Connecticut General Statutes
Chapter 700c - Health Insurance
Section 38a-479ee. - Violations. Penalties. Investigations and staffing. Grievances. Referrals from Healthcare Advocate.

(a) If the Insurance Commissioner determines that a preferred provider network or managed care organization, or both, has not complied with any applicable provision of this part or sections 38a-815 to 38a-819, inclusive, the commissioner may (1) order the preferred provider network or managed care organization, or both if both have not complied, to cease and desist all operations in violation of this part or said sections; (2) terminate or suspend the preferred provider network's license; (3) institute a corrective action against the preferred provider network or managed care organization, or both if both have not complied; (4) order the payment of a civil penalty by the preferred provider network or managed care organization, or both if both have not complied, of not more than one thousand dollars for each and every act or violation; (5) order the payment of such reasonable expenses as may be necessary to compensate the commissioner in conjunction with any proceedings held to investigate or enforce violations of this part or sections 38a-815 to 38a-819, inclusive; and (6) use any of the commissioner's other enforcement powers to obtain compliance with this part or sections 38a-815 to 38a-819, inclusive. The commissioner may hold a hearing concerning any matter governed by this part or sections 38a-815 to 38a-819, inclusive, in accordance with section 38a-16. Subject to the same confidentiality and liability protections set forth in subsections (c) and (k) of section 38a-14, the commissioner may engage the services of attorneys, appraisers, independent actuaries, independent certified public accountants or other professionals and specialists to assist the commissioner in conducting an investigation under this section, the cost of which shall be borne by the managed care organization or preferred provider network, or both, that is the subject of the investigation.

(b) If a preferred provider network fails to comply with any applicable provision of this part or sections 38a-815 to 38a-819, inclusive, the commissioner may assign or require the preferred provider network to assign its rights and obligations under any contract with participating providers in order to ensure that covered benefits are provided.
(c) The commissioner shall receive and investigate (1) any grievance filed against a preferred provider network or managed care organization, or both, by an enrollee or an enrollee's designee concerning matters governed by this part or sections 38a-815 to 38a-819, inclusive, or (2) any referral from the Office of the Healthcare Advocate pursuant to section 38a-1041. The commissioner shall code, track and review such grievances and referrals. The preferred provider network or managed care organization, or both, shall provide the commissioner with all information necessary for the commissioner to investigate such grievances and referrals. The information collected by the commissioner pursuant to this section shall be maintained as confidential and shall not be disclosed to any person except (A) to the extent necessary to carry out the purposes of this part or sections 38a-815 to 38a-819, inclusive, (B) as allowed under this title, (C) to the Healthcare Advocate, and (D) information concerning the nature of any grievance or referral and the commissioner's final determination shall be a public record, as defined in section 1-200, provided no personal information, as defined in section 38a-975, shall be disclosed. The commissioner shall report to the Healthcare Advocate on the resolution of any matter referred to the commissioner by the Healthcare Advocate.
(P.A. 03-169, S. 5; P.A. 05-102, S. 6; P.A. 11-58, S. 79.)
History: P.A. 05-102 amended Subsec. (c) by renaming the Office of Managed Care Ombudsman the Office of the Healthcare Advocate and making conforming changes; P.A. 11-58 deleted references to Secs. 38a-226 to 38a-226d, effective July 1, 2011.

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Structure Connecticut General Statutes

Connecticut General Statutes

Title 38a - Insurance

Chapter 700c - Health Insurance

Section 38a-469. - Definitions.

Section 38a-470. (Formerly Sec. 38-174n). - Lien on workers' compensation awards for insurers. Notice of lien.

Section 38a-471. (Formerly Sec. 38-174o). - Third party prescription programs. Notice of cancellation. Applicability of section.

Section 38a-472. (Formerly Sec. 38-174a). - Assignment of insurance proceeds to doctor, hospital or state agency. Lien for state care. Notice of lien.

Section 38a-472a. - Medical provider indemnification agreements prohibited.

Section 38a-472b. - Medical provider indemnification contracts. Professional actions and related liability.

Section 38a-472c. - Dental policies. Estimate of reimbursement. Material adjustments to fee schedules for in-network providers. Notice.

Section 38a-472d. - Public education outreach program re health insurance availability and eligibility requirements.

Section 38a-472e. - Health insurer. Requirements re offer to contract with a school-based health center.

Section 38a-472f. - Network adequacy. Health carrier duties and responsibilities. Access plan filing.

Section 38a-472g. - Restrictions applicable to prior authorization or precertification.

