mechanism. Insurance Commissioner's powers concerning such mechanisms.
- Sec. 38a-558. (Formerly Sec. 38-380). Office of Health Care Access.
- Sec. 38a-559. (Formerly Sec. 38-381). Commissioner of Social Services. Contract authority concerning Medicaid programs.
- Secs. 38a-560. Small employer grouping for health insurance coverage.
- Secs. 38a-561 to 38a-563.
- Sec. 38a-564. Definitions.
- Sec. 38a-565. Special health care plans.
- Sec. 38a-566. Health insurance plans or insurance arrangements covering employees of a small employer. Trusts. Trade associations. Self-employed individuals.
- Sec. 38a-567. Provisions of small employer plans and arrangements.
- Sec. 38a-568. Coverage under small employer health care plans and arrangements. Approval by commissioner.
- Sec. 38a-569. Connecticut Small Employer Health Reinsurance Pool.
- Sec. 38a-570. Issuance of special health care plans by the Health Reinsurance Association to small employers.
- Sec. 38a-571. Issuance of individual special health care plans by the Health Reinsurance Association.
- Sec. 38a-572. Requirement to provide service to certain low-income persons.
- Sec. 38a-573. Validity of separate provisions.
- Sec. 38a-574. Standard underwriting form.
- Secs. 38a-575 and 38a-576.
- Sec. 38a-577. (Formerly Sec. 38-174ii). Consumer dental health plans. Definitions.
- Sec. 38a-578. (Formerly Sec. 38-174jj). Certificate of authority. Application requirements.
- Sec. 38a-579. (Formerly Sec. 38-174kk). Certificate of authority. Standards for issuance and renewal.
- Sec. 38a-580. (Formerly Sec. 38-174ll). General surplus required.
- Sec. 38a-581. (Formerly Sec. 38-174mm). Evidence of coverage to be provided to enrollees. Approval by commissioner.
- Sec. 38a-582. (Formerly Sec. 38-174nn). Schedule of charges. Approval by commissioner. Appeal of disapproval.
- Sec. 38a-583. (Formerly Sec. 38-174oo). Records. Commissioner's power to examine; maintenance; preservation.
- Sec. 38a-584. (Formerly Sec. 38-174pp). Complaint system.
- Sec. 38a-585. (Formerly Sec. 38-174qq). Requirements re filing of annual reports with commissioner.
- Sec. 38a-586. (Formerly Sec. 38-174rr). False or misleading advertising or solicitation and deceptive evidence of coverage prohibited.
- Sec. 38a-587. (Formerly Sec. 38-174ss). Suspension or revocation of certificate of authority. Hearing. Appeal.
- Sec. 38a-588. (Formerly Sec. 38-174tt). Penalty. Insolvency.
- Sec. 38a-589. (Formerly Sec. 38-174uu). Confidentiality.
- Sec. 38a-590. (Formerly Sec. 38-174vv). Commissioner's power to adopt regulations.
- Secs. 38a-591 to 38a-594.