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Section 38a-469. - Definitions. - As used in this title, unless the context otherwise requires...
Section 38a-470. (Formerly Sec. 38-174n). - Lien on workers' compensation awards for insurers. Notice of lien. - (a) For purposes of this section, “controverted claim” means any...
Section 38a-471. (Formerly Sec. 38-174o). - Third party prescription programs. Notice of cancellation. Applicability of section. - (a) As used in this section, a “third party prescription...
Section 38a-472. (Formerly Sec. 38-174a). - Assignment of insurance proceeds to doctor, hospital or state agency. Lien for state care. Notice of lien. - (a) Whenever a contract by a third party agency provides...
Section 38a-472a. - Medical provider indemnification agreements prohibited. - No contract between a managed care company, other organization or...
Section 38a-472b. - Medical provider indemnification contracts. Professional actions and related liability. - Notwithstanding the provisions of section 38a-472a, every medical provider participating...
Section 38a-472c. - Dental policies. Estimate of reimbursement. Material adjustments to fee schedules for in-network providers. Notice. - (a) For any policy delivered, issued for delivery, renewed, amended...
Section 38a-472d. - Public education outreach program re health insurance availability and eligibility requirements. - (a) Not later than January 1, 2006, the Insurance Commissioner,...
Section 38a-472e. - Health insurer. Requirements re offer to contract with a school-based health center. - Each health insurer licensed to do business in this state...
Section 38a-472f. - Network adequacy. Health carrier duties and responsibilities. Access plan filing. - (a) As used in this section: (1) “Authorized representative” means...
Section 38a-472g. - Restrictions applicable to prior authorization or precertification. - (a)(1) No insurer, health care center, fraternal benefit society, hospital...
Section 38a-472h. - Fees charged by dentists, optometrists and ophthalmologists for noncovered benefits. Notice and posting required. - (a) No insurer, health care center, fraternal benefit society, hospital...
Section 38a-472i. - Payment amount of professional services component of covered colonoscopy or endoscopic services. - Each insurer, health care center, hospital service corporation, medical service...
Section 38a-472j. - Restrictions applicable to cost-sharing for covered benefits. Regulations. - (a) Notwithstanding any provision of the general statutes and to...
Section 38a-472k. - Disability income policies. Discretionary clauses prohibited. Regulations. - No insurer, health care center, fraternal benefit society, hospital service...
Section 38a-472l. - Participating dental provider contracts. Third-party access. Restrictions. Exceptions. - (a) For the purposes of this section: (1) “Covered person”...
Section 38a-473. - Medicare supplement expense factors. Age, gender, previous claim or medical history rating prohibited. - (a) No insurance company, fraternal benefit society, hospital service corporation,...
Section 38a-474. - Medicare supplement policy rate increases: Procedure. Age, gender, previous claim or medical history rating prohibited. - (a) Any insurance company, fraternal benefit society, hospital service corporation,...
Section 38a-475. - Precertification of long-term care policies under the Connecticut Partnership for Long-Term Care. Regulations. - The Insurance Department shall only precertify long-term care insurance policies...
Section 38a-475a. - Minimum set of affordable benefit options for long-term care policies. Regulations. - (a) For the purposes of this section, “long-term care policy”...
Section 38a-476. - Preexisting condition coverage. - (a) For the purposes of this section: (1) “Health insurance...
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... - (a) Each insurance company, fraternal benefit society, hospital service corporation,...
Section 38a-476b. - Standards re psychotropic drug availability in health plans. - Notwithstanding any provision of the general statutes or the regulations...
Section 38a-476c. - Policies and contracts with variable network and enrollee cost-sharing. Approval. Limitations. - (a) The Insurance Commissioner shall approve any health insurance policy...
Section 38a-477. - Standardized claim forms. Information necessary for filing a claim. Regulations. - (a) Except where there is an agreement to the contrary...
Section 38a-477a. - Notification by Insurance Commissioner of required benefits and policy forms. - The Insurance Commissioner shall provide written or electronic notification to...
Section 38a-477aa. - Cost-sharing and health care provider reimbursements for emergency services, urgent crisis center services and surprise bills. - (a) As used in this section: (1) “Emergency condition” has...
Section 38a-477b. - Postclaims underwriting prohibited unless approval granted. Application for approval of rescission, cancellation or limitation. Decision. Appeals. Regulations. - (a) Unless approval is granted pursuant to subsection (b) of...
Section 38a-477bb. - Cost-sharing re facility fees. - (a) As used in this section, “campus”, “facility fee”, “health...
Section 38a-477c. - Disclosure of state and federal medical loss ratio with each health insurance application. - An insurer or health care center shall include a written...
Section 38a-477cc. - Contracts for pharmacy services with health carriers or pharmacy benefits managers. - (a) No contract for pharmacy services entered into in the...
Section 38a-477d. - *(See end of section for amended version and effective date.) Information to be made available to consumers. - (a) Each insurer, health care center, hospital service corporation, medical...
Section 38a-477dd. - Contracts with health carriers. Certain provisions concerning disclosures to covered persons prohibited. - Notwithstanding any provision of the general statutes, and to the...
Section 38a-477e. - Health carriers to maintain Internet web site and toll-free telephone number. Available information. Exception. - (a) On and after January 1, 2017, each health carrier,...
Section 38a-477ee. - Mental health and substance use disorder benefits. Nonquantitative treatment limitations. Reports. Public hearings. Regulations. - (a) For the purposes of this section: (1) “Health carrier”...
Section 38a-477f. - Contract provision prohibiting certain disclosures prohibited. - (a) On and after January 1, 2016, no contract entered...
Section 38a-477ff. - Third-party discounts and payments for covered benefits. Credit required. - Each insurer, health care center, hospital service corporation, medical service...
Section 38a-477g. - Contracts between health carriers and participating providers. - (a) As used in this section: (1) “Covered person”, “facility”...
Section 38a-477gg. - Contracts between health carriers and pharmacy benefits managers. Credit required for third-party discounts and payments for covered prescription drug benefits. - On and after January 1, 2022, each contract entered into...
Section 38a-477h. - Participating provider directories. - (a) As used in this section: (1) “Covered person”, “facility”...
