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Connecticut General Statutes > Title 38a > Chapter 700c - Health Insurance

^{Current as of: 2009}

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§ 38a-469	Definitions
§ 38a-470	Lien on workers' compensation awards for insurers. Notice of lien
§ 38a-471	Third party prescription programs. Notice of cancellation. Applicability of section
§ 38a-472	Assignment of insurance proceeds to doctor, hospital or state agency. Lien for state care. Notice of lien
§ 38a-472a	Medical provider indemnification agreements prohibited
§ 38a-472b	Medical provider indemnification contracts. Professional actions and related liability
§ 38a-472c	Dental policies. Estimate of reimbursement
§ 38a-472d	Public education outreach program re health insurance availability and eligibility requirements
§ 38a-473	Medicare supplement expense factors. Age, gender, previous claim or medical history rating prohibited. Exceptions
§ 38a-474	Rate increases: Procedure. Age, gender, previous claim or medical history rating prohibited. Exceptions
§ 38a-475	Precertification of long-term care policies under the Connecticut Partnership for Long-Term Care. Regulations
§ 38a-476	Preexisting condition coverage
§ 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. C
§ 38a-476b	Standards re psychotropic drug availability in health plans
§ 38a-476c	Policies and contracts with variable network and enrollee cost-sharing. Approval. Limitations
§ 38a-477	Standardized claim forms. Information necessary for filing a claim. Regulations
§ 38a-477a	Notification by Insurance Commissioner of required benefits and policy forms
§ 38a-477b	Postclaims underwriting prohibited unless approval granted. Application for approval of rescission, cancellation or limitation. Decision. Appeals. Regulations
§ 38a-478	Definitions
§ 38a-478a	Commissioner's report to the Governor and the General Assembly
§ 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
§ 38a-478c	Managed care organization's report to the commissioner: Data, reports and information required
§ 38a-478d	List of providers required. Notification to enrollee of removal from list of enrollee's primary care physician
§ 38a-478e	Medical protocols. Procedure prior to change. Physician input. Notification of change
§ 38a-478f	Provider profile development requirements
§ 38a-478g	Managed care contract requirements. Plan description requirements
§ 38a-478h	Removal of providers. Notice requirements. Retaliatory action prohibited
§ 38a-478i	Limitation on enrollee rights prohibited
§ 38a-478j	Coinsurance payments based on negotiated discounts
§ 38a-478k	Gag clauses prohibited
§ 38a-478
§ 38a-478m	Internal grievance procedure. Notice re procedure and final resolution. Penalties. Fines allocated to Office of the Healthcare Advocate
§ 38a-478n	Exhaustion of internal appeal mechanisms. External appeal to commissioner. Applicability to health insurers, managed care organizations and utilization review companies. Fees. Waiver and refund of fees. Request for information. Public education outreach p
§ 38a-478o	Confidentiality and antidiscrimination procedures required
§ 38a-478p	Expedited utilization review. Standardized form required
§ 38a-478q	Use of laboratories covered by plan required
§ 38a-478r	Emergency rooms. Prudent layperson standard. Presenting symptoms or final diagnosis as basis for coverage
§ 38a-478s	Nonapplicability to self-insured employee welfare benefit plans and workers' compensation plans
§ 38a-478t	Commissioner of Public Health to receive data
§ 38a-478u	Regulations
§ 38a-478v	Applicability of Unfair and Prohibited Insurance Practices Act. Examination by Insurance Commissioner. Regulations
§ 38a-479	Definitions. Contracting health organizations to establish procedure allowing physicians to view fee schedules. Fee information to be confidential
§ 38a-479a	Physicians and managed care organizations to discuss issues relative to contracting between such parties
§ 38a-479aa	Preferred provider networks. Definitions. Licensing. Fees. Requirements. Exception, regulations
§ 38a-479bb	Requirements for managed care organizations that contract with preferred provider networks. Requirements for preferred provider networks
§ 38a-479cc	Duties of a preferred provider network when providing services pursuant to a contract with a managed care organization
