2019 Connecticut General Statutes
Title 38a - Insurance
Chapter 705 - Connecticut Insurance Information and Privacy Protection Act
Section 38a-976 - (Formerly Sec. 38-501). Definitions.
As used in sections 38a-975 to 38a-998, inclusive:
(1) “Adverse underwriting decisions” means:
(A) Any of the following actions with respect to insurance transactions involving insurance coverage that is individually underwritten: (i) A declination or termination of insurance coverage; (ii) failure of an agent to apply for insurance coverage with a specific insurance institution which the agent represents and which is requested by an applicant; (iii) in the case of a property or casualty insurance coverage, (I) placement by an insurance institution or agent of a risk with a residual market mechanism, an unauthorized insurer or an insurance institution which specializes in substandard risks, (II) the charging of a higher rate on the basis of information which differs from that which the applicant or policyholder furnished, or (III) changing a risk from a preferred rate program to a standard rate program or from a standard rate program to a nonstandard rate program within the same company or between two companies in the same group; and (iv) in the case of a life, health or disability insurance coverage, an offer to insure at higher than standard rates.
(B) Notwithstanding the provisions of subparagraph (A) of this subdivision, the following actions shall not be considered adverse underwriting decisions: (i) The termination of an individual policy form on a class or state-wide basis; (ii) a declination of insurance coverage solely because such coverage is not available on a class or state-wide basis; or (iii) the rescission of a policy.
(2) “Affiliate” or “affiliated” has the same meaning as provided in section 38a-1.
(3) “Agent” has the same meaning as “insurance producer”, as defined in section 38a-702a.
(4) “Applicant” means any person who seeks to contract for insurance coverage other than a person seeking group insurance that is not individually underwritten.
(5) “Commissioner” means the Insurance Commissioner.
(6) “Consumer report” means any written, oral or other communication of information bearing on an individual's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living which is used or expected to be used in connection with an insurance transaction.
(7) “Consumer reporting agency” means any person who: (A) Regularly engages, in whole or in part, in the practice of assembling or preparing consumer reports for a fee; (B) obtains information primarily from sources other than insurance institutions; and (C) furnishes consumer reports to other persons.
(8) “Control”, including the terms “controlled by” or “under common control with”, has the same meaning as provided in section 38a-1.
(9) “Declination of insurance coverage” means a denial, in whole or in part, by an insurance institution or agent, of requested insurance coverage.
(10) “Individual” means any person who: (A) In the case of property or casualty insurance, is a past, present or proposed named insured or certificate holder; (B) in the case of life, health or disability insurance, is a past, present or proposed principal insured or certificate holder; (C) is a past, present or proposed policyowner; (D) is a past or present applicant or claimant; or (E) derived, derives or is proposed to derive insurance coverage under an insurance policy or certificate subject to sections 38a-975 to 38a-998, inclusive.
(11) “Institutional source” means any person or governmental entity that provides information about an individual to an agent, insurance institution or insurance-support organization, other than: (A) An agent; (B) the individual who is the subject of the information; or (C) an individual acting in a personal capacity rather than a business or professional capacity.
(12) “Insurance institution” means any corporation, limited liability company, association, partnership, reciprocal exchange, interinsurer, Lloyd's insurer, fraternal benefit society or other person engaged in the business of insurance, including health care centers, as defined in section 38a-175, medical service corporations, as defined in section 38a-214, managed care organizations, as defined in section 38a-478 and hospital service corporations, as defined in section 38a-199. It shall not include agents or insurance-support organizations.
(13) (A) “Insurance-support organization” means any person who regularly engages, in whole or in part, in the practice of assembling or collecting information concerning individuals for the primary purpose of providing the information to an insurance institution or agent for insurance transactions, including: (i) The furnishing of consumer reports or investigative consumer reports to an insurance institution or agent for use in connection with an insurance transaction; (ii) the collection of personal information from insurance institutions, agents or other insurance-support organizations for the purpose of detecting or preventing fraud, material misrepresentation or material nondisclosure in connection with insurance underwriting or insurance claim activity; or (iii) collecting medical record information from, disclosing medical record information to, or collecting medical record information on behalf of an insurance institution or agent in the ordinary course of business, including, but not limited to, utilization review companies, benefit management entities, including, but not limited to, pharmaceutical benefit and disease management entities and information or computer management entities.
(B) Notwithstanding subparagraph (A) of this subdivision, the following persons shall not be considered “insurance-support organizations” for purposes of sections 38a-975 to 38a-998, inclusive: Agents, government institutions, insurance institutions, medical care institutions, medical professionals, pharmacies, universities and schools.
(14) “Insurance transaction” means any transaction involving insurance primarily for personal, family or household needs rather than business or professional needs that involves: (A) The determination of an individual's eligibility for an insurance coverage, benefit or payment; or (B) the servicing of an insurance application, policy, contract or certificate.
(15) “Investigative consumer report” means a consumer report or portion thereof in which information about an individual's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with the person's neighbors, friends, associates, acquaintances or others who may have such knowledge.