Section 38a-472h. - Fees charged by dentists, optometrists and ophthalmologists for noncovered benefits. Notice and posting required.

Section 38a-472i. - Payment amount of professional services component of covered colonoscopy or endoscopic services.

Section 38a-472j. - Restrictions applicable to cost-sharing for covered benefits. Regulations.

Section 38a-472k. - Disability income policies. Discretionary clauses prohibited. Regulations.

Section 38a-472l. - Participating dental provider contracts. Third-party access. Restrictions. Exceptions.

Section 38a-473. - Medicare supplement expense factors. Age, gender, previous claim or medical history rating prohibited.

Section 38a-474. - Medicare supplement policy rate increases: Procedure. Age, gender, previous claim or medical history rating prohibited.

Section 38a-475. - Precertification of long-term care policies under the Connecticut Partnership for Long-Term Care. Regulations.

Section 38a-475a. - Minimum set of affordable benefit options for long-term care policies. Regulations.

Section 38a-476. - Preexisting condition coverage.

Section 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 inf...

Section 38a-476b. - Standards re psychotropic drug availability in health plans.

Section 38a-476c. - Policies and contracts with variable network and enrollee cost-sharing. Approval. Limitations.

Section 38a-477. - Standardized claim forms. Information necessary for filing a claim. Regulations.

Section 38a-477a. - Notification by Insurance Commissioner of required benefits and policy forms.

Section 38a-477aa. - Cost-sharing and health care provider reimbursements for emergency services, urgent crisis center services and surprise bills.

Section 38a-477b. - Postclaims underwriting prohibited unless approval granted. Application for approval of rescission, cancellation or limitation. Decision. Appeals. Regulations.

Section 38a-477bb. - Cost-sharing re facility fees.

Section 38a-477c. - Disclosure of state and federal medical loss ratio with each health insurance application.

Section 38a-477cc. - Contracts for pharmacy services with health carriers or pharmacy benefits managers.

Section 38a-477d. - *(See end of section for amended version and effective date.) Information to be made available to consumers.

Section 38a-477dd. - Contracts with health carriers. Certain provisions concerning disclosures to covered persons prohibited.

Section 38a-477e. - Health carriers to maintain Internet web site and toll-free telephone number. Available information. Exception.

Section 38a-477ee. - Mental health and substance use disorder benefits. Nonquantitative treatment limitations. Reports. Public hearings. Regulations.

Section 38a-477f. - Contract provision prohibiting certain disclosures prohibited.

Section 38a-477ff. - Third-party discounts and payments for covered benefits. Credit required.

Section 38a-477g. - Contracts between health carriers and participating providers.

Section 38a-477gg. - Contracts between health carriers and pharmacy benefits managers. Credit required for third-party discounts and payments for covered prescription drug benefits.

Section 38a-477h. - Participating provider directories.

Section 38a-477hh. - Denial of coverage for otherwise covered benefits based on measurement of blood oxygen level by pulse oximeter prohibited.

Section 38a-477ii. - Pulse oximeter accuracy. Educational materials. Distribution and posting required.

Section 38a-477jj. - Prescription drug formularies and lists of covered drugs. Removal or movement to higher cost-sharing tier during plan year prohibited. Exceptions. Study and report.

Section 38a-477kk. - Proof of coverage to disclose whether coverage is fully insured or self-insured. Regulations.

Section 38a-477ll. - Coverage for health enhancement programs.

Section 38a-478. - Definitions.

Section 38a-478a. - Commissioner's report to the Governor and the General Assembly.

Section 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.

Section 38a-478c. - Managed care organization's report to the commissioner: Data, reports and information required.

Section 38a-478d. - Provider directory. Notification to enrollee of termination or withdrawal of enrollee's primary care provider.

Section 38a-478e. - Medical protocols. Procedure prior to change. Physician input. Notification of change.

Section 38a-478f. - Provider profile development requirements.

Section 38a-478g. - Managed care contract requirements. Plan description requirements.

Section 38a-478h. - Contract requirements and notice for removal or departure of provider. Retaliatory action prohibited.

Section 38a-478i. - Limitation on enrollee rights prohibited.

Section 38a-478j. - Coinsurance and deductible payments based on negotiated discounts.

Section 38a-478k. - Gag clauses prohibited.

Section 38a-478l. - Consumer report card required. Content. Data analysis by commissioner.

Section 38a-478m and 38a-478n. - Internal grievance procedure; notice re procedure and final resolution; penalties; fines allocated to Office of the Healthcare Advocate. Exhaustion of internal appeal mechanisms; external appeal to commissioner; appli...