§ 38a-479dd	Preferred provider network examination of outstanding amounts. Notice. Commissioner's duties
§ 38a-479ee	Violations. Penalties. Investigations and staffing. Grievances. Referrals from Healthcare Advocate
§ 38a-479ff	Adverse action or threat of adverse action against complainant prohibited. Exception. Civil actions by aggrieved persons
§ 38a-479gg	Regulations
§ 38a-479qq	Medical discount plans: Definitions, prohibited sales practices, penalties
§ 38a-479rr	Medical discount plan organizations: Licensure. List of authorized marketers. Provider agreements. Minimum net worth. Suspension of authority and revocation or nonrenewal of license. Reinstatement of license. Maintenance of information. Regulations. Penal
§ 38a-479aaa	Pharmacy benefits managers. Definitions
§ 38a-479bbb	Registration of pharmacy benefits managers required. Application for registration. Fee. Surety bond. Exemption from registration
§ 38a-479ccc	Certificate of registration; when issued or refused. Suspension, revocation or refusal to issue or renew registration; grounds
§ 38a-479ddd	Hearing on denial of certificate. Subsequent application
§ 38a-479eee	Investigations and hearings. Powers of commissioner
§ 38a-479fff	Expiration of certificates of registration. Renewal. Fees
§ 38a-479ggg	Regulations
§ 38a-479hhh	Appeals
§ 38a-480	Nonapplication to certain policies or contracts
§ 38a-481	Approval of individual health application, policy form and rates. Medicare supplement policies and certificates: Age, gender, previous claim or medical history rating prohibited. Loss ratios. Optional life insurance riders. Underwriting classifications, c
§ 38a-482	Form of policy
§ 38a-482a	Individual health insurance policy to contain definition of "medically necessary" or "medical necessity"
§ 38a-482b	Individual health insurance policy providing limited coverage to include disclosure. Limited coverage defined
§ 38a-483	Standard provisions of individual health policy
§ 38a-483a	Exclusionary riders for individual health insurance policies. Regulations
§ 38a-483b	Time limits for coverage determinations. Notice requirements
§ 38a-483c	Coverage and notice re experimental treatments. Appeals
§ 38a-484	Policy provisions not to be less favorable than standard. Validity of policy issued in violation of law
§ 38a-485	Copy of application to be part of new policy or to be furnished with renewal. Alteration of application
§ 38a-486	Certain acts not to operate as waiver of rights
§ 38a-487	Coverage after termination date of policy
§ 38a-488	Discrimination
§ 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
§ 38a-488b	Coverage for autism spectrum disorder therapies
§ 38a-489	Continuation of coverage of mentally or physically handicapped children
§ 38a-490	Coverage for newborn infants in health insurance policies. Notice. Application
§ 38a-490a	Coverage for birth-to-three program
§ 38a-490b	Coverage for hearing aids for children twelve and under
§ 38a-490c	Coverage for craniofacial disorders
§ 38a-490d	Mandatory coverage for blood lead screening and risk assessment
§ 38a-491	Coverage for services performed by dentists in certain instances
§ 38a-491a	Coverage for in-patient, outpatient or one-day dental services in certain instances
§ 38a-491b	Assignment of benefits to a dentist or oral surgeon
§ 38a-492	Coverage for accidental ingestion or consumption of controlled drugs. Benefits prescribed
§ 38a-492a	Mandatory coverage for hypodermic needles and syringes
§ 38a-492b	Coverage for off-label drug prescriptions
§ 38a-492c	Coverage for low protein modified food products, amino acid modified preparations and specialized formulas
§ 38a-492d	Mandatory coverage for diabetes testing and treatment
§ 38a-492e	Mandatory coverage for diabetes outpatient self-management training
§ 38a-492f	Mandatory coverage for certain prescription drugs removed from formulary
§ 38a-492g	Mandatory coverage for prostate cancer screening
§ 38a-492h	Mandatory coverage for certain Lyme disease treatments
§ 38a-492i	Mandatory coverage for pain management
§ 38a-492j	Mandatory coverage for ostomy-related supplies
§ 38a-492k	Mandatory coverage for colorectal cancer screening
§ 38a-492
§ 38a-493	Mandatory coverage for home health care. Deductibles. Exception from deductible limits for medical savings accounts, Archer MSAs and health savings accounts
§ 38a-494	#VALUE!
