Chapter 700c. Health Insurance
Section
38a-469Definitions.38a-470(Formerly Sec. 38-174n). Lien on workers' compensation awards for insurers. Notice of lien.38a-471(Formerly Sec. 38-174o). Third party prescription programs. Notice of cancellation. Applicability of section.38a-472(Formerly Sec. 38-174a). Assignment of insurance proceeds to doctor, hospital or state agency. Lien for state care. Notice of lien.38a-472aMedical provider indemnification agreements prohibited.38a-472bMedical provider indemnification contracts. Professional actions and related liability.38a-472cDental policies. Estimate of reimbursement. Material adjustments to fee schedules for in-network providers. Notice.38a-472dPublic education outreach program re health insurance availability and eligibility requirements.38a-472eHealth insurer. Requirements re offer to contract with a school-based health center.38a-472fNetwork adequacy. Health carrier duties and responsibilities. Access plan filing.38a-472gRestrictions applicable to prior authorization or precertification.38a-472hFees charged by dentists, optometrists and ophthalmologists for noncovered benefits. Notice and posting required.38a-472iPayment amount of professional services component of covered colonoscopy or endoscopic services.38a-472jRestrictions applicable to cost-sharing for covered benefits. Regulations.38a-472kDisability income policies. Discretionary clauses prohibited. Regulations.38a-472lParticipating dental provider contracts. Third-party access. Restrictions. Exceptions.38a-473Medicare supplement expense factors. Age, gender, previous claim or medical history rating prohibited.38a-474Medicare supplement policy rate increases: Procedure. Age, gender, previous claim or medical history rating prohibited.38a-475Precertification of long-term care policies under the Connecticut Partnership for Long-Term Care. Regulations.38a-475aMinimum set of affordable benefit options for long-term care policies. Regulations.38a-476Preexisting condition coverage.38a-476aCompliance 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. Construction. Application. Regulations.38a-476bStandards re psychotropic drug availability in health plans.38a-476cPolicies and contracts with variable network and enrollee cost-sharing. Approval. Limitations.38a-477Standardized claim forms. Information necessary for filing a claim. Regulations.38a-477aNotification by Insurance Commissioner of required benefits and policy forms.38a-477bPostclaims underwriting prohibited unless approval granted. Application for approval of rescission, cancellation or limitation. Decision. Appeals. Regulations.38a-477cDisclosure of state and federal medical loss ratio with each health insurance application.38a-477dInformation to be made available to consumers. Explanations of benefits. Disclosures by health carriers. Specifications by consumers. Restrictions.38a-477eHealth carriers to maintain Internet web site and toll-free telephone number. Available information. Exception.38a-477fContract provision prohibiting certain disclosures prohibited.38a-477gContracts between health carriers and participating providers.38a-477hParticipating provider directories.38a-477iContract provisions containing all-or-nothing clauses, anti-steering clauses, anti-tiering clauses or gag clauses prohibited.38a-477j to 38a-477z38a-477j to 38a-477z38a-477aaCost-sharing and health care provider reimbursements for emergency services, urgent crisis center services and surprise bills.38a-477bbCost-sharing re facility fees.38a-477ccContracts for pharmacy services with health carriers or pharmacy benefits managers.38a-477ddContracts with health carriers. Certain provisions concerning disclosures to covered persons prohibited.38a-477eeMental health and substance use disorder benefits. Nonquantitative treatment limitations. Reports. Public hearings. Regulations.38a-477ffThird-party discounts and payments for covered benefits. Credit required.38a-477ggContracts between health carriers and pharmacy benefits managers. Credit required for third-party discounts and payments for covered prescription drug benefits.38a-477hhDenial of coverage for otherwise covered benefits based on measurement of blood oxygen level by pulse oximeter prohibited.38a-477iiPulse oximeter accuracy. Educational materials. Distribution and posting required.38a-477jjPrescription drug formularies and lists of covered drugs. Removal or movement to higher cost-sharing tier during plan year prohibited. Exceptions. Study and report.38a-477kkProof of coverage to disclose whether coverage is fully insured or self-insured. Regulations.38a-477llCoverage for health enhancement programs.38a-477mmProhibition on reduction in amount of reimbursement paid to telehealth provider for covered health care or health services that telehealth provider appropriately provided to insured through telehealth.38a-477nnProhibition on denial of reimbursement or prevention from participating in provider network based solely on health care provider's decision not to maintain specialty certification.38a-478Definitions.38a-478aCommissioner's report to the Governor and the General Assembly.38a-478bPenalty 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-478cManaged care organization's report to the commissioner: Data, reports and information required.38a-478dProvider directory. Notification to enrollee of termination or withdrawal of enrollee's primary care provider.38a-478eMedical protocols. Procedure prior to change. Physician input. Notification