Section 38a-478o. - Confidentiality and antidiscrimination procedures required.

Section 38a-478p. - Expedited utilization review. Standardized process required.

Section 38a-478q. - Use of laboratories covered by plan required.

Section 38a-478r. - Emergency rooms. Prudent layperson standard. Presenting symptoms or final diagnosis as basis for coverage. Mandatory coverage for medically necessary health care services for emergency medical conditions.

Section 38a-478s. - Nonapplicability to self-insured employee welfare benefit plans and workers' compensation plans.

Section 38a-478t. - Commissioner of Public Health to receive data.

Section 38a-478u. - Regulations.

Section 38a-478v. - Applicability of Unfair and Prohibited Insurance Practices Act. Examination by Insurance Commissioner. Regulations.

Section 38a-478w. - Managed care organization's calculation of enrollee liability for covered benefits. Credit required for third-party discounts and payments.

Section 38a-479. - Definitions. Access to fee schedules. Fee information to be confidential.

Section 38a-479a. - Physicians and managed care organizations to discuss issues relative to contracting between such parties.

Section 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.

Section 38a-479aa. - Preferred provider networks. Definitions. Licensing. Fees. Requirements. Exception.

Section 38a-479bb. - Requirements for managed care organizations that contract with preferred provider networks. Requirements for preferred provider networks.

Section 38a-479cc. - Duties of a preferred provider network when providing services pursuant to a contract with a managed care organization.

Section 38a-479dd. - Preferred provider network examination of outstanding amounts. Notice. Commissioner's duties.

Section 38a-479ee. - Violations. Penalties. Investigations and staffing. Grievances. Referrals from Healthcare Advocate.

Section 38a-479ff. - Adverse action or threat of adverse action against complainant prohibited. Exception. Civil actions by aggrieved persons.

Section 38a-479gg. - Regulations.

Section 38a-479aaa. - Pharmacy benefits managers. Definitions.

Section 38a-479bbb. - Registration of pharmacy benefits managers required. Application for registration. Fee. Surety bond. Exemption from registration.

Section 38a-479ccc. - Certificate of registration; when issued or refused. Suspension, revocation or refusal to issue or renew registration; grounds.

Section 38a-479ddd. - Hearing on denial of certificate. Subsequent application.

Section 38a-479eee. - Claims payment to be made by electronic funds transfer upon written request.

Section 38a-479fff. - Expiration of certificates of registration. Renewal. Fees.

Section 38a-479ggg. - Regulations.

Section 38a-479hhh. - Investigations and hearings. Powers of commissioner. Appeals.

Section 38a-479iii. - Pharmacy audits.

Section 38a-479ooo. - Definitions.

Section 38a-479ppp. - Annual report by pharmacy benefits managers. Standardized form. Confidentiality of information. Penalty. Regulations. Commissioner's report to the General Assembly.

Section 38a-479qqq. - Annual report by health carriers. Regulations.

Section 38a-479rrr. - Annual certification by health carriers.

Section 38a-479sss. - Annual report by commissioner to the General Assembly re outpatient prescription drug costs.

Section 38a-479ttt. - Annual report by commissioner to the General Assembly re prescription drug rebates.

Section 38a-479qq. - Medical discount plans: Definitions, prohibited sales practices, penalties.

Section 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 infor...

Section 38a-480. (Formerly Sec. 38-174). - Applicability of statutes to certain policies and contracts.

Section 38a-481. (Formerly Sec. 38-165). - Filing of policy form, application, classification of risks and rates. Approval of rates. Prescription drug rebates. Medicare supplement policies: Age, gender, previous claim or medical history rating prohib...

Section 38a-482. (Formerly Sec. 38-166). - Form of policy.

Section 38a-482a. - Individual health insurance policy to contain definition of “medically necessary” or “medical necessity”.

Section 38a-482b. - Individual health insurance policy providing limited coverage to include disclosure. Limited coverage defined.

Section 38a-482c. - Annual and lifetime limits.

Section 38a-483. (Formerly Sec. 38-167). - Standard provisions of individual health policy.

Section 38a-483a. - Exclusionary riders for individual health insurance policies. Regulations.

Section 38a-483b. - Time limits for coverage determinations. Notice requirements.

Section 38a-483c. - Coverage and notice re experimental treatments. Appeals.

Section 38a-484. (Formerly Sec. 38-168). - Policy provisions not to be less favorable than standard. Validity of policy issued in violation of law.

