§ 38a-469 Definitions
§ 38a-470 Lien on workers’ compensation awards for insurers. Notice of lien
§ 38a-471 Third party prescription programs. Notice of cancellation. Applicability of section
§ 38a-472 Assignment of insurance proceeds to doctor, hospital or state agency. Lien for state care. Notice of lien
§ 38a-472a Medical provider indemnification agreements prohibited
§ 38a-472b Medical provider indemnification contracts. Professional actions and related liability
§ 38a-472c Dental policies. Estimate of reimbursement. Material adjustments to fee schedules for in-network providers. Notice
§ 38a-472d Public education outreach program re health insurance availability and eligibility requirements
§ 38a-472e Health insurer. Requirements re offer to contract with a school-based health center
§ 38a-472f Network adequacy. Health carrier duties and responsibilities. Access plan filing
§ 38a-472g Restrictions applicable to prior authorization or precertification
§ 38a-472h Fees charged by dentists, optometrists and ophthalmologists for noncovered benefits. Notice and posting required
§ 38a-472i Payment amount of professional services component of covered colonoscopy or endoscopic services
§ 38a-472j Restrictions applicable to cost-sharing for covered benefits. Regulations
§ 38a-472k Disability income policies. Discretionary clauses prohibited. Regulations
§ 38a-472l Participating dental provider contracts. Third-party access. Restrictions. Exceptions
§ 38a-473 Medicare supplement expense factors. Age, gender, previous claim or medical history rating prohibited
§ 38a-474 Medicare supplement policy rate increases: Procedure. Age, gender, previous claim or medical history rating prohibited
§ 38a-475 Precertification of long-term care policies under the Connecticut Partnership for Long-Term Care. Regulations
§ 38a-475a Minimum set of affordable benefit options for long-term care policies. Regulations
§ 38a-476 Preexisting condition coverage
§ 38a-476a Compliance with the Health Insurance Portability and Accountability Act. Guaranteed renewability. Discrimination based on health status, newborns’ and mothers’ health prohibited. Parity of mental health benefits. Disclosure of information for employers. C
§ 38a-476b Standards re psychotropic drug availability in health plans
§ 38a-476c Policies and contracts with variable network and enrollee cost-sharing. Approval. Limitations
§ 38a-477 Standardized claim forms. Information necessary for filing a claim. Regulations
§ 38a-477a Notification by Insurance Commissioner of required benefits and policy forms
§ 38a-477b Postclaims underwriting prohibited unless approval granted. Application for approval of rescission, cancellation or limitation. Decision. Appeals. Regulations
§ 38a-477c Disclosure of state and federal medical loss ratio with each health insurance application
§ 38a-477d Information to be made available to consumers. Explanations of benefits. Disclosures by health carriers. Specifications by consumers. Restrictions
§ 38a-477e Health carriers to maintain Internet web site and toll-free telephone number. Available information. Exception
§ 38a-477f Contract provision prohibiting certain disclosures prohibited
§ 38a-477g Contracts between health carriers and participating providers
§ 38a-477h Participating provider directories
§ 38a-477aa Cost-sharing and health care provider reimbursements for emergency services, urgent crisis center services and surprise bills
§ 38a-477bb Cost-sharing re facility fees
§ 38a-477cc Contracts for pharmacy services with health carriers or pharmacy benefits managers
§ 38a-477dd Contracts with health carriers. Certain provisions concerning disclosures to covered persons prohibited
§ 38a-477ee Mental health and substance use disorder benefits. Nonquantitative treatment limitations. Reports. Public hearings. Regulations
§ 38a-477ff Third-party discounts and payments for covered benefits. Credit required
§ 38a-477gg Contracts between health carriers and pharmacy benefits managers. Credit required for third-party discounts and payments for covered prescription drug benefits
§ 38a-477hh Denial of coverage for otherwise covered benefits based on measurement of blood oxygen level by pulse oximeter prohibited
§ 38a-477ii Pulse oximeter accuracy. Educational materials. Distribution and posting required
§ 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
§ 38a-477kk Proof of coverage to disclose whether coverage is fully insured or self-insured. Regulations
§ 38a-477ll Coverage for health enhancement programs
§ 38a-478 Definitions
