§ 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-472e Health insurer. Requirements re offer to contract with a school-based health center
§ 38a-472f Network adequacy. Health carrier duties and responsibilities. Access plan filing
§ 38a-472g Restrictions applicable to preauthorization or precertification
§ 38a-472h Fees charged by dentists and optometrists for noncovered benefits. Notice and posting required
§ 38a-472i Payment amount of professional services component of covered colonoscopy or endoscopic services
§ 38a-473 Medicare supplement expense factors. Age, gender, previous claim or medical history rating prohibited
§ 38a-474 Medicare supplement policy rate increases: Procedure. Age, gender, previous claim or medical history rating prohibited
§ 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-477c Disclosure of state and federal medical loss ratio with each health insurance application
§ 38a-477d Information to be made available to consumers
§ 38a-477e Health carriers to maintain Internet web site and toll-free telephone number. Available information. Exception
§ 38a-477f Contract provision prohibiting certain disclosures prohibited
§ 38a-477g Contracts between health carriers and participating providers
§ 38a-477h Participating provider directories
§ 38a-477aa Cost-sharing and health care provider reimbursements for emergency services and surprise bills
§ 38a-477bb Cost-sharing re facility fees
§ 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. Commissioner’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 Provider directory. Notification to enrollee of termination or withdrawal of enrollee’s primary care provider
§ 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 Contract requirements and notice for removal or departure of provider. Retaliatory action prohibited
§ 38a-478i Limitation on enrollee rights prohibited
§ 38a-478j Coinsurance payments based on negotiated discounts
§ 38a-478k Gag clauses prohibited
§ 38a-478l Consumer report card required. Content. Data analysis by commissioner
§ 38a-478o Confidentiality and antidiscrimination procedures required
§ 38a-478p Expedited utilization review. Standardized process 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. Access to fee schedules. Fee information to be confidential
§ 38a-479a Physicians and managed care organizations to discuss issues relative to contracting between such parties
§ 38a-479b Material changes to fee schedules. Return of payment by provider. Appeals. Filing of claim by provider under other applicable insurance coverage. Certain clauses, covenants and agreements prohibited. Exception
§ 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 Claims payment to be made by electronic funds transfer upon written request
§ 38a-479fff Expiration of certificates of registration. Renewal. Fees
§ 38a-479ggg Regulations
§ 38a-479hhh Investigations and hearings. Powers of commissioner. Appeals
§ 38a-479iii Pharmacy audits
§ 38a-480 Applicability of statutes to certain policies and contracts
§ 38a-481 Filing of policy form, application, classification of risks and rates. Approval of rates. Medicare supplement policies: Age, gender, previous claim or medical history rating prohibited. Reduction of payments on basis of Medicare el
§ 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-482c Lifetime limit
§ 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 newly born children. Notification to insurer
§ 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 certain 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 and treatment
§ 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-492l Mandatory coverage for neuropsychological testing for children diagnosed with cancer
§ 38a-492m Mandatory coverage for certain renewals of prescription eye drops
§ 38a-492n Mandatory coverage for certain wound-care supplies
§ 38a-492o Mandatory coverage for bone marrow testing
§ 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 Home health care by recognized nonmedical systems
§ 38a-495 Medicare supplement policies. Coverage of home health aide 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. Preexisting conditions. Coverage for the disabled and qualified Medicare beneficiaries. Regulations
§ 38a-495d Refund of prepaid premium for Medicare supplement policies
§ 38a-496 Coverage for occupational therapy
§ 38a-497 Termination of coverage of children in individual policies. Coverage for stepchildren
§ 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 Prior authorization 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 Coverage for services of physician assistants and certain nurses
§ 38a-499a Coverage for telehealth services
§ 38a-500 Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries. Subrogation rights
§ 38a-501 Individual long-term care policies. Disclosures. Spreading of premium rate increases of twenty per cent or more. Disclosure of premium rate increase
§ 38a-501a Individual short-term care policies. Approval of rates and forms. Disclosures. Regulations
§ 38a-502 Mandatory coverage for services provided by the Healthcare Center maintained by the Department of Veterans Affairs
§ 38a-503 Mandatory coverage for mammography, breast ultrasound and magnetic resonance imaging. Breast density information included in mammography report
§ 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. Interhospital transfer of newborn infant and mother
§ 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. Orally administered anticancer medications
§ 38a-504a Coverage for routine patient care costs associated with certain clinical trials
§ 38a-504b Clinical trial criteria
§ 38a-504c Evidence and information re eligibility for clinical trial. No coverage required for otherwise reimbursable costs
§ 38a-504d Clinical trials: Routine patient care costs
§ 38a-504e Clinical trials: Billing. Payments
§ 38a-504f Clinical trials: Standardized forms. Time frame for coverage determinations. Appeals. Regulations
§ 38a-504g Clinical trials: Submission and certification of policy forms
§ 38a-505 Insurance Commissioner’s powers concerning comprehensive health care plans. Disclosures
§ 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. Step therapy use
§ 38a-510a Prescription drug coverage. Synchronized refills