Section 38a-477hh. - Denial of coverage for otherwise covered benefits based on measurement of blood oxygen level by pulse oximeter prohibited. - No insurer, health care center, hospital service corporation, medical service...
Section 38a-477ii. - Pulse oximeter accuracy. Educational materials. Distribution and posting required. - (a) For the purposes of this section: (1) “Health carrier”...
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. - (a) For the purposes of this section: (1) “Affordable Care...
Section 38a-477kk. - Proof of coverage to disclose whether coverage is fully insured or self-insured. Regulations. - (a) For the purposes of this section: (1) “Health carrier”...
Section 38a-477ll. - Coverage for health enhancement programs. - (a) For the purposes of this section, “health enhancement program”...
Section 38a-478. - Definitions. - As used in this section, sections 38a-478a to 38a-478o, inclusive,...
Section 38a-478a. - Commissioner's report to the Governor and the General Assembly. - On March first annually, the Insurance Commissioner shall submit a...
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. - (a) Each managed care organization, as defined in section 38a-478,...
Section 38a-478c. - Managed care organization's report to the commissioner: Data, reports and information required. - (a) On or before May first of each year, each...
Section 38a-478d. - Provider directory. Notification to enrollee of termination or withdrawal of enrollee's primary care provider. - For any contract delivered, issued for delivery, renewed, amended or...
Section 38a-478e. - Medical protocols. Procedure prior to change. Physician input. Notification of change. - (a) Each managed care organization shall, prior to implementing new...
Section 38a-478f. - Provider profile development requirements. - Each managed care organization, in developing provider profiles or otherwise...
Section 38a-478g. - Managed care contract requirements. Plan description requirements. - (a) Each managed care contract delivered, issued for delivery, renewed,...
Section 38a-478h. - Contract requirements and notice for removal or departure of provider. Retaliatory action prohibited. - (a) Each contract delivered, issued for delivery, renewed, amended or...
Section 38a-478i. - Limitation on enrollee rights prohibited. - No contract delivered, issued for delivery, renewed, amended or continued...
Section 38a-478j. - Coinsurance and deductible payments based on negotiated discounts. - Each managed care plan that requires a deductible or percentage...
Section 38a-478k. - Gag clauses prohibited. - (a) No contract delivered, issued for delivery, renewed, amended or...
Section 38a-478l. - Consumer report card required. Content. Data analysis by commissioner. - (a) Not later than October fifteenth of each year, the...
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... - Sections 38a-478m and 38a-478n are repealed, effective July 1, 2011....
Section 38a-478o. - Confidentiality and antidiscrimination procedures required. - (a) Each managed care organization shall conform to all applicable...
Section 38a-478p. - Expedited utilization review. Standardized process required. - Section 38a-478p is repealed, effective July 1, 2011. (P.A. 97-99,...
Section 38a-478q. - Use of laboratories covered by plan required. - Each provider, as defined in section 38a-478, in utilizing laboratories...
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. - (a) Each provider, as defined in section 38a-478, shall code...
Section 38a-478s. - Nonapplicability to self-insured employee welfare benefit plans and workers' compensation plans. - (a) Nothing in sections 38a-478 to 38a-478o, inclusive, sections 38a-591a...
Section 38a-478t. - Commissioner of Public Health to receive data. - The Commissioner of Public Health may request and shall receive...
Section 38a-478u. - Regulations. - The Insurance Commissioner may adopt regulations in accordance with the...
Section 38a-478v. - Applicability of Unfair and Prohibited Insurance Practices Act. Examination by Insurance Commissioner. Regulations. - (a) Each managed care organization, as defined in section 38a-478,...
Section 38a-478w. - Managed care organization's calculation of enrollee liability for covered benefits. Credit required for third-party discounts and payments. - For any contract delivered, issued for delivery, renewed, amended or...
Section 38a-479. - Definitions. Access to fee schedules. Fee information to be confidential. - (a) As used in this section and section 38a-479b: (1)...
Section 38a-479a. - Physicians and managed care organizations to discuss issues relative to contracting between such parties. - The chairpersons and ranking members of the joint standing committee...
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. - (a) No contracting health organization shall make material changes to...
Section 38a-479aa. - Preferred provider networks. Definitions. Licensing. Fees. Requirements. Exception. - (a) As used in this part and subsection (b) of...
Section 38a-479bb. - Requirements for managed care organizations that contract with preferred provider networks. Requirements for preferred provider networks. - (a) On and after May 1, 2004, no managed care...
Section 38a-479cc. - Duties of a preferred provider network when providing services pursuant to a contract with a managed care organization. - (a) Whenever a preferred provider network is providing services pursuant...
Section 38a-479dd. - Preferred provider network examination of outstanding amounts. Notice. Commissioner's duties. - Each preferred provider network shall examine its outstanding amounts in...
Section 38a-479ee. - Violations. Penalties. Investigations and staffing. Grievances. Referrals from Healthcare Advocate. - (a) If the Insurance Commissioner determines that a preferred provider...
Section 38a-479ff. - Adverse action or threat of adverse action against complainant prohibited. Exception. Civil actions by aggrieved persons. - No health insurer, health care center, utilization review company, as...
Section 38a-479gg. - Regulations. - The Insurance Commissioner may adopt regulations, in accordance with chapter...
Section 38a-479aaa. - Pharmacy benefits managers. Definitions. - As used in this section and sections 38a-479bbb to 38a-479iii,...
Section 38a-479bbb. - Registration of pharmacy benefits managers required. Application for registration. Fee. Surety bond. Exemption from registration. - (a) Except as provided in subsection (d) of this section,...
Section 38a-479ccc. - Certificate of registration; when issued or refused. Suspension, revocation or refusal to issue or renew registration; grounds. - (a) Upon receipt of a completed application, evidence of a...
Section 38a-479ddd. - Hearing on denial of certificate. Subsequent application. - (a) Upon refusal to issue or renew a certificate, the...
Section 38a-479eee. - Claims payment to be made by electronic funds transfer upon written request. - Upon written request from a pharmacy, a pharmacy benefits manager...
Section 38a-479fff. - Expiration of certificates of registration. Renewal. Fees. - (a) All certificates of registration issued under section 38a-479ccc shall...