§ 38a-478a Commissioner’s report to the Governor and the General Assembly
§ 38a-478b Penalty for managed care organization’s failure to file data and reports. Commissioner’s report to the Governor and the General Assembly on organizations that fail to file data and reports
§ 38a-478c Managed care organization’s report to the commissioner: Data, reports and information required
§ 38a-478d Provider directory. Notification to enrollee of termination or withdrawal of enrollee’s primary care provider
§ 38a-478e Medical protocols. Procedure prior to change. Physician input. Notification of change
§ 38a-478f Provider profile development requirements
§ 38a-478g Managed care contract requirements. Plan description requirements
§ 38a-478h Contract requirements and notice for removal or departure of provider. Retaliatory action prohibited
§ 38a-478i Limitation on enrollee rights prohibited
§ 38a-478j Coinsurance and deductible payments based on negotiated discounts
§ 38a-478k Gag clauses prohibited
§ 38a-478l Consumer report card required. Content. Data analysis by commissioner
§ 38a-478o Confidentiality and antidiscrimination procedures required
§ 38a-478p Expedited utilization review. Standardized process required
§ 38a-478q Use of laboratories covered by plan required
§ 38a-478r Emergency rooms. Prudent layperson standard. Presenting symptoms or final diagnosis as basis for coverage. Mandatory coverage for medically necessary health care services for emergency medical conditions
§ 38a-478s Nonapplicability to self-insured employee welfare benefit plans and workers’ compensation plans
§ 38a-478t Commissioner of Public Health to receive data
§ 38a-478u Regulations
§ 38a-478v Applicability of Unfair and Prohibited Insurance Practices Act. Examination by Insurance Commissioner. Regulations
§ 38a-478w Managed care organization’s calculation of enrollee liability for covered benefits. Credit required for third-party discounts and payments
§ 38a-479 Definitions. Access to fee schedules. Fee information to be confidential
§ 38a-479a Physicians and managed care organizations to discuss issues relative to contracting between such parties
§ 38a-479b Material changes to fee schedules. Return of payment by provider. Appeals. Filing of claim by provider under other applicable insurance coverage. Certain clauses, covenants and agreements prohibited. Exception
§ 38a-479aa Preferred provider networks. Definitions. Licensing. Fees. Requirements. Exception
§ 38a-479bb Requirements for managed care organizations that contract with preferred provider networks. Requirements for preferred provider networks
§ 38a-479cc Duties of a preferred provider network when providing services pursuant to a contract with a managed care organization
§ 38a-479dd Preferred provider network examination of outstanding amounts. Notice. Commissioner’s duties
§ 38a-479ee Violations. Penalties. Investigations and staffing. Grievances. Referrals from Healthcare Advocate
§ 38a-479ff Adverse action or threat of adverse action against complainant prohibited. Exception. Civil actions by aggrieved persons
§ 38a-479gg Regulations
§ 38a-479qq Medical discount plans: Definitions, prohibited sales practices, penalties
§ 38a-479rr Medical discount plan organizations: Licensure. List of authorized marketers. Provider agreements. Minimum net worth. Suspension of authority and revocation or nonrenewal of license. Reinstatement of license. Maintenance of information. Regulations. Penal
§ 38a-479aaa Pharmacy benefits managers. Definitions
§ 38a-479bbb Registration of pharmacy benefits managers required. Application for registration. Fee. Surety bond. Exemption from registration
§ 38a-479ccc Certificate of registration; when issued or refused. Suspension, revocation or refusal to issue or renew registration; grounds
§ 38a-479ddd Hearing on denial of certificate. Subsequent application
§ 38a-479eee Claims payment to be made by electronic funds transfer upon written request
§ 38a-479fff Expiration of certificates of registration. Renewal. Fees
§ 38a-479ggg Regulations
§ 38a-479hhh Investigations and hearings. Powers of commissioner. Appeals
§ 38a-479iii Pharmacy audits
§ 38a-479ooo Definitions
§ 38a-479ppp Annual report by pharmacy benefits managers. Standardized form. Confidentiality of information. Penalty. Regulations. Commissioner’s report to the General Assembly
§ 38a-479qqq Annual report by health carriers. Regulations
§ 38a-479rrr Annual certification by health carriers
§ 38a-479sss Annual report by commissioner to the General Assembly re outpatient prescription drug costs
§ 38a-479ttt Annual report by commissioner to the General Assembly re prescription drug rebates