of change.38a-478fProvider profile development requirements.38a-478gManaged care contract requirements. Plan description requirements.38a-478hContract requirements and notice for removal or departure of provider. Retaliatory action prohibited.38a-478iLimitation on enrollee rights prohibited.38a-478jCoinsurance and deductible payments based on negotiated discounts.38a-478kGag clauses prohibited.38a-478lConsumer report card required. Content. Data analysis by commissioner.38a-478m and 38a-478nInternal 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; applicability to health insurers, managed care organizations and utilization review companies; fees; preliminary review; full review; public outreach program; expedited external appeal; requirements for and approval of independent review entities; filing of report.38a-478oConfidentiality and antidiscrimination procedures required.38a-478pExpedited utilization review. Standardized process required.38a-478qUse of laboratories covered by plan required.38a-478rEmergency 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-478sNonapplicability to self-insured employee welfare benefit plans and workers' compensation plans.38a-478tCommissioner of Public Health to receive data.38a-478uRegulations.38a-478vApplicability of Unfair and Prohibited Insurance Practices Act. Examination by Insurance Commissioner. Regulations.38a-478wManaged care organization's calculation of enrollee liability for covered benefits. Credit required for third-party discounts and payments.38a-479Definitions. Access to fee schedules. Fee information to be confidential.38a-479aPhysicians and managed care organizations to discuss issues relative to contracting between such parties.38a-479bMaterial 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-479c to 38a-479z38a-479c to 38a-479z38a-479aaPreferred provider networks. Definitions. Licensing. Fees. Requirements. Exception.38a-479bbRequirements for managed care organizations that contract with preferred provider networks. Requirements for preferred provider networks.38a-479ccDuties of a preferred provider network when providing services pursuant to a contract with a managed care organization.38a-479ddPreferred provider network examination of outstanding amounts. Notice. Commissioner's duties.38a-479eeViolations. Penalties. Investigations and staffing. Grievances. Referrals from Healthcare Advocate.38a-479ffAdverse action or threat of adverse action against complainant prohibited. Exception. Civil actions by aggrieved persons.38a-479ggRegulations.38a-479hh to 38a-479pp38a-479hh to 38a-479pp38a-479qqMedical discount plans: Definitions, prohibited sales practices, penalties.38a-479rrMedical 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. Penalties. Advertising and marketing materials. Investigations.38a-479ss to 38a-479zz38a-479ss to 38a-479zz38a-479aaaPharmacy benefits managers. Definitions.38a-479bbbRegistration of pharmacy benefits managers required. Application for registration. Fee. Surety bond. Exemption from registration.38a-479cccCertificate of registration; when issued or refused. Suspension, revocation or refusal to issue or renew registration; grounds.38a-479dddHearing on denial of certificate. Subsequent application.38a-479eeeClaims payment to be made by electronic funds transfer upon written request.38a-479fffExpiration of certificates of registration. Renewal. Fees.38a-479gggRegulations.38a-479hhhInvestigations and hearings. Powers of commissioner. Appeals.38a-479iiiPharmacy audits.38a-479jjjContract with 340B covered entity. Prohibited provisions. Reimbursement rates. Regulations.38a-479kkk to 38a-479nnn38a-479kkk to 38a-479nnn38a-479oooDefinitions.38a-479pppAnnual report by pharmacy benefits managers. Standardized form. Confidentiality of information. Penalty. Regulations. Commissioner's report to the General Assembly.38a-479qqqAnnual report by health carriers. Regulations.38a-479rrrAnnual certification by health carriers.38a-479sssAnnual report by commissioner to the General Assembly re outpatient prescription drug costs.38a-479tttAnnual report by commissioner to the General Assembly re prescription drug rebates.38a-480(Formerly Sec. 38-174). Applicability of statutes to certain policies and contracts.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 prohibited. Reduction of payments on basis of Medicare eligibility. Optional life insurance rider. Treatment of health insurance issued to association or certain other insurance arrangements. Special enrollment periods. Grandfathered and nongrandfathered plans.38a-482(Formerly Sec. 38-166). Form of policy.38a-482aIndividual health insurance policy to contain definition of “medically necessary” or “medical necessity”.38a-482bIndividual health insurance policy providing limited coverage to include disclosure. Limited coverage defined.38a-482cAnnual and lifetime limits.38a-483(Formerly Sec. 38-167). Standard provisions of individual health policy.38a-483aExclusionary riders for individual health insurance policies. Regulations.38a-483bTime limits for coverage determinations. Notice requirements.38a-483cCoverage and notice re experimental treatments. Appeals.38a-484(Formerly Sec. 38-168). Policy provisions not to be less favorable than standard. Validity of policy issued in violation of law.38a-485(Formerly Sec. 38-169). Copy of application to be part of new policy or to be furnished with renewal. Alteration of application.38a-486(Formerly Sec. 38-170). Certain acts not to operate as waiver