(a) Each insurance company, hospital service corporation, medical service corporation, health care center or fraternal benefit society that delivers, issues for delivery, renews, amends or continues in this state individual health insurance policies providing coverage of the type specified in subdivisions (1), (2), (4), (10), (11) and (12) of section 38a-469, shall provide coverage under such policies for the surgical removal of tumors and treatment of leukemia, including outpatient chemotherapy, reconstructive surgery, cost of any nondental prosthesis including any maxillo-facial prosthesis used to replace anatomic structures lost during treatment for head and neck tumors or additional appliances essential for the support of such prosthesis, outpatient chemotherapy following surgical procedure in connection with the treatment of tumors, and a wig if prescribed by a licensed oncologist for a patient who suffers hair loss as a result of chemotherapy. Such benefits shall be subject to the same terms and conditions applicable to all other benefits under such policies.
(b) Except as provided in subsection (c) of this section, the coverage required by subsection (a) of this section shall provide at least a yearly benefit of five hundred dollars for the surgical removal of tumors, five hundred dollars for reconstructive surgery, five hundred dollars for outpatient chemotherapy, three hundred fifty dollars for a wig and three hundred dollars for a nondental prosthesis, except that for purposes of the surgical removal of breasts due to tumors the yearly benefit for such prosthesis shall be at least three hundred dollars for each breast removed.
(c) The coverage required by subsection (a) of this section shall provide benefits for the reasonable costs of reconstructive surgery on each breast on which a mastectomy has been performed, and reconstructive surgery on a nondiseased breast to produce a symmetrical appearance. Such benefits shall be subject to the same terms and conditions applicable to all other benefits under such policies. For the purposes of this subsection, reconstructive surgery includes, but is not limited to, augmentation mammoplasty, reduction mammoplasty and mastopexy.
(d) (1) Each policy of the type specified in subsection (a) of this section that provides coverage for intravenously administered and orally administered anticancer medications used to kill or slow the growth of cancerous cells that are prescribed by a prescribing practitioner, as defined in section 20-571, shall provide coverage for orally administered anticancer medications on a basis that is no less favorable than intravenously administered anticancer medications.
(2) No insurance company, hospital service corporation, medical service corporation, health care center or fraternal benefit society that delivers, issues for delivery, renews, amends or continues in this state a policy of the type specified in subsection (a) of this section shall reclassify such anticancer medications or increase the coinsurance, copayment, deductible or other out-of-pocket expense imposed under such policy for such medications to achieve compliance with this subsection.
(P.A. 79-327, S. 2; P.A. 86-54; P.A. 87-40; 87-275, S. 2; P.A. 90-243, S. 94; P.A. 97-198, S. 3, 5; P.A. 98-27, S. 17; P.A. 04-34, S. 1; P.A. 10-5, S. 24; 10-63, S. 1; P.A. 11-19, S. 10.)
History: P.A. 86-54 clarified the section by limiting its applicability to individual and group medical expense insurance policies and contract plans, rather than to all individual and group health insurance policies and contract plans; P.A. 87-40 amended Subsec. (c) to increase the minimum coverage requirement for prosthesis from $200 to $300; P.A. 87-275 amended Subsec. (c) to provide that the yearly benefit for prosthesis shall be at least $300 for each breast surgically removed due to tumors; P.A. 90-243 deleted former Subsec. (a) re group coverages, relettered the remaining Subsecs., added references to health care centers, substituted references to health insurance policies for references to medical expense policies or contracts; Sec. 38-262i transferred to Sec. 38a-504 in 1991; P.A. 97-198 added exception in Subsec. (b) and added new Subsec. (c) re breast reconstruction after mastectomy, effective July 1, 1997; P.A. 98-27 amended Subsec. (a) to delete reference to Sec. 38a-469(6); P.A. 04-34 amended Subsec. (a) to substitute “Each” for “Any” and require coverage for a wig if prescribed for a patient who suffers hair loss as a result of chemotherapy and amended Subsec. (b) to require a yearly benefit of $350 for a wig; P.A. 10-5 made technical changes in Subsecs. (a) and (b), effective January 1, 2011; P.A. 10-63 made technical changes in Subsecs. (a) and (b), and added Subsec. (d) re orally administered anticancer medications, effective January 1, 2011; P.A. 11-19 made technical changes in Subsec. (d).
See Ch. 700d re fraternal benefit societies.
See Secs. 38a-199 to 38a-209, inclusive, re hospital service corporations.
See Secs. 38a-214 to 38a-225, inclusive, re medical service corporations.
See Sec. 38a-542 for similar provisions re group policies.
See Sec. 38a-800 re fraternal agents.
Structure Connecticut General Statutes
Chapter 700c - Health Insurance
Section 38a-469. - Definitions.
Section 38a-472a. - Medical provider indemnification agreements prohibited.
Section 38a-472g. - Restrictions applicable to prior authorization or precertification.
Section 38a-472j. - Restrictions applicable to cost-sharing for covered benefits. Regulations.
Section 38a-472k. - Disability income policies. Discretionary clauses prohibited. Regulations.
Section 38a-476. - Preexisting condition coverage.
Section 38a-476b. - Standards re psychotropic drug availability in health plans.
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-477bb. - Cost-sharing re facility fees.
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-477h. - Participating provider directories.