§ 38a-480 Applicability of statutes to certain policies and contracts
§ 38a-481 Filing of policy form, application, classification of risks and rates. Approval of rates. Prescription drug rebates. Medicare supplement policies: Age, gender, previous claim or medical history rating prohibited. Reduction of payme
§ 38a-482 Form of policy
§ 38a-482a Individual health insurance policy to contain definition of “medically necessary” or “medical necessity”
§ 38a-482b Individual health insurance policy providing limited coverage to include disclosure. Limited coverage defined
§ 38a-482c Annual and lifetime limits
§ 38a-483 Standard provisions of individual health policy
§ 38a-483a Exclusionary riders for individual health insurance policies. Regulations
§ 38a-483b Time limits for coverage determinations. Notice requirements
§ 38a-483c Coverage and notice re experimental treatments. Appeals
§ 38a-484 Policy provisions not to be less favorable than standard. Validity of policy issued in violation of law
§ 38a-485 Copy of application to be part of new policy or to be furnished with renewal. Alteration of application
§ 38a-486 Certain acts not to operate as waiver of rights
§ 38a-487 Coverage after termination date of policy
§ 38a-488 Discrimination
§ 38a-488a Mandatory coverage for the diagnosis and treatment of mental or nervous conditions. Exceptions. Benefits payable re type of provider or facility. State’s claim against proceeds. Direct reimbursement for certain covered services rendered by certain out-of-
§ 38a-488b Coverage for autism spectrum disorder therapies
§ 38a-488c Mental health and substance use disorder benefits. Nonquantitative treatment limitations
§ 38a-488d Coverage for substance abuse services provided pursuant to court order
§ 38a-488e Coverage for mental health wellness examinations
§ 38a-488f Coverage for services provided under the Collaborative Care Model
§ 38a-488g Acute inpatient psychiatric coverage. Prior authorization not required
§ 38a-489 Continuation of coverage of mentally or physically handicapped children
§ 38a-490 Coverage for newly born children. Notification to insurer
§ 38a-490a Coverage for birth-to-three program
§ 38a-490b Coverage for hearing aids
§ 38a-490c Coverage for craniofacial disorders
§ 38a-490d Mandatory coverage for blood lead screening and risk assessment
§ 38a-491 Coverage for services performed by dentists in certain instances
§ 38a-491a Coverage for in-patient, outpatient or one-day dental services in certain instances
§ 38a-491b Assignment of benefits to a dentist or oral surgeon
§ 38a-492 Coverage for accidental ingestion or consumption of controlled drugs. Benefits prescribed
§ 38a-492a Mandatory coverage for hypodermic needles and syringes
§ 38a-492b Coverage for certain off-label drug prescriptions
§ 38a-492c Coverage for low protein modified food products, amino acid modified preparations and specialized formulas
§ 38a-492d Mandatory coverage for diabetes screening, testing and treatment
§ 38a-492e Mandatory coverage for diabetes outpatient self-management training
§ 38a-492f Mandatory coverage for certain prescription drugs removed from formulary
§ 38a-492g Mandatory coverage for prostate cancer screening and treatment
§ 38a-492h Mandatory coverage for certain Lyme disease treatments
§ 38a-492i Mandatory coverage for pain management
§ 38a-492j Mandatory coverage for ostomy-related supplies
§ 38a-492k Mandatory coverage for colorectal cancer screening
§ 38a-492l Mandatory coverage for neuropsychological testing for children diagnosed with cancer
§ 38a-492m Mandatory coverage for certain renewals of prescription eye drops
§ 38a-492n Mandatory coverage for certain wound-care supplies
§ 38a-492o Mandatory coverage for bone marrow testing
§ 38a-492p Mandatory coverage for medically monitored inpatient detoxification
§ 38a-492q Mandatory coverage for essential health benefits
§ 38a-492r Mandatory coverage for certain immunizations and consultation with health care provider
§ 38a-492s Mandatory coverage for certain preventive care and screenings for individuals who are twenty-one years of age or younger
§ 38a-492t Mandatory coverage for prosthetic devices
§ 38a-492u Coverage for psychotropic drugs. Standards re availability
§ 38a-493 Mandatory coverage for home health care. Deductibles. Exception from deductible limits for medical savings accounts, Archer MSAs and health savings accounts
§ 38a-494 Home health care by recognized nonmedical systems
§ 38a-495 Medicare supplement policies. Coverage of home health aide services and mammography. Prescription drug riders