Section 38a-485. (Formerly Sec. 38-169). - Copy of application to be part of new policy or to be furnished with renewal. Alteration of application.

Section 38a-486. (Formerly Sec. 38-170). - Certain acts not to operate as waiver of rights.

Section 38a-487. (Formerly Sec. 38-171). - Coverage after termination date of policy.

Section 38a-488. (Formerly Sec. 38-172). - Discrimination.

Section 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. Direct reimbursement for certain covered services re...

Section 38a-488b. - Coverage for autism spectrum disorder therapies.

Section 38a-488c. - Mental health and substance use disorder benefits. Nonquantitative treatment limitations.

Section 38a-488d. - Coverage for substance abuse services provided pursuant to court order.

Section 38a-488e. - Coverage for mental health wellness examinations.

Section 38a-488f. - Coverage for services provided under the Collaborative Care Model.

Section 38a-488g. - Acute inpatient psychiatric coverage. Prior authorization not required.

Section 38a-489. (Formerly Sec. 38-174e). - Continuation of coverage of mentally or physically handicapped children.

Section 38a-490. (Formerly Sec. 38-174g). - Coverage for newly born children. Notification to insurer.

Section 38a-490a. - Coverage for birth-to-three program.

Section 38a-490b. - Coverage for hearing aids.

Section 38a-490c. - Coverage for craniofacial disorders.

Section 38a-490d. - Mandatory coverage for blood lead screening and risk assessment.

Section 38a-491. (Formerly Sec. 38-174h). - Coverage for services performed by dentists in certain instances.

Section 38a-491a. - Coverage for in-patient, outpatient or one-day dental services in certain instances.

Section 38a-491b. - Assignment of benefits to a dentist or oral surgeon.

Section 38a-492. (Formerly Sec. 38-174i). - Coverage for accidental ingestion or consumption of controlled drugs. Benefits prescribed.

Section 38a-492a. - Mandatory coverage for hypodermic needles and syringes.

Section 38a-492b. - Coverage for certain off-label drug prescriptions.

Section 38a-492c. - Coverage for low protein modified food products, amino acid modified preparations and specialized formulas.

Section 38a-492d. - Mandatory coverage for diabetes screening, testing and treatment.

Section 38a-492e. - Mandatory coverage for diabetes outpatient self-management training.

Section 38a-492f. - Mandatory coverage for certain prescription drugs removed from formulary.

Section 38a-492g. - Mandatory coverage for prostate cancer screening and treatment.

Section 38a-492h. - Mandatory coverage for certain Lyme disease treatments.

Section 38a-492i. - Mandatory coverage for pain management.

Section 38a-492j. - Mandatory coverage for ostomy-related supplies.

Section 38a-492k. - Mandatory coverage for colorectal cancer screening.

Section 38a-492l. - Mandatory coverage for neuropsychological testing for children diagnosed with cancer.

Section 38a-492m. - Mandatory coverage for certain renewals of prescription eye drops.

Section 38a-492n. - Mandatory coverage for certain wound-care supplies.

Section 38a-492o. - Mandatory coverage for bone marrow testing.

Section 38a-492p. - Mandatory coverage for medically monitored inpatient detoxification.

Section 38a-492q. - Mandatory coverage for essential health benefits.

Section 38a-492r. - Mandatory coverage for certain immunizations and consultation with health care provider.

Section 38a-492s. - Mandatory coverage for certain preventive care and screenings for individuals who are twenty-one years of age or younger.

Section 38a-492t. - Mandatory coverage for prosthetic devices.

Section 38a-492u. - Coverage for psychotropic drugs. Standards re availability.

Section 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.

Section 38a-494. (Formerly Sec. 38-174l). - Home health care by recognized nonmedical systems.

Section 38a-495. (Formerly Sec. 38-174m). - Medicare supplement policies. Coverage of home health aide services and mammography. Prescription drug riders.

Section 38a-495a. - Medicare supplement policies and certificates. Minimum required policy benefits and standards. Regulations.

Section 38a-495b. - Medicare supplement policies and certificates. Definitions.

Section 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. Excepti...

Section 38a-495d. - Refund of prepaid premium for Medicare supplement policies.

Section 38a-496. (Formerly Sec. 38-174q). - Coverage for occupational therapy.

Section 38a-497. (Formerly Sec. 38-174r). - Termination of coverage of child, stepchild, or other dependent child in individual policies. Dental or vision coverage.

Section 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.