Section 38a-479ggg. - Regulations. - The commissioner shall adopt regulations, in accordance with chapter 54,...
Section 38a-479hhh. - Investigations and hearings. Powers of commissioner. Appeals. - (a) The commissioner may conduct investigations and hold hearings on...
Section 38a-479iii. - Pharmacy audits. - (a) As used in this section: (1) “Extrapolation” means the...
Section 38a-479ooo. - Definitions. - For the purposes of this part: (1) “Commissioner” means the...
Section 38a-479ppp. - Annual report by pharmacy benefits managers. Standardized form. Confidentiality of information. Penalty. Regulations. Commissioner's report to the General Assembly. - (a) Not later than March 1, 2021, and annually thereafter,...
Section 38a-479qqq. - Annual report by health carriers. Regulations. - (a) Each health carrier that delivers, issues for delivery, renews,...
Section 38a-479rrr. - Annual certification by health carriers. - Beginning on March 1, 2022, and annually thereafter, each health...
Section 38a-479sss. - Annual report by commissioner to the General Assembly re outpatient prescription drug costs. - Not later than March 1, 2022, and annually thereafter, the...
Section 38a-479ttt. - Annual report by commissioner to the General Assembly re prescription drug rebates. - Not later than March 1, 2021, and annually thereafter, the...
Section 38a-479qq. - Medical discount plans: Definitions, prohibited sales practices, penalties. - (a) As used in this section and section 38a-479rr: (1)...
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... - (a) Before doing business in this state as a medical...
Section 38a-480. (Formerly Sec. 38-174). - Applicability of statutes to certain policies and contracts. - (a) Nothing in sections 38a-481 to 38a-488, inclusive, shall apply...
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... - (a) No individual health insurance policy shall be delivered or...
Section 38a-482. (Formerly Sec. 38-166). - Form of policy. - No individual health insurance policy shall be delivered or issued...
Section 38a-482a. - Individual health insurance policy to contain definition of “medically necessary” or “medical necessity”. - (a) No insurer, health care center, hospital service corporation, medical...
Section 38a-482b. - Individual health insurance policy providing limited coverage to include disclosure. Limited coverage defined. - (a) Each individual health insurance policy, subscriber contract or certificate...
Section 38a-482c. - Annual and lifetime limits. - (a) No individual health insurance policy providing coverage of the...
Section 38a-483. (Formerly Sec. 38-167). - Standard provisions of individual health policy. - (a) Except as provided in subsection (c) of this section,...
Section 38a-483a. - Exclusionary riders for individual health insurance policies. Regulations. - Notwithstanding the provisions of section 38a-476, the Insurance Commissioner may...
Section 38a-483b. - Time limits for coverage determinations. Notice requirements. - Section 38a-483b is repealed, effective October 1, 2015. (P.A. 99-284,...
Section 38a-483c. - Coverage and notice re experimental treatments. Appeals. - (a) Each individual health insurance policy delivered, issued for delivery,...
Section 38a-484. (Formerly Sec. 38-168). - Policy provisions not to be less favorable than standard. Validity of policy issued in violation of law. - (a) No policy provision which is not subject to section...
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. - (a) The insured shall not be bound by any statement...
Section 38a-486. (Formerly Sec. 38-170). - Certain acts not to operate as waiver of rights. - The acknowledgment by any insurer of the receipt of notice...
Section 38a-487. (Formerly Sec. 38-171). - Coverage after termination date of policy. - If any individual health insurance policy contains a provision establishing,...
Section 38a-488. (Formerly Sec. 38-172). - Discrimination. - Discrimination between individuals of the same class in the amount...
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... - (a) For the purposes of this section: (1) (A) “Mental...
Section 38a-488b. - Coverage for autism spectrum disorder therapies. - (a) As used in this section: (1) “Applied behavior analysis”...
Section 38a-488c. - Mental health and substance use disorder benefits. Nonquantitative treatment limitations. - No individual health insurance policy providing coverage of the type...
Section 38a-488d. - Coverage for substance abuse services provided pursuant to court order. - No individual health insurance policy providing coverage of the type...
Section 38a-488e. - Coverage for mental health wellness examinations. - (a) For the purposes of this section: (1) “Licensed mental...
Section 38a-488f. - Coverage for services provided under the Collaborative Care Model. - (a) For the purposes of this section: (1) “Collaborative Care...
Section 38a-488g. - Acute inpatient psychiatric coverage. Prior authorization not required. - (a) No individual health insurance policy providing coverage of the...
Section 38a-489. (Formerly Sec. 38-174e). - Continuation of coverage of mentally or physically handicapped children. - Each individual health insurance policy providing coverage of the type...
Section 38a-490. (Formerly Sec. 38-174g). - Coverage for newly born children. Notification to insurer. - (a) Each individual health insurance policy delivered, issued for delivery,...
Section 38a-490a. - Coverage for birth-to-three program. - (a) Each individual health insurance policy providing coverage of the...
Section 38a-490b. - Coverage for hearing aids. - Each individual health insurance policy providing coverage of the type...
Section 38a-490c. - Coverage for craniofacial disorders. - Each individual health insurance policy providing coverage of the type...
Section 38a-490d. - Mandatory coverage for blood lead screening and risk assessment. - Each individual health insurance policy providing coverage of the type...
Section 38a-491. (Formerly Sec. 38-174h). - Coverage for services performed by dentists in certain instances. - Whenever the term “physician” or “doctor” is used in any...
Section 38a-491a. - Coverage for in-patient, outpatient or one-day dental services in certain instances. - (a) Each individual health insurance policy providing coverage of the...
Section 38a-491b. - Assignment of benefits to a dentist or oral surgeon. - No insurer, health care center, hospital service corporation, medical service...
Section 38a-492. (Formerly Sec. 38-174i). - Coverage for accidental ingestion or consumption of controlled drugs. Benefits prescribed. - No individual health insurance policy providing coverage of the type...
Section 38a-492a. - Mandatory coverage for hypodermic needles and syringes. - Each individual health insurance policy providing coverage of the type...