§ 38a-495	Medicare supplement policies. Coverage of home health aid services and mammography. Prescription drug riders
§ 38a-495a	Medicare supplement policies and certificates. Minimum required policy benefits and standards. Regulations
§ 38a-495b	Medicare supplement policies and certificates. Definitions
§ 38a-495c	Medicare supplement premium rates charged on a community rate basis. Age, gender, previous claim or medical history rating prohibited. Exceptions. Preexisting conditions. Exceptions. Coverage for the disabled. Regulations
§ 38a-495d	Refund of prepaid premium for Medicare supplement policies
§ 38a-496	Coverage for occupational therapy. Definitions. Benefits
§ 38a-497	Termination of coverage of children in individual policies
§ 38a-497a	Group coverage and benefits of a noncustodial parent. National Medical Support Notice. Notification of new employer by IV-D agency. Notification to parent. Enrollment of child
§ 38a-498	Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider
§ 38a-498a	Preauthorization prohibited for certain 9-1-1 emergency calls
§ 38a-498b	Mandatory coverage for mobile field hospital
§ 38a-498c	Denial of coverage prohibited for health care services rendered to persons with an elevated blood alcohol content
§ 38a-499	Mandatory coverage for services of physician assistants and certain nurses
§ 38a-500	Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries. Subrogation rights
§ 38a-501	Long-term care policies
§ 38a-502	Mandatory coverage for services provided by the Veterans' Home
§ 38a-503	Mandatory coverage for mammography and breast ultrasound
§ 38a-503a	Mandatory coverage for breast cancer survivors
§ 38a-503b	Carriers to permit direct access to obstetrician-gynecologist
§ 38a-503c	Mandatory coverage for maternity care. Notice required
§ 38a-503d	Mandatory coverage for mastectomy care. Termination of provider contract prohibited
§ 38a-503e	Mandatory coverage for prescription contraceptives
§ 38a-504	Mandatory coverage for treatment of tumors and leukemia. Mandatory coverage for reconstructive surgery, prosthesis, chemotherapy and wigs. Mandatory coverage for breast reconstruction after mastectomy
§ 38a-504a	Coverage for certain cancer clinical trials
§ 38a-504b	Cancer clinical trials that are eligible for coverage
§ 38a-504c	Evidence and information re eligibility for cancer clinical trial. No coverage required for otherwise reimbursable costs
§ 38a-504d	Cancer clinical trials: Routine patient care costs
§ 38a-504e	Cancer clinical trials: Billing. Payments. Appeals
§ 38a-504f	Cancer clinical trials: Standardized forms. Time frames for coverage determinations. Appeals. Regulations
§ 38a-504g	Cancer clinical trials: Submission and certification of policy forms
§ 38a-505	Insurance Commissioner's powers concerning comprehensive health care plans. Notification to purchasers of policy
§ 38a-506	Penalty
§ 38a-507	Coverage for services performed by chiropractors
§ 38a-508	Coverage for adopted children
§ 38a-509	Mandatory coverage for infertility diagnosis and treatment. Limitations
§ 38a-510	Prescription drug coverage. Mail order pharmacies
§ 38a-511	Copayments re in-network imaging services
§ 38a-512	Applicability of statutes to certain major medical expense policies
§ 38a-513	Approval of group health insurance policies and certificates. Medicare supplement policies and certificates: Age, gender, previous claim or medical history rating prohibited. Exceptions. Optional life insurance riders. Regulations. Group specified disease
§ 38a-513a	Time limits for coverage determinations. Notice requirements
§ 38a-513b	Coverage and notice re experimental treatments. Appeals
§ 38a-513c	Group health insurance policy to contain definition of "medically necessary" or "medical necessity"
§ 38a-513d	Insurers prohibited from issuing policy with limited coverage to employer as replacement for a comprehensive health insurance plan. Disclosure required in policy providing limited coverage. Limited coverage defined
§ 38a-514	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