Section 38a-498. (Formerly Sec. 38-174t). - Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider.

Section 38a-498a. - Prior authorization prohibited for certain 9-1-1 emergency calls.

Section 38a-498b. - Mandatory coverage for mobile field hospital.

Section 38a-498c. - Denial of coverage prohibited for health care services rendered to persons with an elevated blood alcohol content.

Section 38a-499. (Formerly Sec. 38-174v). - Coverage for services of physician assistants and certain nurses.

Section 38a-499a. - *(See end of section for amended version and effective date.) Coverage for telehealth services.

Section 38a-500. (Formerly Sec. 38-174w). - Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries. Subrogation rights.

Section 38a-501. (Formerly Sec. 38-174x). - Individual long-term care policies. Insurers authorized. Disclosures. Premium rate increases of twenty per cent or more. Disclosure of premium rate increase and minimum set of affordable benefit options.

Section 38a-501a. - Individual short-term care policies. Approval of rates and forms. Disclosures. Regulations.

Section 38a-502. (Formerly Sec. 38-174ff). - Mandatory coverage for services provided by the Healthcare Center maintained by the Department of Veterans Affairs.

Section 38a-503. (Formerly Sec. 38-174gg). - Mandatory coverage for mammography, breast ultrasound and magnetic resonance imaging. Breast density information included in mammography report.

Section 38a-503a. - Mandatory coverage for breast cancer survivors.

Section 38a-503b. - Carriers to permit direct access to obstetrician-gynecologist.

Section 38a-503c. - Mandatory coverage for maternity care. Interhospital transfer of newborn infant and mother.

Section 38a-503d. - Mandatory coverage for mastectomy care. Termination of provider contract prohibited.

Section 38a-503e. - Mandatory coverage for contraceptives and sterilization.

Section 38a-503f. - Mandatory coverage for certain health benefits and services for women, infants, children and adolescents.

Section 38a-503g. - Mandatory coverage for ovarian cancer screening and monitoring.

Section 38a-504. (Formerly Sec. 38-262i). - Mandatory coverage for treatment of tumors and leukemia. Mandatory coverage for reconstructive surgery, prosthesis, chemotherapy and wigs. Orally administered anticancer medications.

Section 38a-504a. - Coverage for routine patient care costs associated with certain clinical trials.

Section 38a-504b. - Clinical trial criteria.

Section 38a-504c. - Evidence and information re eligibility for clinical trial. No coverage required for otherwise reimbursable costs.

Section 38a-504d. - Clinical trials: Routine patient care costs.

Section 38a-504e. - Clinical trials: Billing. Payments.

Section 38a-504f. - Clinical trials: Standardized forms. Time frame for coverage determinations. Appeals. Regulations.

Section 38a-504g. - Clinical trials: Submission and certification of policy forms.

Section 38a-505. (Formerly Sec. 38-378). - Insurance Commissioner's powers concerning comprehensive health care plans. Disclosures.

Section 38a-506. (Formerly Sec. 38-173). - Penalty.

Section 38a-507. - Coverage for services performed by chiropractors.

Section 38a-508. - Coverage for adopted children.

Section 38a-509. - Mandatory coverage for infertility diagnosis and treatment. Limitations.

Section 38a-510. - Prescription drug coverage. Mail order pharmacies. Step therapy use.

Section 38a-510a. - Prescription drug coverage. Synchronized refills.

Section 38a-510b. - Prescription drug coverage. Prior authorization for naloxone hydrochloride or similar drug not required.

Section 38a-510c. - Coverage for investigational drug, biological product or device for insureds with terminal illnesses. Liability of health carrier.

Section 38a-511. - Copayments re in-network imaging services.

Section 38a-511a. - Copayments re in-network physical therapy services and in-network occupational therapy services.

Section 38a-512. - Applicability of statutes to certain major medical expense policies.

Section 38a-512a. - Continuation of coverage.

Section 38a-512b. - Termination of coverage of child, stepchild or other dependent child in group policies. Dental or vision coverage.

Section 38a-512c. - Annual and lifetime limits.

Section 38a-513. - Approval of policy forms and small employer rates. Prescription drug rebates. Medicare supplement policies. Age, gender, previous claim or medical history rating prohibited. Optional life insurance rider. Group specified disease po...

Section 38a-513a. - Time limits for coverage determinations. Notice requirements.

Section 38a-513b. - Coverage and notice re experimental treatments. Appeals.

Section 38a-513c. - Group health insurance policy to contain definition of “medically necessary” or “medical necessity”.