§ 38a-495a Medicare supplement policies and certificates. Minimum required policy benefits and standards. Regulations
§ 38a-495b Medicare supplement policies and certificates. Definitions
§ 38a-495c Medicare supplement premium rates charged on a community rate basis. Age, gender, previous claim or medical history rating prohibited. Preexisting conditions. Coverage for the disabled and qualified Medicare beneficiaries. Exception. Regulations
§ 38a-495d Refund of prepaid premium for Medicare supplement policies
§ 38a-496 Coverage for occupational therapy
§ 38a-497 Termination of coverage of child, stepchild, or other dependent child in individual policies. Dental or vision coverage
§ 38a-497a Group coverage and benefits of a noncustodial parent. National Medical Support Notice. Notification of new employer by IV-D agency. Notification to parent. Enrollment of child
§ 38a-498 Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider
§ 38a-498a Prior authorization prohibited for certain 9-1-1 emergency calls
§ 38a-498b Mandatory coverage for mobile field hospital
§ 38a-498c Denial of coverage prohibited for health care services rendered to persons with an elevated blood alcohol content
§ 38a-499 Coverage for services of physician assistants and certain nurses
§ 38a-499a *(See end of section for amended version and effective date.) Coverage for telehealth services
§ 38a-500 Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries. Subrogation rights
§ 38a-501 Individual long-term care policies. Insurers authorized. Disclosures. Premium rate increases of twenty per cent or more. Disclosure of premium rate increase and minimum set of affordable benefit options
§ 38a-501a Individual short-term care policies. Approval of rates and forms. Disclosures. Regulations
§ 38a-502 Mandatory coverage for services provided by the Healthcare Center maintained by the Department of Veterans Affairs
§ 38a-503 Mandatory coverage for diagnostic and screening mammography, diagnostic and screening breast ultrasound, diagnostic and screening magnetic resonance imaging, breast biopsies, prophylactic mastectomies and breast reconstructive su
§ 38a-503a Mandatory coverage for breast cancer survivors
§ 38a-503b Carriers to permit direct access to obstetrician-gynecologist
§ 38a-503c Mandatory coverage for maternity care. Interhospital transfer of newborn infant and mother
§ 38a-503d Mandatory coverage for mastectomy care. Termination of provider contract prohibited
§ 38a-503e Mandatory coverage for contraceptives and sterilization
§ 38a-503f Mandatory coverage for certain health benefits and services for women, infants, children and adolescents
§ 38a-503g Mandatory coverage for ovarian cancer screening and monitoring
§ 38a-504 Mandatory coverage for treatment of tumors and leukemia. Mandatory coverage for reconstructive surgery, prosthesis, chemotherapy and wigs. Orally administered anticancer medications
§ 38a-504a Coverage for routine patient care costs associated with certain clinical trials
§ 38a-504b Clinical trial criteria
§ 38a-504c Evidence and information re eligibility for clinical trial. No coverage required for otherwise reimbursable costs
§ 38a-504d Clinical trials: Routine patient care costs
§ 38a-504e Clinical trials: Billing. Payments
§ 38a-504f Clinical trials: Standardized forms. Time frame for coverage determinations. Appeals. Regulations
§ 38a-504g Clinical trials: Submission and certification of policy forms
§ 38a-505 Insurance Commissioner’s powers concerning comprehensive health care plans. Disclosures
§ 38a-506 Penalty
§ 38a-507 Coverage for services performed by chiropractors
§ 38a-508 Coverage for adopted children
§ 38a-509 Mandatory coverage for infertility diagnosis and treatment. Limitations
§ 38a-510 Prescription drug coverage. Mail order pharmacies. Step therapy use
§ 38a-510a Prescription drug coverage. Synchronized refills
§ 38a-510b Prescription drug coverage. Prior authorization for naloxone hydrochloride or similar drug not required
§ 38a-510c Coverage for investigational drug, biological product or device for insureds with terminal illnesses. Liability of health carrier
§ 38a-511 Copayments re in-network imaging services
§ 38a-511a Copayments re in-network physical therapy services and in-network occupational therapy services
§ 38a-512 Applicability of statutes to certain major medical expense policies
§ 38a-512a Continuation of coverage
§ 38a-512b Termination of coverage of child, stepchild or other dependent child in group policies. Dental or vision coverage
§ 38a-512c Annual and lifetime limits