Section 38a-492b. - Coverage for certain off-label drug prescriptions. - (a)(1) Each individual health insurance policy delivered, issued for delivery,...
Section 38a-492c. - Coverage for low protein modified food products, amino acid modified preparations and specialized formulas. - (a) For purposes of this section: (1) “Inherited metabolic disease”...
Section 38a-492d. - Mandatory coverage for diabetes screening, testing and treatment. - (a) For the purposes of this section: (1) “Diabetes device”...
Section 38a-492e. - Mandatory coverage for diabetes outpatient self-management training. - (a) Each individual health insurance policy providing coverage of the...
Section 38a-492f. - Mandatory coverage for certain prescription drugs removed from formulary. - Each individual health insurance policy providing coverage of the type...
Section 38a-492g. - Mandatory coverage for prostate cancer screening and treatment. - Each individual health insurance policy providing coverage of the type...
Section 38a-492h. - Mandatory coverage for certain Lyme disease treatments. - Each individual health insurance policy providing coverage of the type...
Section 38a-492i. - Mandatory coverage for pain management. - (a) Each individual health insurance policy providing coverage of the...
Section 38a-492j. - Mandatory coverage for ostomy-related supplies. - Each individual health insurance policy providing coverage of the type...
Section 38a-492k. - Mandatory coverage for colorectal cancer screening. - (a) Each individual health insurance policy providing coverage of the...
Section 38a-492l. - Mandatory coverage for neuropsychological testing for children diagnosed with cancer. - Each individual health insurance policy providing coverage of the type...
Section 38a-492m. - Mandatory coverage for certain renewals of prescription eye drops. - Each individual health insurance policy providing coverage of the type...
Section 38a-492n. - Mandatory coverage for certain wound-care supplies. - Each individual health insurance policy providing coverage of the type...
Section 38a-492o. - Mandatory coverage for bone marrow testing. - (a) Subject to the provisions of subsection (b) of this...
Section 38a-492p. - Mandatory coverage for medically monitored inpatient detoxification. - Each insurance company, hospital service corporation, medical service corporation, health...
Section 38a-492q. - Mandatory coverage for essential health benefits. - (a) For the purposes of this section, “essential health benefits”...
Section 38a-492r. - Mandatory coverage for certain immunizations and consultation with health care provider. - (a) Each individual health insurance policy providing coverage of the...
Section 38a-492s. - Mandatory coverage for certain preventive care and screenings for individuals who are twenty-one years of age or younger. - (a) Each individual health insurance policy providing coverage of the...
Section 38a-492t. - Mandatory coverage for prosthetic devices. - (a) As used in this section, “prosthetic device” means an...
Section 38a-492u. - Coverage for psychotropic drugs. Standards re availability. - Notwithstanding any provision of the general statutes, no individual health...
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. - (a) Each individual health insurance policy providing coverage of the...
Section 38a-494. (Formerly Sec. 38-174l). - Home health care by recognized nonmedical systems. - Notwithstanding the provisions of section 38a-493, no insurer, health care...
Section 38a-495. (Formerly Sec. 38-174m). - Medicare supplement policies. Coverage of home health aide services and mammography. Prescription drug riders. - (a) As used in this section, “Medicare” means the Health...
Section 38a-495a. - Medicare supplement policies and certificates. Minimum required policy benefits and standards. Regulations. - (a) As used in this section: (1) “Applicant” means (A)...
Section 38a-495b. - Medicare supplement policies and certificates. Definitions. - (a) As used in sections 38a-473, 38a-474 and 38a-481, subsection...
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... - (a) Each insurance company, fraternal benefit society, hospital service corporation,...
Section 38a-495d. - Refund of prepaid premium for Medicare supplement policies. - Each insurance company, fraternal benefit society, hospital service corporation, medical...
Section 38a-496. (Formerly Sec. 38-174q). - Coverage for occupational therapy. - (a) For the purposes of this section: (1) “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. - (a) Each individual health insurance policy providing coverage of the...
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. - (a) As used in this section (1) “insurer” has the...
Section 38a-498. (Formerly Sec. 38-174t). - Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider. - (a) Each individual health insurance policy providing coverage of the...
Section 38a-498a. - Prior authorization prohibited for certain 9-1-1 emergency calls. - No individual health insurance policy providing coverage of the type...
Section 38a-498b. - Mandatory coverage for mobile field hospital. - Each individual health insurance policy providing coverage of the type...
Section 38a-498c. - Denial of coverage prohibited for health care services rendered to persons with an elevated blood alcohol content. - No individual health insurance policy providing coverage of the type...
Section 38a-499. (Formerly Sec. 38-174v). - Coverage for services of physician assistants and certain nurses. - (a) For the purposes of this section: (1) “Advanced practice...
Section 38a-499a. - *(See end of section for amended version and effective date.) Coverage for telehealth services. - (a) As used in this section, “telehealth” has the same...
Section 38a-500. (Formerly Sec. 38-174w). - Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries. Subrogation rights. - (a) Notwithstanding any other provision of the general statutes, no...
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. - (a)(1) As used in this section and section 38a-475a, “long-term...
Section 38a-501a. - Individual short-term care policies. Approval of rates and forms. Disclosures. Regulations. - (a) As used in this section, “short-term care policy” means...
Section 38a-502. (Formerly Sec. 38-174ff). - Mandatory coverage for services provided by the Healthcare Center maintained by the Department of Veterans Affairs. - No individual health insurance policy delivered, issued for delivery or...
Section 38a-503. (Formerly Sec. 38-174gg). - Mandatory coverage for mammography, breast ultrasound and magnetic resonance imaging. Breast density information included in mammography report. - (a) For purposes of this section: (1) “Healthcare Common Procedure...
Section 38a-503a. - Mandatory coverage for breast cancer survivors. - Section 38a-503 is repealed, effective January 1, 2020. (P.A. 96-177,...
Section 38a-503b. - Carriers to permit direct access to obstetrician-gynecologist. - (a) As used in this section, “carrier” means each insurer,...
Section 38a-503c. - Mandatory coverage for maternity care. Interhospital transfer of newborn infant and mother. - (a) As used in this section, “carrier” means each insurer,...