Section 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.

Section 38a-513e. - Premium payment by employer following employee termination. Exceptions. Right to continuation of coverage following relocation or closing of covered establishment not affected.

Section 38a-513f. - Claims information to be provided to certain employers. Restrictions. Subpoenas.

Section 38a-513g. - Employer submission of plan cost information to Comptroller.

Section 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 claims against proceeds. Direct reimbursement for ce...

Section 38a-514a. - Biologically-based mental illness. Coverage required.

Section 38a-514b. - Coverage for autism spectrum disorder.

Section 38a-514c. - Mental health and substance use disorder benefits. Nonquantitative treatment limitations.

Section 38a-514d. - Coverage for substance abuse services provided pursuant to court order.

Section 38a-514e. - Coverage for mental health wellness exams.

Section 38a-514f. - Coverage for services provided under the Collaborative Care Model.

Section 38a-514g. - Acute patient psychiatric coverage. Prior authorization not required.

Section 38a-515. - Continuation of coverage of mentally or physically handicapped children.

Section 38a-516. - Coverage for newly born children. Notification to insurer.

Section 38a-516a. - Coverage for birth-to-three program.

Section 38a-516b. - Coverage for hearing aids.

Section 38a-516c. - Coverage for craniofacial disorders.

Section 38a-516d. - Coverage for neuropsychological testing for children diagnosed with cancer.

Section 38a-517. - Coverage for services performed by dentist in certain instances.

Section 38a-517a. - Coverage for in-patient, outpatient or one-day dental services in certain instances.

Section 38a-517b. - Assignment of benefits to a dentist or oral surgeon.

Section 38a-518. - Coverage for accidental ingestion or consumption of controlled drugs. Benefits prescribed.

Section 38a-518a. - Mandatory coverage for hypodermic needles and syringes.

Section 38a-518b. - Coverage for certain off-label drug prescriptions.

Section 38a-518c. - Coverage for low protein modified food products, amino acid modified preparations and specialized formulas.

Section 38a-518d. - Mandatory coverage for diabetes screening, testing and treatment.

Section 38a-518e. - Mandatory coverage for diabetes outpatient self-management training.

Section 38a-518f. - Mandatory coverage for certain prescription drugs removed from formulary.

Section 38a-518g. - Mandatory coverage for prostate cancer screening and treatment.

Section 38a-518h. - Mandatory coverage for certain Lyme disease treatments.

Section 38a-518i. - Mandatory coverage for pain management.

Section 38a-518j. - Mandatory coverage for ostomy-related supplies.

Section 38a-518k. - Mandatory coverage for colorectal cancer screening.

Section 38a-518l. - Mandatory coverage for certain renewals of prescription eye drops.

Section 38a-518m. - Mandatory coverage for certain wound-care supplies.

Section 38a-518o. - Mandatory coverage for bone marrow testing.

Section 38a-518p. - Mandating coverage for medically monitored inpatient detoxification.

Section 38a-518q. - Mandatory coverage for essential health benefits.

Section 38a-518r. - Mandatory coverage for certain immunizations and consultation with health care provider.

Section 38a-518s. - Mandatory coverage for certain preventive care and screenings for individuals who are twenty-one years of age or younger.

Section 38a-518t. - Mandatory coverage for prosthetic devices.

Section 38a-518u. - Coverage for psychotropic drugs. Standards re availability.

Section 38a-519. (Formerly Sec. 38-174j). - Offset proviso prohibited in certain policies. Required disclosures for group long-term disability policies.

Section 38a-520. - Mandatory coverage for home health care. Deductibles. Exception from deductible limits for medical savings accounts. Archer MSAs and health savings accounts.

Section 38a-521. - Home health care by recognized nonmedical systems.

Section 38a-522. - Medicare supplement policies. Coverage of home health aide service.

Section 38a-523. (Formerly Sec. 38-174p). - Group hospital or medical insurance coverage for comprehensive rehabilitation services.

Section 38a-524. - Coverage for occupational therapy.

Section 38a-525. - Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider.

Section 38a-525a. - Prior authorization prohibited for certain 9-1-1 emergency calls.

Section 38a-525b. - Mandatory coverage for mobile field hospital.

Section 38a-525c. - Denial of coverage prohibited for health care services rendered to persons with an elevated blood alcohol content.

Section 38a-526. - Coverage for services of physician assistants and certain nurses.

Section 38a-526a. - *(See end of section for amended version and effective date.) Coverage for telehealth services.

Section 38a-527. - Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries.