§ 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 policies
§ 38a-513a Time limits for coverage determinations. Notice requirements
§ 38a-513b Coverage and notice re experimental treatments. Appeals
§ 38a-513c Group health insurance policy to contain definition of “medically necessary” or “medical necessity”
§ 38a-513d Insurers prohibited from issuing policy with limited coverage to employer as replacement for a comprehensive health insurance plan. Disclosure required in policy providing limited coverage. Limited coverage defined
§ 38a-513e Premium payment by employer following employee termination. Exceptions. Right to continuation of coverage following relocation or closing of covered establishment not affected
§ 38a-513f Claims information to be provided to certain employers. Restrictions. Subpoenas
§ 38a-513g Employer submission of plan cost information to Comptroller
§ 38a-514 Mandatory coverage for the diagnosis and treatment of mental or nervous conditions. Exceptions. Benefits payable re type of provider or facility. State’s claims against proceeds. Direct reimbursement for certain covered services r
§ 38a-514a Biologically-based mental illness. Coverage required
§ 38a-514b Coverage for autism spectrum disorder
§ 38a-514c Mental health and substance use disorder benefits. Nonquantitative treatment limitations
§ 38a-514d Coverage for substance abuse services provided pursuant to court order
§ 38a-514e Coverage for mental health wellness exams
§ 38a-514f Coverage for services provided under the Collaborative Care Model
§ 38a-514g Acute patient psychiatric coverage. Prior authorization not required
§ 38a-515 Continuation of coverage of mentally or physically handicapped children
§ 38a-516 Coverage for newly born children. Notification to insurer
§ 38a-516a Coverage for birth-to-three program
§ 38a-516b Coverage for hearing aids
§ 38a-516c Coverage for craniofacial disorders
§ 38a-516d Coverage for neuropsychological testing for children diagnosed with cancer
§ 38a-517 Coverage for services performed by dentist in certain instances
§ 38a-517a Coverage for in-patient, outpatient or one-day dental services in certain instances
§ 38a-517b Assignment of benefits to a dentist or oral surgeon
§ 38a-518 Coverage for accidental ingestion or consumption of controlled drugs. Benefits prescribed
§ 38a-518a Mandatory coverage for hypodermic needles and syringes
§ 38a-518b Coverage for certain off-label drug prescriptions
§ 38a-518c Coverage for low protein modified food products, amino acid modified preparations and specialized formulas
§ 38a-518d Mandatory coverage for diabetes screening, testing and treatment
§ 38a-518e Mandatory coverage for diabetes outpatient self-management training
§ 38a-518f Mandatory coverage for certain prescription drugs removed from formulary
§ 38a-518g Mandatory coverage for prostate cancer screening and treatment
§ 38a-518h Mandatory coverage for certain Lyme disease treatments
§ 38a-518i Mandatory coverage for pain management
§ 38a-518j Mandatory coverage for ostomy-related supplies
§ 38a-518k Mandatory coverage for colorectal cancer screening
§ 38a-518l Mandatory coverage for certain renewals of prescription eye drops
§ 38a-518m Mandatory coverage for certain wound-care supplies
§ 38a-518o Mandatory coverage for bone marrow testing
§ 38a-518p Mandating coverage for medically monitored inpatient detoxification
§ 38a-518q Mandatory coverage for essential health benefits
§ 38a-518r Mandatory coverage for certain immunizations and consultation with health care provider
§ 38a-518s Mandatory coverage for certain preventive care and screenings for individuals who are twenty-one years of age or younger
§ 38a-518t Mandatory coverage for prosthetic devices
§ 38a-518u Coverage for psychotropic drugs. Standards re availability
§ 38a-519 Offset proviso prohibited in certain policies. Required disclosures for group long-term disability policies
§ 38a-520 Mandatory coverage for home health care. Deductibles. Exception from deductible limits for medical savings accounts. Archer MSAs and health savings accounts
§ 38a-521 Home health care by recognized nonmedical systems
§ 38a-522 Medicare supplement policies. Coverage of home health aide service
§ 38a-523 Group hospital or medical insurance coverage for comprehensive rehabilitation services
§ 38a-524 Coverage for occupational therapy
§ 38a-525 Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider
§ 38a-525a Prior authorization prohibited for certain 9-1-1 emergency calls
§ 38a-525b Mandatory coverage for mobile field hospital