§ 38a-510b Prescription drug coverage. Prior authorization for naloxone hydrochloride or similar drug not required
§ 38a-510c Coverage for investigational drug, biological product or device for insureds with terminal illnesses. Liability of health carrier
§ 38a-511 Copayments re in-network imaging services
§ 38a-511a Copayments re in-network physical therapy services and in-network occupational therapy services
§ 38a-512 Applicability of statutes to certain major medical expense policies
§ 38a-512a Continuation of coverage
§ 38a-512b Termination of coverage of children in group policies. Coverage for stepchildren
§ 38a-512c Lifetime limit
§ 38a-513 Approval of policy forms and small employer rates. Medicare supplement policies. Age, gender, previous claim or medical history rating prohibited. Optional life insurance rider. Group specified disease policies
§ 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-513e Premium payment by employer following employee termination. Exceptions. Right to continuation of coverage following relocation or closing of covered establishment not affected
§ 38a-513f Claims information to be provided to certain employers. Restrictions. Subpoenas
§ 38a-513g Employer submission of plan cost information to Comptroller
§ 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
§ 38a-515 Continuation of coverage of mentally or physically handicapped children
§ 38a-516 Coverage for newly born children. Notification to insurer
§ 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 certain 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 and treatment
§ 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-518l Mandatory coverage for certain renewals of prescription eye drops
§ 38a-518m Mandatory coverage for certain wound-care supplies
§ 38a-518o Mandatory coverage for bone marrow testing
§ 38a-519 Offset proviso prohibited in certain policies. Required disclosures for group long-term disability 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
§ 38a-525 Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider
§ 38a-525a Prior authorization 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 Coverage for services of physician assistants and certain nurses
§ 38a-526a Coverage for telehealth services
§ 38a-527 Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries
§ 38a-528 Group long-term care policies. Disclosures. Spreading of premium rate increases of twenty per cent or more. Disclosure of premium rate increase
§ 38a-529 Mandatory coverage for services provided by the Healthcare Center maintained by the Department of Veterans Affairs
§ 38a-530 Mandatory coverage for mammography, breast ultrasound and magnetic resonance imaging. Breast density information included in mammography report
§ 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. Interhospital transfer of newborn infant and mother
§ 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 Coverage for services performed by chiropractors
§ 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
§ 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, prosthesis, chemotherapy and wigs. Orally administered anticancer medications
§ 38a-542a Coverage for routine patient care costs associated with certain clinical trials
§ 38a-542b Clinical trial criteria
§ 38a-542c Evidence and information re eligibility for clinical trial. No coverage required for otherwise reimbursable costs
§ 38a-542d Clinical trials: Routine patient care costs
§ 38a-542e Clinical trials: Billing. Payments
§ 38a-542f Clinical trials: Standardized forms. Time frame for coverage determinations. Appeals. Regulations
§ 38a-542g Clinical trials: Submission and certification of policy forms
§ 38a-543 Reduction of payments on basis of Medicare eligibility
§ 38a-544 Prescription drug coverage. Mail order pharmacies. Step therapy use
§ 38a-544a Prescription drug coverage. Synchronized refills
§ 38a-544b Prescription drug coverage. Prior authorization for naloxone hydrochloride or similar drug not required
§ 38a-545 Group dental health insurance plans. Alternative coverage option
§ 38a-546 Discontinuation and replacement of group health insurance policy. Regulations
§ 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-550a Copayments re in-network physical therapy services and in-network occupational therapy services
§ 38a-551 Definitions
§ 38a-552 Provision of service to certain low-income individuals
§ 38a-556 Health Reinsurance Association. Board of directors. Powers and authority. Rates. Net loss assessment. Immunity from liability
§ 38a-556a Connecticut Clearinghouse
§ 38a-557 Hospital service corporations 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-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
§ 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-573 Validity of separate provisions
§ 38a-574 Standard family health statement
§ 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 General surplus required
§ 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
§ 38a-591 Compliance with the Patient Protection and Affordable Care Act. Regulations
§ 38a-591a Definitions
§ 38a-591b Health carrier responsibilities re utilization review
§ 38a-591c Utilization review criteria and procedures
§ 38a-591d Utilization review and benefit determinations. Urgent care requests. Information provided in notice of adverse determination
§ 38a-591e Internal grievance process of adverse determinations based on medical necessity. Expedited review of adverse determinations of urgent care requests
§ 38a-591f Internal grievance process of adverse determinations not based on medical necessity
§ 38a-591g External reviews and expedited external reviews
§ 38a-591h Record-keeping requirements. Report to commissioner upon request
§ 38a-591i Regulations
§ 38a-591j Utilization review companies: Licensure. Fees. Investigation of grievances. Duties
§ 38a-591k Violations. Notice and hearing. Penalties. Appeal
§ 38a-591l Independent review organizations conducting external reviews and expedited external reviews
§ 38a-591m Independent review organizations: Conflicts of interest. Liability. Record-keeping requirements. Report to commissioner upon request
§ 38a-591n Documents, communications, information and evidence provided to covered person or covered person’s authorized representative upon request