Connecticut General Statutes 38a-492v – Mandatory coverage for hospice services provided in home through a hospice care program to the extent provided for inpatient hospice services
(a) As used in this section, “hospice care program” has the same meaning as provided in section 19a-122e.
Terms Used In Connecticut General Statutes 38a-492v
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Insurance: means any agreement to pay a sum of money, provide services or any other thing of value on the happening of a particular event or contingency or to provide indemnity for loss in respect to a specified subject by specified perils in return for a consideration. See Connecticut General Statutes 38a-1
- Insured: means a person to whom or for whose benefit an insurer makes a promise in an insurance policy. See Connecticut General Statutes 38a-1
- Policy: means any document, including attached endorsements and riders, purporting to be an enforceable contract, which memorializes in writing some or all of the terms of an insurance contract. See Connecticut General Statutes 38a-1
- State: means any state, district, or territory of the United States. See Connecticut General Statutes 38a-1
(b) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for hospice services provided to an insured in the home through a hospice care program, to the extent coverage is provided for inpatient hospice services in a hospital. Such coverage shall be subject to the same terms and conditions applicable to all other benefits under such policy.
(c) No such policy shall exclude a hospice service for coverage solely because such hospice service is provided in the home and not at a hospital, provided hospice care in the home is appropriate for the insured.
(d) Nothing in this section shall prohibit or limit a health insurer, health care center, hospital service corporation, medical service corporation or other entity from conducting utilization review for in-home hospice services, provided such utilization review is conducted in the same manner and uses the same clinical review criteria as a utilization review for the same hospice services provided in a hospital.