§ 38a-525c Denial of coverage prohibited for health care services rendered to persons with an elevated blood alcohol content
§ 38a-526 Coverage for services of physician assistants and certain nurses
§ 38a-526a *(See end of section for amended version and effective date.) Coverage for telehealth services
§ 38a-527 Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries
§ 38a-528 Group long-term care policies. Insurers authorized. Disclosures. Premium rate increases of twenty per cent or more. Disclosure of premium rate increase and minimum set of affordable benefit options
§ 38a-528a Group short-term care policies. Approval of rates and forms. Disclosures. Regulations
§ 38a-529 Mandatory coverage for services provided by the Healthcare Center maintained by the Department of Veterans Affairs
§ 38a-530 Mandatory coverage for diagnostic and screening mammography, diagnostic and screening breast ultrasound, diagnostic and screening magnetic resonance imaging, breast biopsies, prophylactic mastectomies and breast reconstructive surgery. Breast density info
§ 38a-530a Mandatory coverage for breast cancer survivors
§ 38a-530b Carriers to permit direct access to obstetrician-gynecologist
§ 38a-530c Mandatory coverage for maternity care. Interhospital transfer of newborn infant and mother
§ 38a-530d Mandatory coverage for mastectomy care. Termination of provider contract prohibited
§ 38a-530e Mandatory coverage for contraceptives and sterilization
§ 38a-530f Mandatory coverage for certain health benefits and services for women, infants, children and adolescents
§ 38a-530g Mandatory coverage for ovarian cancer screening and monitoring
§ 38a-531 Mandatory coverage for employees of certain employers. Approval of policy forms
§ 38a-532 Assignment of incidents of ownership under group life, health or accident policy
§ 38a-533 Mandatory coverage for the treatment of medical complications of alcoholism
§ 38a-534 Coverage for services performed by chiropractors
§ 38a-535 Mandatory coverage for preventive pediatric care and blood lead screening and risk assessment
§ 38a-535a Notification of individual coverage and benefits of a noncustodial parent to a custodial parent, when. Regulations
§ 38a-536 Mandatory coverage for infertility diagnosis and treatment. Limitations
§ 38a-537 Notice of cancellation or discontinuation to covered employees. Fine. Notice of transfer of coverage. Failure to procure coverage
§ 38a-538 Continuation of benefits under group employee health plans
§ 38a-539 Group hospital or medical expense insurance policy coverage for treatment of alcoholism on an outpatient basis
§ 38a-540 Duplication of coverage under group health insurance policies
§ 38a-541 Group health policy to allow spouse coverage as both employee and dependent, when. Effect of collective bargaining agreements
§ 38a-542 Mandatory coverage for treatment of tumors and leukemia. Mandatory coverage for reconstructive surgery, prosthesis, chemotherapy and wigs. Orally administered anticancer medications
§ 38a-542a Coverage for routine patient care costs associated with certain clinical trials
§ 38a-542b Clinical trial criteria
§ 38a-542c Evidence and information re eligibility for clinical trial. No coverage required for otherwise reimbursable costs
§ 38a-542d Clinical trials: Routine patient care costs
§ 38a-542e Clinical trials: Billing. Payments
§ 38a-542f Clinical trials: Standardized forms. Time frame for coverage determinations. Appeals. Regulations
§ 38a-542g Clinical trials: Submission and certification of policy forms
§ 38a-543 Reduction of payments on basis of Medicare eligibility
§ 38a-544 Prescription drug coverage. Mail order pharmacies. Step therapy use
§ 38a-544a Prescription drug coverage. Synchronized refills
§ 38a-544b Prescription drug coverage. Prior authorization for naloxone hydrochloride or similar drug not required
§ 38a-545 Group dental health insurance plans. Alternative coverage option
§ 38a-546 Discontinuation and replacement of group health insurance policy. Regulations
§ 38a-547 Termination of policy or contract due to insurer ceasing to offer health insurance in this state; maternity benefits to continue for six weeks following termination of the pregnancy, when
§ 38a-548 Penalty
§ 38a-549 Coverage for adopted children
§ 38a-550 Copayments re in-network imaging services
§ 38a-550a Copayments re in-network physical therapy services and in-network occupational therapy services
§ 38a-551 Definitions
§ 38a-552 Provision of service to certain low-income individuals
§ 38a-556 Health Reinsurance Association. Board of directors. Powers and authority. Rates. Net loss assessment. Immunity from liability