Section 38a-528. - Group long-term care policies. Insurers authorized. Disclosures. Premium rate increases of twenty per cent or more. Disclosure of premium rate increase and minimum set of affordable benefit options.

Section 38a-528a. - Group short-term care policies. Approval of rates and forms. Disclosures. Regulations.

Section 38a-529. - Mandatory coverage for services provided by the Healthcare Center maintained by the Department of Veterans Affairs.

Section 38a-530. - Mandatory coverage for mammography, breast ultrasound and magnetic resonance imaging. Breast density information included in mammography report.

Section 38a-530a. - Mandatory coverage for breast cancer survivors.

Section 38a-530b. - Carriers to permit direct access to obstetrician-gynecologist.

Section 38a-530c. - Mandatory coverage for maternity care. Interhospital transfer of newborn infant and mother.

Section 38a-530d. - Mandatory coverage for mastectomy care. Termination of provider contract prohibited.

Section 38a-530e. - Mandatory coverage for contraceptives and sterilization.

Section 38a-530f. - Mandatory coverage for certain health benefits and services for women, infants, children and adolescents.

Section 38a-530g. - Mandatory coverage for ovarian cancer screening and monitoring.

Section 38a-531. (Formerly Sec. 38-174hh). - Mandatory coverage for employees of certain employers. Approval of policy forms.

Section 38a-532. (Formerly Sec. 38-262a). - Assignment of incidents of ownership under group life, health or accident policy.

Section 38a-533. (Formerly Sec. 38-262b). - Mandatory coverage for the treatment of medical complications of alcoholism.

Section 38a-534. - Coverage for services performed by chiropractors.

Section 38a-535. - Mandatory coverage for preventive pediatric care and blood lead screening and risk assessment.

Section 38a-535a. - Notification of individual coverage and benefits of a noncustodial parent to a custodial parent, when. Regulations.

Section 38a-536. - Mandatory coverage for infertility diagnosis and treatment. Limitations.

Section 38a-537. (Formerly Sec. 38-262c). - Notice of cancellation or discontinuation to covered employees. Fine. Notice of transfer of coverage. Failure to procure coverage.

Section 38a-538. (Formerly Sec. 38-262d). - Continuation of benefits under group employee health plans.

Section 38a-539. (Formerly Sec. 38-262f). - Group hospital or medical expense insurance policy coverage for treatment of alcoholism on an outpatient basis.

Section 38a-540. (Formerly Sec. 38-262g). - Duplication of coverage under group health insurance policies.

Section 38a-541. (Formerly Sec. 38-262h). - Group health policy to allow spouse coverage as both employee and dependent, when. Effect of collective bargaining agreements.

Section 38a-542. - Mandatory coverage for treatment of tumors and leukemia. Mandatory coverage for reconstructive surgery, prosthesis, chemotherapy and wigs. Orally administered anticancer medications.

Section 38a-542a. - Coverage for routine patient care costs associated with certain clinical trials.

Section 38a-542b. - Clinical trial criteria.

Section 38a-542c. - Evidence and information re eligibility for clinical trial. No coverage required for otherwise reimbursable costs.

Section 38a-542d. - Clinical trials: Routine patient care costs.

Section 38a-542e. - Clinical trials: Billing. Payments.

Section 38a-542f. - Clinical trials: Standardized forms. Time frame for coverage determinations. Appeals. Regulations.

Section 38a-542g. - Clinical trials: Submission and certification of policy forms.

Section 38a-543. (Formerly Sec. 38-262j). - Reduction of payments on basis of Medicare eligibility.

Section 38a-544. - Prescription drug coverage. Mail order pharmacies. Step therapy use.

Section 38a-544a. - Prescription drug coverage. Synchronized refills.

Section 38a-544b. - Prescription drug coverage. Prior authorization for naloxone hydrochloride or similar drug not required.

Section 38a-545. (Formerly Sec. 38-262k). - Group dental health insurance plans. Alternative coverage option.

Section 38a-546. (Formerly Sec. 38-379). - Discontinuation and replacement of group health insurance policy. Regulations.

Section 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.

Section 38a-548. - Penalty.

Section 38a-549. - Coverage for adopted children.

Section 38a-550. - Copayments re in-network imaging services.

Section 38a-550a. - Copayments re in-network physical therapy services and in-network occupational therapy services.

Section 38a-551. (Formerly Sec. 38-371). - Definitions.

Section 38a-552. (Formerly Sec. 38-372). - Provision of service to certain low-income individuals.