Section 38a-503d. - Mandatory coverage for mastectomy care. Termination of provider contract prohibited. - (a) Each individual health insurance policy providing coverage of the...
Section 38a-503e. - Mandatory coverage for contraceptives and sterilization. - (a) Each individual health insurance policy providing coverage of the...
Section 38a-503f. - Mandatory coverage for certain health benefits and services for women, infants, children and adolescents. - (a)(1) Except as provided in subdivision (2) of this subsection,...
Section 38a-503g. - Mandatory coverage for ovarian cancer screening and monitoring. - (a) For purposes of this section: (1) “At risk for...
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. - (a) Each insurance company, hospital service corporation, medical service corporation,...
Section 38a-504a. - Coverage for routine patient care costs associated with certain clinical trials. - Each individual health insurance policy providing coverage of the type...
Section 38a-504b. - Clinical trial criteria. - A clinical trial for the prevention of cancer shall be...
Section 38a-504c. - Evidence and information re eligibility for clinical trial. No coverage required for otherwise reimbursable costs. - In order to be eligible for coverage of routine patient...
Section 38a-504d. - Clinical trials: Routine patient care costs. - (a) For purposes of sections 38a-504a to 38a-504g, inclusive, “routine...
Section 38a-504e. - Clinical trials: Billing. Payments. - (a) Providers, hospitals and institutions that provide routine patient care...
Section 38a-504f. - Clinical trials: Standardized forms. Time frame for coverage determinations. Appeals. Regulations. - (a)(1) For purposes of cancer clinical trials, the Insurance Department,...
Section 38a-504g. - Clinical trials: Submission and certification of policy forms. - (a) Any insurer or health care center with coverage policies...
Section 38a-505. (Formerly Sec. 38-378). - Insurance Commissioner's powers concerning comprehensive health care plans. Disclosures. - In order to provide reasonable simplification of terms and coverages...
Section 38a-506. (Formerly Sec. 38-173). - Penalty. - Any insurer, hospital service corporation, medical service corporation, health care...
Section 38a-507. - Coverage for services performed by chiropractors. - Each individual health insurance policy providing coverage of the type...
Section 38a-508. - Coverage for adopted children. - (a) Each individual health insurance policy providing coverage of the...
Section 38a-509. - Mandatory coverage for infertility diagnosis and treatment. Limitations. - (a) Subject to the limitations set forth in subsection (b)...
Section 38a-510. - Prescription drug coverage. Mail order pharmacies. Step therapy use. - (a) No insurance company, hospital service corporation, medical service corporation,...
Section 38a-510a. - Prescription drug coverage. Synchronized refills. - No individual health insurance policy providing coverage of the type...
Section 38a-510b. - Prescription drug coverage. Prior authorization for naloxone hydrochloride or similar drug not required. - No individual health insurance policy providing coverage of the type...
Section 38a-510c. - Coverage for investigational drug, biological product or device for insureds with terminal illnesses. Liability of health carrier. - (a) As used in this section, “health carrier” means an...
Section 38a-511. - Copayments re in-network imaging services. - (a) No health insurer, health care center, hospital service corporation,...
Section 38a-511a. - Copayments re in-network physical therapy services and in-network occupational therapy services. - No individual health insurance policy providing coverage of the type...
Section 38a-512. - Applicability of statutes to certain major medical expense policies. - Any policy providing major medical expense coverage that is written...
Section 38a-512a. - Continuation of coverage. - (a)(1) Each insurer, health care center, hospital service corporation, medical...
Section 38a-512b. - Termination of coverage of child, stepchild or other dependent child in group policies. Dental or vision coverage. - (a) Each group health insurance policy providing coverage of the...
Section 38a-512c. - Annual and lifetime limits. - (a) No group health insurance policy providing coverage of the...
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... - (a)(1) No group health insurance policy, as defined by the...
Section 38a-513a. - Time limits for coverage determinations. Notice requirements. - Section 38a-513a is repealed, effective October 1, 2015. (P.A. 99-284,...
Section 38a-513b. - Coverage and notice re experimental treatments. Appeals. - (a) Each group health insurance policy delivered, issued for delivery,...
Section 38a-513c. - Group health insurance policy to contain definition of “medically necessary” or “medical necessity”. - (a) No insurer, health care center, hospital service corporation, medical...
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. - (a) No insurer, health care center, hospital service corporation, medical...
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. - (a) In the event (1) an employer, as defined in...
Section 38a-513f. - Claims information to be provided to certain employers. Restrictions. Subpoenas. - (a) As used in this section: (1) “Claims paid” means...
Section 38a-513g. - Employer submission of plan cost information to Comptroller. - (a) For the purposes of this section, “employer” has the...
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... - (a) For the purposes of this section: (1) (A) “Mental...
Section 38a-514a. - Biologically-based mental illness. Coverage required. - Section 38a-514a is repealed, effective January 1, 2000. (P.A. 97-99,...
Section 38a-514b. - Coverage for autism spectrum disorder. - (a) As used in this section: (1) “Applied behavior analysis”...
Section 38a-514c. - Mental health and substance use disorder benefits. Nonquantitative treatment limitations. - No group health insurance policy providing coverage of the type...
Section 38a-514d. - Coverage for substance abuse services provided pursuant to court order. - No group health insurance policy providing coverage of the type...
Section 38a-514e. - Coverage for mental health wellness exams. - (a) For the purposes of this section: (1) “Licensed mental...
Section 38a-514f. - Coverage for services provided under the Collaborative Care Model. - (a) For the purposes of this section: (1) “Collaborative Care...
Section 38a-514g. - Acute patient psychiatric coverage. Prior authorization not required. - (a) No group health insurance policy providing coverage of the...
Section 38a-515. - Continuation of coverage of mentally or physically handicapped children. - (a) Each group health insurance policy providing coverage of the...
Section 38a-516. - Coverage for newly born children. Notification to insurer. - (a) Each group health insurance policy delivered, issued for delivery,...
Section 38a-516a. - Coverage for birth-to-three program. - (a) Each group health insurance policy providing coverage of the...
Section 38a-516b. - Coverage for hearing aids. - Each group health insurance policy providing coverage of the type...