of rights.38a-487(Formerly Sec. 38-171). Coverage after termination date of policy.38a-488(Formerly Sec. 38-172). Discrimination.38a-488aMandatory 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-network providers.38a-488bCoverage for autism spectrum disorder therapies.38a-488cMental health and substance use disorder benefits. Nonquantitative treatment limitations.38a-488dCoverage for substance abuse services provided pursuant to court order.38a-488eCoverage for mental health wellness examinations.38a-488fCoverage for services provided under the Collaborative Care Model.38a-488gAcute inpatient psychiatric coverage. Prior authorization not required.38a-489(Formerly Sec. 38-174e). Continuation of coverage of mentally or physically handicapped children.38a-490(Formerly Sec. 38-174g). Coverage for newly born children. Notification to insurer.38a-490aCoverage for birth-to-three program.38a-490bCoverage for hearing aids.38a-490cCoverage for craniofacial disorders.38a-490dMandatory coverage for blood lead screening and risk assessment.38a-491(Formerly Sec. 38-174h). Coverage for services performed by dentists in certain instances.38a-491aCoverage for in-patient, outpatient or one-day dental services in certain instances.38a-491bAssignment of benefits to a dentist or oral surgeon.38a-492(Formerly Sec. 38-174i). Coverage for accidental ingestion or consumption of controlled drugs. Benefits prescribed.38a-492aMandatory coverage for hypodermic needles and syringes.38a-492bCoverage for certain off-label drug prescriptions.38a-492cCoverage for low protein modified food products, amino acid modified preparations and specialized formulas.38a-492dMandatory coverage for diabetes screening, testing and treatment.38a-492eMandatory coverage for diabetes outpatient self-management training.38a-492fMandatory coverage for certain prescription drugs removed from formulary.38a-492gMandatory coverage for prostate cancer screening and treatment.38a-492hMandatory coverage for certain Lyme disease treatments.38a-492iMandatory coverage for pain management.38a-492jMandatory coverage for ostomy-related supplies.38a-492kMandatory coverage for colorectal cancer screening.38a-492lMandatory coverage for neuropsychological testing for children diagnosed with cancer.38a-492mMandatory coverage for certain renewals of prescription eye drops.38a-492nMandatory coverage for certain wound-care supplies.38a-492oMandatory coverage for bone marrow testing.38a-492pMandatory coverage for medically monitored inpatient detoxification.38a-492qMandatory coverage for essential health benefits.38a-492rMandatory coverage for certain immunizations and consultation with health care provider.38a-492sMandatory coverage for certain preventive care and screenings for individuals who are twenty-one years of age or younger.38a-492tMandatory coverage for prosthetic devices.38a-492uCoverage for psychotropic drugs. Standards re availability.38a-492vMandatory coverage for hospice services provided in home through a hospice care program to the extent provided for inpatient hospice services.38a-492wMedically necessary wheelchair repairs, replacements. Coverage requirements.38a-492xMandatory coverage for coronary calcium scans.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.38a-494(Formerly Sec. 38-174l). Home health care by recognized nonmedical systems.38a-495(Formerly Sec. 38-174m). Medicare supplement policies. Coverage of home health aide services and mammography. Prescription drug riders.38a-495aMedicare supplement policies and certificates. Minimum required policy benefits and standards. Regulations.38a-495bMedicare supplement policies and certificates. Definitions.38a-495cMedicare 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-495dRefund of prepaid premium for Medicare supplement policies.38a-496(Formerly Sec. 38-174q). Coverage for occupational therapy.38a-497(Formerly Sec. 38-174r). Termination of coverage of child, stepchild, or other dependent child in individual policies. Dental or vision coverage.38a-497aGroup 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(Formerly Sec. 38-174t). Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider.38a-498aPrior authorization prohibited for certain 9-1-1 emergency calls or transporting enrollee to a hospital by ambulance when medically necessary. Denial of payment to ambulance provider responding to 9-1-1 local prehospital emergency medical service system call prohibited on basis that enrollee did not obtain approval prior to calling such system or transporting such enrollee when medically necessary by ambulance to a hospital.38a-498bMandatory coverage for mobile field hospital.38a-498cDenial of coverage prohibited for health care services rendered to persons with an elevated blood alcohol content.38a-499(Formerly Sec. 38-174v). Coverage for services of physician assistants and certain nurses.38a-499aCoverage for telehealth services.38a-500(Formerly Sec. 38-174w). Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries. Subrogation rights.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.38a-501aIndividual short-term care policies. Approval of rates and forms. Disclosures. Regulations.38a-502(Formerly Sec. 38-174ff). Mandatory coverage for services provided by the Healthcare Center maintained by the Department of Veterans Affairs.38a-503(Formerly Sec. 38-174gg). 