2013 Connecticut General Statutes
Title 38a - Insurance
Chapter 700c - Health Insurance
Section 38a-483b - Time limits for coverage determinations. Notice requirements.

Except as otherwise provided in this title, each insurer, health care center, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, amending or continuing any individual health insurance policy in this state providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 shall complete any coverage determination with respect to such policy and notify the insured or the insured’s health care provider of its decision not later than forty-five days after a request for such determination is received by the insurer, health care center, hospital service corporation, medical service corporation or other entity. In the case of a denial of coverage, such entity shall notify the insured and the insured’s health care provider of the reasons for such denial. If the reasons for such denial include that the requested service is not medically necessary or is not a covered benefit under such policy, the entity shall (1) notify the insured that such insured may contact the Office of the Healthcare Advocate if the insured believes the insured has been given erroneous information, and (2) provide to such insured the contact information for said office.

(P.A. 99-284, S. 12; P.A. 10-24, S. 1; P.A. 11-19, S. 23.)

History: P.A. 10-24 made technical changes and added requirement for information re Office of the Healthcare Advocate to be provided to insured for certain denials of coverage, effective January 1, 2011; P.A. 11-19 made technical changes.

See Sec. 38a-513a for similar provisions re group policies.