§ 38a-514a	Biologically-based mental illness. Coverage required
§ 38a-514b	Coverage for autism spectrum disorder therapies
§ 38a-515	Continuation of coverage of mentally retarded or physically handicapped dependent children
§ 38a-516	Coverage for newborn infants in health insurance policies. Notice. Application
§ 38a-516a	Coverage for birth-to-three program
§ 38a-516b	Coverage for hearing aids for children twelve and under
§ 38a-516c	Coverage for craniofacial disorders
§ 38a-516d	Coverage for neuropsychological testing for children diagnosed with cancer
§ 38a-517	Coverage for services performed by dentist in certain instances
§ 38a-517a	Coverage for in-patient, outpatient or one-day dental services in certain instances
§ 38a-517b	Assignment of benefits to a dentist or oral surgeon
§ 38a-518	Coverage for accidental ingestion or consumption of controlled drugs. Benefits prescribed
§ 38a-518a	Mandatory coverage for hypodermic needles and syringes
§ 38a-518b	Coverage for off-label drug prescriptions
§ 38a-518c	Coverage for low protein modified food products, amino acid modified preparations and specialized formulas
§ 38a-518d	Mandatory coverage for diabetes testing and treatment
§ 38a-518e	Mandatory coverage for diabetes outpatient self-management training
§ 38a-518f	Mandatory coverage for certain prescription drugs removed from formulary
§ 38a-518g	Mandatory coverage for prostate cancer screening
§ 38a-518h	Mandatory coverage for certain Lyme disease treatments
§ 38a-518i	Mandatory coverage for pain management
§ 38a-518j	Mandatory coverage for ostomy-related supplies
§ 38a-518k	Mandatory coverage for colorectal cancer screening
§ 38a-519	Offset proviso prohibited in certain policies
§ 38a-520	Mandatory coverage for home health care. Deductibles. Exception from deductible limits for medical savings accounts. Archer MSAs and health savings accounts
§ 38a-521	Home health care by recognized nonmedical systems
§ 38a-522	Medicare supplement policies. Coverage of home health aide service
§ 38a-523	Group hospital or medical insurance coverage for comprehensive rehabilitation services
§ 38a-524	Coverage for occupational therapy. Definitions. Benefits
§ 38a-525	Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider
§ 38a-525a	Preauthorization prohibited for certain 9-1-1 emergency calls
§ 38a-525b	Mandatory coverage for mobile field hospital
§ 38a-525c	Denial of coverage prohibited for health care services rendered to persons with an elevated blood alcohol content
§ 38a-526	Mandatory coverage for services of physician assistants and certain nurses
§ 38a-527	Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries
§ 38a-528	Long-term care policies
§ 38a-529	Mandatory coverage for services provided by the Veterans' Home
§ 38a-530	Mandatory coverage for mammography and breast ultrasound
§ 38a-530a	Mandatory coverage for breast cancer survivors
§ 38a-530b	Carriers to permit direct access to obstetrician-gynecologist
§ 38a-530c	Mandatory coverage for maternity care. Notice required
§ 38a-530d	Mandatory coverage for mastectomy care. Termination of provider contract prohibited
§ 38a-530e	Mandatory coverage for prescription contraceptives
§ 38a-531	Mandatory coverage for employees of certain employers. Approval of policy forms
§ 38a-532	Assignment of incidents of ownership under group life, health or accident policy
§ 38a-533	Mandatory coverage for the treatment of medical complications of alcoholism
§ 38a-534	Mandatory coverage for chiropractic services
§ 38a-535	Mandatory coverage for preventive pediatric care and blood lead screening and risk assessment
§ 38a-535a	Notification of individual coverage and benefits of a noncustodial parent to a custodial parent, when. Regulations
§ 38a-536	Mandatory coverage for infertility diagnosis and treatment. Limitations
§ 38a-537	Notice of cancellation or discontinuation to covered employees. Fine. Notice of transfer of coverage. Failure to procure coverage. Retroactive coverage
§ 38a-538	Continuation of benefits under group employee health plans
§ 38a-539	Group hospital or medical expense insurance policy coverage for treatment of alcoholism on an outpatient basis