(16) “Medical-care institution” means any facility or institution that is licensed to provide health care services to individuals, including but not limited to health care centers, home-health agencies, hospitals, medical clinics, public health agencies, rehabilitation agencies and skilled nursing facilities.
(17) “Medical professional” means any person licensed or certified to provide health care services to individuals, including, but not limited to, a chiropractor, clinical dietitian, clinical psychologist, dentist, nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician, podiatrist, psychiatric social worker or speech therapist.
(18) “Medical-record information” means personal information that: (A) Relates to the physical, mental or behavioral health condition, medical history or medical treatment of an individual or a member of the individual's family; and (B) is obtained from a medical professional or medical-care institution, from a pharmacy or pharmacist, from the individual, or from the individual's spouse, parent or legal guardian or from the provision of or payment for health care to or on behalf of an individual or a member of the individual's family. “Medical-record information” does not include such information from which personal identifiers that either directly reveal the identity of the patient, or provide a means of identifying the patient, have been removed or have been encrypted or encoded such that the identity of the individual is not revealed without the use of an encryption key or code.
(19) “Person” has the same meaning as provided in section 38a-1.
(20) “Personal information” means any individually identifiable information gathered in connection with an insurance transaction from which judgments can be made about an individual's character, habits, avocations, finances, occupation, general reputation, credit, health or any other personal characteristics. “Personal information” includes an individual's name and address and “medical-record information” but does not include “privileged information”.
(21) “Policyholder” means any person who: (A) In the case of individual property or casualty insurance, is a present named insured; (B) in the case of individual life, health or disability insurance, is a present policyowner; or (C) in the case of group insurance that is individually underwritten, is a present group certificate holder.
(22) “Pretext interview” means an interview where a person, in an attempt to obtain information about an individual, performs one or more of the following acts: (A) Pretends to be someone he is not; (B) pretends to represent a person he is not in fact representing; (C) misrepresents the true purpose of the interview; or (D) refuses to identify himself upon request.
(23) “Privileged information” means any individually identifiable information that: (A) Relates to a claim for insurance benefits or a civil or criminal proceeding involving an individual; and (B) is collected in connection with or in reasonable anticipation of a claim for insurance benefits or a civil or criminal proceeding involving an individual. Information otherwise meeting the requirements of this subdivision shall nevertheless be considered “personal information” under sections 38a-975 to 38a-998, inclusive, if it is disclosed in violation of section 38a-988.
(24) “Residual market mechanism” means an association, organization or other entity defined or described in sections 38a-328, 38a-329 and 38a-670.
(25) “Termination of insurance coverage” or “termination of an insurance policy” means either a cancellation or nonrenewal of an insurance policy, in whole or in part, for any reason other than the failure to pay a premium as required by the policy.
(26) “Unauthorized insurer” has the same meaning as provided in section 38a-1.
(P.A. 81-368, S. 2, 25; P.A. 83-177, S. 1, 2; P.A. 90-243, S. 165; P.A. 94-160, S. 23, 24; P.A. 95-79, S. 152, 189; P.A. 99-284, S. 17, 60; P.A. 01-113, S. 29, 42; P.A. 14-122, S. 175; 14-235, S. 6.)
History: P.A. 83-177 amended Subsec. (a) by redefining “adverse underwriting decision” to include any change from a preferred rate program to a standard rate program or from a standard rate program to a nonstandard rate program and amended Subsec. (x) by including agreements to insure uninsurable applicants as outlined in Sec. 38-201h, within the definition of a “residual market mechanism”; P.A. 90-243 redefined “affiliate”, “affiliated”, “control”, “person” and “unauthorized insurer”; Sec. 38-501 transferred to Sec. 38a-976 in 1991; P.A. 94-160 substituted “producer” for “insurance broker” in definition of “agent” to accurately reflect the modernization and nomenclature of the industry, effective June 2, 1994; P.A. 95-79 redefined “insurance institution” to include a limited liability company, effective May 31, 1995; P.A. 99-284 amended definition of “insurance institution” to include managed care organizations, amended definition of “insurance-support organization” to add Subpara. (1)(C) re collecting or disclosing medical record information in the ordinary course of business, and amended Subdiv. (2) to exclude “pharmacies, universities and schools” from the definition of “insurance-support organization”, and amended definition of “medical-record information” to substitute “information which: (1) Relates to the physical, mental or behavioral health condition, medical history or medical treatment of an individual or a member of the individual's family” for “information which: (1) Relates to an individual's physical or mental condition, medical history or medical treatment”, amended Subdiv. (2) to include information obtained from a pharmacy or pharmacist, or from the provision of or payment for health care re an individual or member of the individual's family, and excluded from definition encrypted or encoded information or other information from which personal identifiers have been removed, effective July 1, 2000; P.A. 01-113 amended definition of “agent” to delete “insurance agent” from definition, make a technical change and substitute “section 38a-702a” for “section 38a-702”, effective September 1, 2002; P.A. 14-122 made a technical change; P.A. 14-235 replaced alphabetic designators with numeric designators and made technical changes.