Section 38a-516c. - Coverage for craniofacial disorders. - Each group health insurance policy providing coverage of the type...
Section 38a-516d. - Coverage for neuropsychological testing for children diagnosed with cancer. - Each group health insurance policy providing coverage of the type...
Section 38a-517. - Coverage for services performed by dentist in certain instances. - Whenever the term “physician” or “doctor” is used in any...
Section 38a-517a. - Coverage for in-patient, outpatient or one-day dental services in certain instances. - (a) Each group health insurance policy providing coverage of the...
Section 38a-517b. - Assignment of benefits to a dentist or oral surgeon. - No insurer, health care center, hospital service corporation, medical service...
Section 38a-518. - Coverage for accidental ingestion or consumption of controlled drugs. Benefits prescribed. - No group health insurance policy providing coverage of the type...
Section 38a-518a. - Mandatory coverage for hypodermic needles and syringes. - Each group health insurance policy providing coverage of the type...
Section 38a-518b. - Coverage for certain off-label drug prescriptions. - (a)(1) Each group health insurance policy delivered, issued for delivery,...
Section 38a-518c. - Coverage for low protein modified food products, amino acid modified preparations and specialized formulas. - (a) For purposes of this section: (1) “Inherited metabolic disease”...
Section 38a-518d. - Mandatory coverage for diabetes screening, testing and treatment. - (a) For the purposes of this section: (1) “Diabetes device”...
Section 38a-518e. - Mandatory coverage for diabetes outpatient self-management training. - (a) Each group health insurance policy providing coverage of the...
Section 38a-518f. - Mandatory coverage for certain prescription drugs removed from formulary. - Each group health insurance policy providing coverage of the type...
Section 38a-518g. - Mandatory coverage for prostate cancer screening and treatment. - Each group health insurance policy providing coverage of the type...
Section 38a-518h. - Mandatory coverage for certain Lyme disease treatments. - Each group health insurance policy providing coverage of the type...
Section 38a-518i. - Mandatory coverage for pain management. - (a) Each group health insurance policy providing coverage of the...
Section 38a-518j. - Mandatory coverage for ostomy-related supplies. - Each group health insurance policy providing coverage of the type...
Section 38a-518k. - Mandatory coverage for colorectal cancer screening. - (a) Each group health insurance policy providing coverage of the...
Section 38a-518l. - Mandatory coverage for certain renewals of prescription eye drops. - Each group health insurance policy providing coverage of the type...
Section 38a-518m. - Mandatory coverage for certain wound-care supplies. - Each group health insurance policy providing coverage of the type...
Section 38a-518o. - Mandatory coverage for bone marrow testing. - (a) Subject to the provisions of subsection (b) of this...
Section 38a-518p. - Mandating coverage for medically monitored inpatient detoxification. - Each insurance company, hospital service corporation, medical service corporation, health...
Section 38a-518q. - Mandatory coverage for essential health benefits. - (a) For the purposes of this section: (1) “Employee” has...
Section 38a-518r. - Mandatory coverage for certain immunizations and consultation with health care provider. - (a) Each group health insurance policy providing coverage of the...
Section 38a-518s. - Mandatory coverage for certain preventive care and screenings for individuals who are twenty-one years of age or younger. - (a) Each group health insurance policy providing coverage of the...
Section 38a-518t. - Mandatory coverage for prosthetic devices. - (a) As used in this section, “prosthetic device” means an...
Section 38a-518u. - Coverage for psychotropic drugs. Standards re availability. - Notwithstanding any provision of the general statutes, no group health...
Section 38a-519. (Formerly Sec. 38-174j). - Offset proviso prohibited in certain policies. Required disclosures for group long-term disability policies. - (a) No group health insurance policy that provides disability income...
Section 38a-520. - Mandatory coverage for home health care. Deductibles. Exception from deductible limits for medical savings accounts. Archer MSAs and health savings accounts. - (a) Each group health insurance policy providing coverage of the...
Section 38a-521. - Home health care by recognized nonmedical systems. - Notwithstanding the provisions of section 38a-520, no insurer, health care...
Section 38a-522. - Medicare supplement policies. Coverage of home health aide service. - (a) As used in this section, “Medicare” means the Health...
Section 38a-523. (Formerly Sec. 38-174p). - Group hospital or medical insurance coverage for comprehensive rehabilitation services. - (a) For the purposes of this section: (1) “Comprehensive rehabilitation...
Section 38a-524. - Coverage for occupational therapy. - (a) For the purposes of this section: (1) “Occupational therapy”...
Section 38a-525. - Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider. - (a) Each group health insurance policy providing coverage of the...
Section 38a-525a. - Prior authorization prohibited for certain 9-1-1 emergency calls. - No group health insurance policy providing coverage of the type...
Section 38a-525b. - Mandatory coverage for mobile field hospital. - Each group health insurance policy providing coverage of the type...
Section 38a-525c. - Denial of coverage prohibited for health care services rendered to persons with an elevated blood alcohol content. - No group health insurance policy providing coverage of the type...
Section 38a-526. - Coverage for services of physician assistants and certain nurses. - (a) For the purposes of this section: (1) “Certified nurse...
Section 38a-526a. - *(See end of section for amended version and effective date.) Coverage for telehealth services. - (a) As used in this section, “telehealth” has the same...
Section 38a-527. - Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries. - (a) Notwithstanding any other provision of the general statutes, no...
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. - (a)(1) As used in this section and section 38a-475a, “long-term...
Section 38a-528a. - Group short-term care policies. Approval of rates and forms. Disclosures. Regulations. - (a) As used in this section, “short-term care policy” means...
Section 38a-529. - Mandatory coverage for services provided by the Healthcare Center maintained by the Department of Veterans Affairs. - No group health insurance policy delivered, issued for delivery or...
Section 38a-530. - Mandatory coverage for mammography, breast ultrasound and magnetic resonance imaging. Breast density information included in mammography report. - (a) For purposes of this section: (1) “Healthcare Common Procedure...
Section 38a-530a. - Mandatory coverage for breast cancer survivors. - Section 38a-530a is repealed, effective January 1, 2020. (P.A. 96-177,...