§ 38a-556a Connecticut Clearinghouse
§ 38a-557 Hospital service corporations and medical service corporations. Residual market mechanism. Insurance Commissioner’s powers concerning such mechanisms
§ 38a-558 Office of Health Care Access
§ 38a-559 Commissioner of Social Services. Contract authority concerning Medicaid programs
§ 38a-560 Small employer grouping for health insurance coverage
§ 38a-564 Definitions
§ 38a-565 Special health care plans
§ 38a-566 Health insurance plans or insurance arrangements covering employees of a small employer. Trusts. Trade associations
§ 38a-567 Provisions of small employer plans and arrangements
§ 38a-568 Coverage under small employer health care plans and arrangements. Approval by commissioner
§ 38a-569 Connecticut Small Employer Health Reinsurance Pool
§ 38a-573 Validity of separate provisions
§ 38a-574 Standard family health statement
§ 38a-577 Consumer dental health plans. Definitions
§ 38a-578 Certificate of authority. Application requirements
§ 38a-579 Certificate of authority. Standards for issuance and renewal
§ 38a-580 General surplus required
§ 38a-581 Evidence of coverage to be provided to enrollees. Approval by commissioner
§ 38a-582 Schedule of charges. Approval by commissioner. Appeal of disapproval
§ 38a-583 Records. Commissioner’s power to examine; maintenance; preservation
§ 38a-584 Complaint system
§ 38a-585 Requirements re filing of annual reports with commissioner
§ 38a-586 False or misleading advertising or solicitation and deceptive evidence of coverage prohibited
§ 38a-587 Suspension or revocation of certificate of authority. Hearing. Appeal
§ 38a-588 Penalty. Insolvency
§ 38a-589 Confidentiality
§ 38a-590 Commissioner’s power to adopt regulations
§ 38a-591 Compliance with the Patient Protection and Affordable Care Act. Regulations
§ 38a-591a Definitions
§ 38a-591b Health carrier responsibilities re utilization review
§ 38a-591c Utilization review criteria and procedures
§ 38a-591d Utilization review and benefit determinations. Urgent care requests. Information provided in notice of adverse determination
§ 38a-591e Internal grievance process of adverse determinations based on medical necessity. Expedited review of adverse determinations of urgent care requests
§ 38a-591f Internal grievance process of adverse determinations not based on medical necessity
§ 38a-591g External reviews and expedited external reviews
§ 38a-591h Record-keeping requirements. Report to commissioner upon request
§ 38a-591i Regulations
§ 38a-591j Utilization review companies: Licensure. Fees. Investigation of grievances. Duties
§ 38a-591k Violations. Notice and hearing. Penalties. Appeal
§ 38a-591l Independent review organizations conducting external reviews and expedited external reviews
§ 38a-591m Independent review organizations: Conflicts of interest. Liability. Record-keeping requirements. Report to commissioner upon request
§ 38a-591n Documents, communications, information and evidence provided to covered person or covered person’s authorized representative upon request
§ 38a-477i A;(Note: This section is effective July 1, 2024.) Contract provisions containing all-or-nothing clauses, anti-steering clauses, anti-tiering clauses or gas clauses prohibited
§ 38a-479jjj Contract with 340B covered entity. Prohibited provisions. Reimbursement rates. Regulations
§ 38a-492v Mandatory coverage for hospice services provided in home through a hospice care program to the extent provided for inpatient hospice services
§ 38a-518v Mandatory coverage for hospice services in the home through a hospice care program to the extent provided for inpatient hospice services
§ 38a-591o (Note: This section is effective January 1, 2025.) Restrictions applicable to prospective or concurrent review of certain recurring prescription drugs. Exceptions
lawyer at desk

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

Terms Used In Connecticut General Statutes > Chapter 700c - Health Insurance

  • Alien insurer: means any insurer that has been chartered by or organized or constituted within or under the laws of any jurisdiction or country without the United States. See Connecticut General Statutes 38a-1
  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
  • another: may extend and be applied to communities, companies, corporations, public or private, limited liability companies, societies and associations. See Connecticut General Statutes 1-1
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Appellate: About appeals; an appellate court has the power to review the judgement of another lower court or tribunal.