§ 38a-540	Duplication of coverage under group health insurance policies
§ 38a-541	Group health policy to allow spouse coverage as both employee and dependent, when. Effect of collective bargaining agreements
§ 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
§ 38a-542a	Cancer clinical trials: Coverage for routine patient care costs
§ 38a-542b	Cancer clinical trials: When eligible for coverage
§ 38a-542c	Cancer clinical trials: Evidence and information re eligibility for. No coverage required for otherwise reimbursable costs
§ 38a-542d	Cancer clinical trials: Routine patient care costs
§ 38a-542e	Cancer clinical trials: Billing. Payments. Appeals
§ 38a-542f	Cancer clinical trials: Standardized forms. Time frames for coverage determinations. Appeals. Regulations
§ 38a-542g	Cancer clinical trials: Submission and certification of policy forms
§ 38a-543	Age discrimination in group insurance coverage prohibited
§ 38a-544	Prescription drug coverage. Mail order pharmacies
§ 38a-545	Group dental health insurance plans. Alternative coverage option
§ 38a-546	Continuation of benefits under group health policies
§ 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
§ 38a-548	Penalty
§ 38a-549	Coverage for adopted children
§ 38a-550	Copayments re in-network imaging services
§ 38a-551	Definitions
§ 38a-552	Applicability. Individual and group comprehensive health care plans
§ 38a-553	Minimum standard benefits of comprehensive health care plans. Optional and excludable benefits. Preexisting conditions. Use of managed care plans
§ 38a-554	Additional requirements and eligibility under group comprehensive health care plans. Continuation of benefits under group plans. Insurance Commissioner's authority to coordinate benefits
§ 38a-555	Additional requirements for individual comprehensive health care plans. Carrier obligations concerning termination of coverage
§ 38a-556	Health Reinsurance Association. Classes of risk. Audits. Insurance Commissioner's powers. Qualification as an acceptable alternative mechanism
§ 38a-557	Hospital and medical service corporations. Residual market mechanism. Insurance Commissioner's powers concerning such mechanisms
§ 38a-558	Office of Health Care Access
§ 38a-559	Commissioner of Social Services. Contract authority concerning Medicaid programs
§ 38a-560	Small employer grouping for health insurance coverage
§ 38a-564	Definitions
§ 38a-565	Special health care plans
§ 38a-566	Health insurance plans or insurance arrangements covering employees of a small employer. Trusts. Trade associations. Self-employed individuals
§ 38a-567	Provisions of small employer plans and arrangements
§ 38a-568	Coverage under small employer health care plans and arrangements. Approval by commissioner
§ 38a-569	Connecticut Small Employer Health Reinsurance Pool
§ 38a-570	Issuance of special health care plans by the Health Reinsurance Association to small employers
§ 38a-571	Issuance of individual special health care plans by the Health Reinsurance Association
§ 38a-572	Requirement to provide service to certain low-income persons
§ 38a-573	Validity of separate provisions
§ 38a-574	Standard underwriting form
§ 38a-577	Consumer dental health plans. Definitions
§ 38a-578	Certificate of authority. Application requirements
§ 38a-579	Certificate of authority. Standards for issuance and renewal
§ 38a-580	#VALUE!
§ 38a-581	Evidence of coverage to be provided to enrollees. Approval by commissioner
§ 38a-582	Schedule of charges. Approval by commissioner. Appeal of disapproval
§ 38a-583	Records. Commissioner's power to examine; maintenance; preservation
§ 38a-584	Complaint system
§ 38a-585	Requirements re filing of annual reports with commissioner
§ 38a-586	False or misleading advertising or solicitation and deceptive evidence of coverage prohibited
§ 38a-587	Suspension or revocation of certificate of authority. Hearing. Appeal
§ 38a-588	Penalty. Insolvency
§ 38a-589	Confidentiality
§ 38a-590	Commissioner's power to adopt regulations

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