Section 38a-530b. - Carriers to permit direct access to obstetrician-gynecologist. - (a) As used in this section, “carrier” means each insurer,...
Section 38a-530c. - Mandatory coverage for maternity care. Interhospital transfer of newborn infant and mother. - (a) As used in this section, “carrier” means each insurer,...
Section 38a-530d. - Mandatory coverage for mastectomy care. Termination of provider contract prohibited. - (a) Each group health insurance policy providing coverage of the...
Section 38a-530e. - Mandatory coverage for contraceptives and sterilization. - (a) Each group health insurance policy providing coverage of the...
Section 38a-530f. - Mandatory coverage for certain health benefits and services for women, infants, children and adolescents. - (a)(1) Except as provided in subdivision (2) of this subsection,...
Section 38a-530g. - Mandatory coverage for ovarian cancer screening and monitoring. - (a) For purposes of this section: (1) “At risk for...
Section 38a-531. (Formerly Sec. 38-174hh). - Mandatory coverage for employees of certain employers. Approval of policy forms. - (a) For purposes of this section: (1) “Employer” means any...
Section 38a-532. (Formerly Sec. 38-262a). - Assignment of incidents of ownership under group life, health or accident policy. - Any person who is insured under any policy of group...
Section 38a-533. (Formerly Sec. 38-262b). - Mandatory coverage for the treatment of medical complications of alcoholism. - (a) Except as provided in subsection (c) of this section,...
Section 38a-534. - Coverage for services performed by chiropractors. - Each group health insurance policy providing coverage of the type...
Section 38a-535. - Mandatory coverage for preventive pediatric care and blood lead screening and risk assessment. - (a) For purposes of this section, “preventive pediatric care” means...
Section 38a-535a. - Notification of individual coverage and benefits of a noncustodial parent to a custodial parent, when. Regulations. - Section 38a-535a is repealed, effective July 1, 1995. (May Sp....
Section 38a-536. - Mandatory coverage for infertility diagnosis and treatment. Limitations. - (a) Subject to the limitations set forth in subsection (b)...
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. - (a) Any individual, partnership, corporation or unincorporated association providing group...
Section 38a-538. (Formerly Sec. 38-262d). - Continuation of benefits under group employee health plans. - Section 38a-538 is repealed, effective July 10, 2015. (P.A. 75-417;...
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-539 is repealed, effective January 1, 2000. (P.A. 77-237;...
Section 38a-540. (Formerly Sec. 38-262g). - Duplication of coverage under group health insurance policies. - In any case in which spouses are employed by the...
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. - Every health insurance policy issued under a group insurance plan...
Section 38a-542. - Mandatory coverage for treatment of tumors and leukemia. Mandatory coverage for reconstructive surgery, prosthesis, chemotherapy and wigs. Orally administered anticancer medications. - (a) Each insurance company, hospital service corporation, medical service corporation,...
Section 38a-542a. - Coverage for routine patient care costs associated with certain clinical trials. - Each group health insurance policy providing coverage of the type...
Section 38a-542b. - Clinical trial criteria. - A clinical trial for the prevention of cancer shall be...
Section 38a-542c. - Evidence and information re eligibility for clinical trial. No coverage required for otherwise reimbursable costs. - In order to be eligible for coverage of routine patient...
Section 38a-542d. - Clinical trials: Routine patient care costs. - (a) For purposes of sections 38a-542a to 38a-542g, inclusive, “routine...
Section 38a-542e. - Clinical trials: Billing. Payments. - (a) Providers, hospitals and institutions that provide routine patient care...
Section 38a-542f. - Clinical trials: Standardized forms. Time frame for coverage determinations. Appeals. Regulations. - (a)(1) For purposes of cancer clinical trials, the Insurance Department,...
Section 38a-542g. - Clinical trials: Submission and certification of policy forms. - (a) Any insurer or health care center with coverage policies...
Section 38a-543. (Formerly Sec. 38-262j). - Reduction of payments on basis of Medicare eligibility. - No group health insurance policy delivered, issued for delivery, renewed,...
Section 38a-544. - Prescription drug coverage. Mail order pharmacies. Step therapy use. - (a) No insurance company, hospital service corporation, medical service corporation,...
Section 38a-544a. - Prescription drug coverage. Synchronized refills. - No group health insurance policy providing coverage of the type...
Section 38a-544b. - Prescription drug coverage. Prior authorization for naloxone hydrochloride or similar drug not required. - No group health insurance policy providing coverage of the type...
Section 38a-545. (Formerly Sec. 38-262k). - Group dental health insurance plans. Alternative coverage option. - Any employer or other organization which had twenty-five or more...
Section 38a-546. (Formerly Sec. 38-379). - Discontinuation and replacement of group health insurance policy. Regulations. - (a) In any case of the discontinuance of a group...
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. - As used in this section, the term “employer” means any...
Section 38a-548. - Penalty. - Any insurer, hospital service corporation, medical service corporation, health care...
Section 38a-549. - Coverage for adopted children. - (a) Each group health insurance policy providing coverage of the...
Section 38a-550. - Copayments re in-network imaging services. - (a) No health insurer, health care center, hospital service corporation,...
Section 38a-550a. - Copayments re in-network physical therapy services and in-network occupational therapy services. - No group health insurance policy providing coverage of the type...
Section 38a-551. (Formerly Sec. 38-371). - Definitions. - For the purposes of this section and sections 38a-552 and...
Section 38a-552. (Formerly Sec. 38-372). - Provision of service to certain low-income individuals. - No individual or organization that provides medical advice, diagnosis, care...
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... - Sections 38a-553 to 38a-555, inclusive, are repealed, effective July 10,...
Section 38a-556. (Formerly Sec. 38-376). - Health Reinsurance Association. Board of directors. Powers and authority. Rates. Net loss assessment. Immunity from liability. - (a) There is hereby created a nonprofit legal entity to...
Section 38a-556a. - Connecticut Clearinghouse. - (a) There is established a program which shall be known...
Section 38a-557. (Formerly Sec. 38-377). - Hospital service corporations and medical service corporations. Residual market mechanism. Insurance Commissioner's powers concerning such mechanisms. - (a) Hospital service corporations and medical service corporations may participate...