  • Arrest: Taking physical custody of a person by lawful authority.
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
  • Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Commissioner: means the Insurance Commissioner. See Connecticut General Statutes 38a-1
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Continuance: Putting off of a hearing ot trial until a later time.
  • Contract: A legal written agreement that becomes binding when signed.
  • Conviction: A judgement of guilt against a criminal defendant.
  • 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.
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Dependent: A person dependent for support upon another.
  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • Domestic insurer: means any insurer that has been chartered by, incorporated, organized or constituted within or under the laws of this state. See Connecticut General Statutes 38a-1
  • Donor: The person who makes a gift.
  • Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) Source: OCC
  • Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Fraud: Intentional deception resulting in injury to another.
  • Freedom of Information Act: A federal law that mandates that all the records created and kept by federal agencies in the executive branch of government must be open for public inspection and copying. The only exceptions are those records that fall into one of nine exempted categories listed in the statute. Source: OCC
  • Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. Source: Federal Reserve
  • Grantor: The person who establishes a trust and places property into it.
  • Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. Source: FDIC
  • insolvent: means , for any insurer, that it is unable to pay its obligations when they are due, or when its admitted assets do not exceed its liabilities plus the greater of: (A) Capital and surplus required by law for its organization and continued operation. See Connecticut General Statutes 38a-1
  • 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
  • insurance company: includes any person or combination of persons doing any kind or form of insurance business other than a fraternal benefit society, and shall include a receiver of any insurer when the context reasonably permits. 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
  • intellectual disability: means a significant limitation in intellectual functioning existing concurrently with deficits in adaptive behavior that originated during the developmental period before eighteen years of age. See Connecticut General Statutes 1-1g
  • Interest rate: The amount paid by a borrower to a lender in exchange for the use of the lender's money for a certain period of time. Interest is paid on loans or on debt instruments, such as notes or bonds, either at regular intervals or as part of a lump sum payment when the issue matures. Source: OCC
  • Irrevocable trust: A trust arrangement that cannot be revoked, rescinded, or repealed by the grantor.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • Life insurance: means insurance on human lives and insurances pertaining to or connected with human life. See Connecticut General Statutes 38a-1
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • month: means a calendar month, and the word "year" means a calendar year, unless otherwise expressed. See Connecticut General Statutes 1-1
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Oversight: Committee review of the activities of a Federal agency or program.
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Person: means an individual, a corporation, a partnership, a limited liability company, an association, a joint stock company, a business trust, an unincorporated organization or other legal entity. See Connecticut General Statutes 38a-1
  • Plaintiff: The person who files the complaint in a civil lawsuit.
  • 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
  • Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
  • Recourse: An arrangement in which a bank retains, in form or in substance, any credit risk directly or indirectly associated with an asset it has sold (in accordance with generally accepted accounting principles) that exceeds a pro rata share of the bank's claim on the asset. If a bank has no claim on an asset it has sold, then the retention of any credit risk is recourse. Source: FDIC
  • Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
  • Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
  • Service of process: The service of writs or summonses to the appropriate party.
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • State: means any state, district, or territory of the United States. See Connecticut General Statutes 38a-1
  • Statute: A law passed by a legislature.
  • Subpoena: A command to a witness to appear and give testimony.
  • succeeding: when used by way of reference to any section or sections, mean the section or sections next preceding, next following or next succeeding, unless some other section is expressly designated in such reference. See Connecticut General Statutes 1-1
  • Summons: Another word for subpoena used by the criminal justice system.
  • Testify: Answer questions in court.
  • Testimony: Evidence presented orally by witnesses during trials or before grand juries.
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • Trustee: A person or institution holding and administering property in trust.
  • under common control with: means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with the person. See Connecticut General Statutes 38a-1
  • United States: means the United States of America, its territories and possessions, the Commonwealth of Puerto Rico and the District of Columbia. See Connecticut General Statutes 38a-1
  • Uphold: The decision of an appellate court not to reverse a lower court decision.
  • Venue: The geographical location in which a case is tried.