Section 38a-553 to 38a-555. (Formerly Secs. 38-373 to 38-375). - Minimum standard benefits of comprehensive health care plans; optional and excludable benefits; preexisting conditions; use of managed care plans. Additional requirements and eligibilit...

Section 38a-556. (Formerly Sec. 38-376). - Health Reinsurance Association. Board of directors. Powers and authority. Rates. Net loss assessment. Immunity from liability.

Section 38a-556a. - Connecticut Clearinghouse.

Section 38a-557. (Formerly Sec. 38-377). - Hospital service corporations and medical service corporations. Residual market mechanism. Insurance Commissioner's powers concerning such mechanisms.

Section 38a-558. (Formerly Sec. 38-380). - Office of Health Care Access.

Section 38a-559. (Formerly Sec. 38-381). - Commissioner of Social Services. Contract authority concerning Medicaid programs.

Section 38a-560. - Small employer grouping for health insurance coverage.

Section 38a-564. - Definitions.

Section 38a-565. - Special health care plans.

Section 38a-566. - Health insurance plans or insurance arrangements covering employees of a small employer. Trusts. Trade associations.

Section 38a-567. - Provisions of small employer plans and arrangements.

Section 38a-568. - Coverage under small employer health care plans and arrangements. Approval by commissioner.

Section 38a-569. - Connecticut Small Employer Health Reinsurance Pool.

Section 38a-570 to 38a-572. - Issuance of special health care plans by the Health Reinsurance Association to small employers. Issuance of individual special health care plans by the Health Reinsurance Association. Requirement to provide service to ce...

Section 38a-573. - Validity of separate provisions.

Section 38a-574. - Standard family health statement.

Section 38a-577. (Formerly Sec. 38-174ii). - Consumer dental health plans. Definitions.

Section 38a-578. (Formerly Sec. 38-174jj). - Certificate of authority. Application requirements.

Section 38a-579. (Formerly Sec. 38-174kk). - Certificate of authority. Standards for issuance and renewal.

Section 38a-580. (Formerly Sec. 38-174ll). - General surplus required.

Section 38a-581. (Formerly Sec. 38-174mm). - Evidence of coverage to be provided to enrollees. Approval by commissioner.

Section 38a-582. (Formerly Sec. 38-174nn). - Schedule of charges. Approval by commissioner. Appeal of disapproval.

Section 38a-583. (Formerly Sec. 38-174oo). - Records. Commissioner's power to examine; maintenance; preservation.

Section 38a-584. (Formerly Sec. 38-174pp). - Complaint system.

Section 38a-585. (Formerly Sec. 38-174qq). - Requirements re filing of annual reports with commissioner.

Section 38a-586. (Formerly Sec. 38-174rr). - False or misleading advertising or solicitation and deceptive evidence of coverage prohibited.

Section 38a-587. (Formerly Sec. 38-174ss). - Suspension or revocation of certificate of authority. Hearing. Appeal.

Section 38a-588. (Formerly Sec. 38-174tt). - Penalty. Insolvency.

Section 38a-589. (Formerly Sec. 38-174uu). - Confidentiality.

Section 38a-590. (Formerly Sec. 38-174vv). - Commissioner's power to adopt regulations.

Section 38a-591. - Compliance with the Patient Protection and Affordable Care Act. Regulations.

Section 38a-591a. - Definitions.

Section 38a-591b. - Health carrier responsibilities re utilization review.

Section 38a-591c. - Utilization review criteria and procedures.

Section 38a-591d. - Utilization review and benefit determinations. Urgent care requests. Information provided in notice of adverse determination.

Section 38a-591e. - Internal grievance process of adverse determinations based on medical necessity. Expedited review of adverse determinations of urgent care requests.

Section 38a-591f. - Internal grievance process of adverse determinations not based on medical necessity.

Section 38a-591g. - External reviews and expedited external reviews.

Section 38a-591h. - Record-keeping requirements. Report to commissioner upon request.

Section 38a-591i. - Regulations.

Section 38a-591j. - Utilization review companies: Licensure. Fees. Investigation of grievances. Duties.

Section 38a-591k. - Violations. Notice and hearing. Penalties. Appeal.

Section 38a-591l. - Independent review organizations conducting external reviews and expedited external reviews.

Section 38a-591m. - Independent review organizations: Conflicts of interest. Liability. Record-keeping requirements. Report to commissioner upon request.

Section 38a-591n. - Documents, communications, information and evidence provided to covered person or covered person's authorized representative upon request.