Section 38a-558. (Formerly Sec. 38-380). - Office of Health Care Access. - Section 38a-558 is repealed, effective May 14, 2018. (P.A. 75-616,...
Section 38a-559. (Formerly Sec. 38-381). - Commissioner of Social Services. Contract authority concerning Medicaid programs. - The Commissioner of Social Services may enter into contractual agreements...
Section 38a-560. - Small employer grouping for health insurance coverage. - Small employers, as defined in section 38a-564, may group together...
Section 38a-564. - Definitions. - As used in this section and sections 38a-566, 38a-567, 38a-569...
Section 38a-565. - Special health care plans. - Section 38a-565 is repealed, effective July 10, 2015. (P.A. 90-134,...
Section 38a-566. - Health insurance plans or insurance arrangements covering employees of a small employer. Trusts. Trade associations. - (a) Any individual or group health insurance plan or any...
Section 38a-567. - Provisions of small employer plans and arrangements. - Health insurance plans, associations of small employers and other insurance...
Section 38a-568. - Coverage under small employer health care plans and arrangements. Approval by commissioner. - Section 38a-568 is repealed, effective July 10, 2015. (P.A. 90-134,...
Section 38a-569. - Connecticut Small Employer Health Reinsurance Pool. - (a)(1) There is established a nonprofit entity to be known...
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... - Sections 38a-570 to 38a-572, inclusive, are repealed, effective July 10,...
Section 38a-573. - Validity of separate provisions. - If any provision of section 38a-564, 38a-566, 38a-567 or 38a-569...
Section 38a-574. - Standard family health statement. - (a) The board of directors of the Connecticut Small Employer...
Section 38a-577. (Formerly Sec. 38-174ii). - Consumer dental health plans. Definitions. - (a) For the purposes of sections 38a-577 to 38a-590, inclusive:...
Section 38a-578. (Formerly Sec. 38-174jj). - Certificate of authority. Application requirements. - (a) No dentist or group of dentists may establish, operate...
Section 38a-579. (Formerly Sec. 38-174kk). - Certificate of authority. Standards for issuance and renewal. - (a) The commissioner shall issue a certificate of authority if...
Section 38a-580. (Formerly Sec. 38-174ll). - General surplus required. - The amount of a general surplus that a dental plan...
Section 38a-581. (Formerly Sec. 38-174mm). - Evidence of coverage to be provided to enrollees. Approval by commissioner. - (a) An enrollee shall be entitled to receive evidence of...
Section 38a-582. (Formerly Sec. 38-174nn). - Schedule of charges. Approval by commissioner. Appeal of disapproval. - (a) No schedule of charges for enrollee coverage for dental...
Section 38a-583. (Formerly Sec. 38-174oo). - Records. Commissioner's power to examine; maintenance; preservation. - (a) The commissioner or his designee may investigate the business...
Section 38a-584. (Formerly Sec. 38-174pp). - Complaint system. - (a) A dental plan organization shall establish and maintain a...
Section 38a-585. (Formerly Sec. 38-174qq). - Requirements re filing of annual reports with commissioner. - Every dental plan organization shall, on or before March first...
Section 38a-586. (Formerly Sec. 38-174rr). - False or misleading advertising or solicitation and deceptive evidence of coverage prohibited. - (a) No dental plan organization or representative thereof may cause...
Section 38a-587. (Formerly Sec. 38-174ss). - Suspension or revocation of certificate of authority. Hearing. Appeal. - (a) The commissioner may suspend or revoke any certificate of...
Section 38a-588. (Formerly Sec. 38-174tt). - Penalty. Insolvency. - Any dental plan organization that violates any provision of sections...
Section 38a-589. (Formerly Sec. 38-174uu). - Confidentiality. - (a) Applications, filings and reports required under sections 38a-577 to...
Section 38a-590. (Formerly Sec. 38-174vv). - Commissioner's power to adopt regulations. - The commissioner may adopt regulations, in accordance with the provisions...
Section 38a-591. - Compliance with the Patient Protection and Affordable Care Act. Regulations. - (a) For purposes of this section, “Affordable Care Act” means...
Section 38a-591a. - Definitions. - As used in this section and sections 38a-591b to 38a-591n,...
Section 38a-591b. - Health carrier responsibilities re utilization review. - (a) Sections 38a-591a to 38a-591n, inclusive, shall apply to (1)...
Section 38a-591c. - Utilization review criteria and procedures. - (a)(1) Each health carrier shall contract with (A) health care...
Section 38a-591d. - Utilization review and benefit determinations. Urgent care requests. Information provided in notice of adverse determination. - (a)(1) Each health carrier shall maintain written procedures for (A)...
Section 38a-591e. - Internal grievance process of adverse determinations based on medical necessity. Expedited review of adverse determinations of urgent care requests. - (a)(1) Each health carrier shall establish and maintain written procedures...
Section 38a-591f. - Internal grievance process of adverse determinations not based on medical necessity. - (a) Each health carrier shall establish and maintain written procedures...
Section 38a-591g. - External reviews and expedited external reviews. - (a)(1) A covered person or a covered person's authorized representative...
Section 38a-591h. - Record-keeping requirements. Report to commissioner upon request. - (a)(1) Each health carrier shall maintain written records to document...
Section 38a-591i. - Regulations. - The commissioner shall adopt regulations, in accordance with chapter 54,...
Section 38a-591j. - Utilization review companies: Licensure. Fees. Investigation of grievances. Duties. - (a) No utilization review company shall conduct utilization review in...
Section 38a-591k. - Violations. Notice and hearing. Penalties. Appeal. - (a) Whenever the commissioner has reason to believe that a...
Section 38a-591l. - Independent review organizations conducting external reviews and expedited external reviews. - (a)(1) The commissioner shall approve independent review organizations eligible to...
Section 38a-591m. - Independent review organizations: Conflicts of interest. Liability. Record-keeping requirements. Report to commissioner upon request. - (a) The commissioner shall not assign an independent review organization,...
Section 38a-591n. - Documents, communications, information and evidence provided to covered person or covered person's authorized representative upon request. - (a)(1) Upon request pursuant to subparagraph (E) of subdivision (1)...