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-478f. - Provider profile development requirements.
Section 38a-478g. - Managed care contract requirements. Plan description requirements.
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-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-478t. - Commissioner of Public Health to receive data.
Section 38a-478u. - Regulations.
Section 38a-479. - Definitions. Access to fee schedules. Fee information to be confidential.
Section 38a-479gg. - Regulations.
Section 38a-479aaa. - Pharmacy benefits managers. Definitions.
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-479qqq. - Annual report by health carriers. Regulations.
Section 38a-479rrr. - Annual certification by health carriers.
Section 38a-479qq. - Medical discount plans: Definitions, prohibited sales practices, penalties.
Section 38a-482. (Formerly Sec. 38-166). - Form of policy.
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-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-488b. - Coverage for autism spectrum disorder therapies.
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-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-491b. - Assignment of benefits to a dentist or oral surgeon.
Section 38a-492a. - Mandatory coverage for hypodermic needles and syringes.
Section 38a-492b. - Coverage for certain off-label drug prescriptions.
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-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-492t. - Mandatory coverage for prosthetic devices.
Section 38a-492u. - Coverage for psychotropic drugs. Standards re availability.
Section 38a-494. (Formerly Sec. 38-174l). - Home health care by recognized nonmedical systems.
Section 38a-495b. - Medicare supplement policies and certificates. Definitions.
Section 38a-495d. - Refund of prepaid premium for Medicare supplement policies.
Section 38a-496. (Formerly Sec. 38-174q). - Coverage for occupational therapy.
Section 38a-498a. - Prior authorization prohibited for certain 9-1-1 emergency calls.
Section 38a-498b. - Mandatory coverage for mobile field hospital.
Section 38a-503a. - Mandatory coverage for breast cancer survivors.
Section 38a-503b. - Carriers to permit direct access to obstetrician-gynecologist.
Section 38a-503e. - Mandatory coverage for contraceptives and sterilization.
Section 38a-503g. - Mandatory coverage for ovarian cancer screening and monitoring.
Section 38a-504a. - Coverage for routine patient care costs associated with certain clinical trials.
Section 38a-504b. - Clinical trial criteria.
Section 38a-504d. - Clinical trials: Routine patient care costs.
Section 38a-504e. - Clinical trials: Billing. Payments.
Section 38a-504g. - Clinical trials: Submission and certification of policy forms.
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-511. - Copayments re in-network imaging services.
Section 38a-512. - Applicability of statutes to certain major medical expense policies.
Section 38a-512a. - Continuation of coverage.
Section 38a-512c. - Annual and lifetime limits.
Section 38a-513a. - Time limits for coverage determinations. Notice requirements.
Section 38a-513b. - Coverage and notice re experimental treatments. Appeals.
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-514a. - Biologically-based mental illness. Coverage required.
Section 38a-514b. - Coverage for autism spectrum disorder.
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-517b. - Assignment of benefits to a dentist or oral surgeon.
Section 38a-518a. - Mandatory coverage for hypodermic needles and syringes.
Section 38a-518b. - Coverage for certain off-label drug prescriptions.
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-518t. - Mandatory coverage for prosthetic devices.
Section 38a-518u. - Coverage for psychotropic drugs. Standards re availability.
Section 38a-521. - Home health care by recognized nonmedical systems.
Section 38a-522. - Medicare supplement policies. Coverage of home health aide service.
Section 38a-524. - Coverage for occupational therapy.
Section 38a-525a. - Prior authorization prohibited for certain 9-1-1 emergency calls.
Section 38a-525b. - Mandatory coverage for mobile field hospital.
Section 38a-526. - Coverage for services of physician assistants and certain nurses.
Section 38a-530a. - Mandatory coverage for breast cancer survivors.
Section 38a-530b. - Carriers to permit direct access to obstetrician-gynecologist.
Section 38a-530e. - Mandatory coverage for contraceptives and sterilization.
Section 38a-530g. - Mandatory coverage for ovarian cancer screening and monitoring.
Section 38a-534. - Coverage for services performed by chiropractors.
Section 38a-536. - Mandatory coverage for infertility diagnosis and treatment. Limitations.
Section 38a-542a. - Coverage for routine patient care costs associated with certain clinical trials.
Section 38a-542b. - Clinical trial criteria.
Section 38a-542d. - Clinical trials: Routine patient care costs.
Section 38a-542e. - Clinical trials: Billing. Payments.
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-549. - Coverage for adopted children.
Section 38a-550. - Copayments re in-network imaging 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-556a. - Connecticut Clearinghouse.
Section 38a-558. (Formerly Sec. 38-380). - Office of Health Care Access.
Section 38a-560. - Small employer grouping for health insurance coverage.
Section 38a-564. - Definitions.
Section 38a-565. - Special health care plans.
Section 38a-567. - Provisions of small employer plans and arrangements.
Section 38a-569. - Connecticut Small Employer Health Reinsurance Pool.
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-580. (Formerly Sec. 38-174ll). - General surplus required.
Section 38a-584. (Formerly Sec. 38-174pp). - Complaint system.
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-591g. - External reviews and expedited external reviews.
Section 38a-591h. - Record-keeping requirements. Report to commissioner upon request.
Section 38a-591i. - Regulations.
Section 38a-591k. - Violations. Notice and hearing. Penalties. Appeal.