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 information included in report.38a-503aMandatory coverage for breast cancer survivors.38a-503bCarriers to permit direct access to obstetrician-gynecologist.38a-503cMandatory coverage for maternity care. Interhospital transfer of newborn infant and mother.38a-503dMandatory coverage for mastectomy care. Termination of provider contract prohibited.38a-503eMandatory coverage for contraceptives and sterilization.38a-503fMandatory coverage for certain health benefits and services for women, infants, children and adolescents and certain evidence-based items or services for individuals.38a-503gMandatory coverage for ovarian cancer screening and monitoring.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.38a-504aCoverage for routine patient care costs associated with certain clinical trials.38a-504bClinical trial criteria.38a-504cEvidence and information re eligibility for clinical trial. No coverage required for otherwise reimbursable costs.38a-504dClinical trials: Routine patient care costs.38a-504eClinical trials: Billing. Payments.38a-504fClinical trials: Standardized forms. Time frame for coverage determinations. Appeals. Regulations.38a-504gClinical trials: Submission and certification of policy forms.38a-505(Formerly Sec. 38-378). Insurance Commissioner's powers concerning comprehensive health care plans. Disclosures.38a-506(Formerly Sec. 38-173). Penalty.38a-507Coverage for services performed by chiropractors.38a-508Coverage for adopted children.38a-509Mandatory coverage for infertility diagnosis and treatment. Limitations.38a-510Prescription drug coverage. Mail order pharmacies. Step therapy use.38a-510aPrescription drug coverage. Synchronized refills.38a-510bPrescription drug coverage. Prior authorization for naloxone hydrochloride or similar drug not required.38a-510cCoverage for investigational drug, biological product or device for insureds with terminal illnesses. Liability of health carrier.38a-511Copayments re in-network imaging services.38a-511aCopayments re in-network physical therapy services and in-network occupational therapy services.38a-512Applicability of statutes to certain major medical expense policies.38a-512aContinuation of coverage.38a-512bTermination of coverage of child, stepchild or other dependent child in group policies. Dental or vision coverage.38a-512cAnnual and lifetime limits.38a-513Approval 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-513aTime limits for coverage determinations. Notice requirements.38a-513bCoverage and notice re experimental treatments. Appeals.38a-513cGroup health insurance policy to contain definition of “medically necessary” or “medical necessity”.38a-513dInsurers 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-513ePremium payment by employer following employee termination. Exceptions. Right to continuation of coverage following relocation or closing of covered establishment not affected.38a-513fClaims information to be provided to certain employers. Restrictions. Subpoenas.38a-513gEmployer submission of plan cost information to Comptroller.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 certain covered services rendered by certain out-of-network providers.38a-514aBiologically-based mental illness. Coverage required.38a-514bCoverage for autism spectrum disorder.38a-514cMental health and substance use disorder benefits. Nonquantitative treatment limitations.38a-514dCoverage for substance abuse services provided pursuant to court order.38a-514eCoverage for mental health wellness exams.38a-514fCoverage for services provided under the Collaborative Care Model.38a-514gAcute inpatient psychiatric coverage. Prior authorization not required.38a-515Continuation of coverage of mentally or physically handicapped children.38a-516Coverage for newly born children. Notification to insurer.38a-516aCoverage for birth-to-three program.38a-516bCoverage for hearing aids.38a-516cCoverage for craniofacial disorders.38a-516dCoverage for neuropsychological testing for children diagnosed with cancer.38a-517Coverage for services performed by dentist in certain instances.38a-517aCoverage for in-patient, outpatient or one-day dental services in certain instances.38a-517bAssignment of benefits to a dentist or oral surgeon.38a-518Coverage for accidental ingestion or consumption of controlled drugs. Benefits prescribed.38a-518aMandatory coverage for hypodermic needles and syringes.38a-518bCoverage for certain off-label drug prescriptions.38a-518cCoverage for low protein modified food products, amino acid modified preparations and specialized formulas.38a-518dMandatory coverage for diabetes screening, testing and treatment.38a-518eMandatory coverage for diabetes outpatient self-management training.38a-518fMandatory coverage for certain prescription drugs removed from formulary.38a-518gMandatory coverage for prostate cancer screening and treatment.38a-518hMandatory coverage for certain Lyme disease treatments.38a-518iMandatory coverage for pain management.38a-518jMandatory coverage for ostomy-related supplies.38a-518kMandatory coverage for colorectal cancer screening.38a-518lMandatory coverage for certain renewals of prescription eye drops.38a-518mMandatory coverage for certain wound-care supplies.38a-518n38a-518n38a-518oMandatory coverage for bone marrow testing.38a-518pMandating coverage for medically monitored inpatient detoxification.38a-518qMandatory coverage for essential health benefits.38a-518rMandatory coverage for certain immunizations and consultation with health care provider.38a-518sMandatory coverage for certain preventive care and screenings for individuals who are twenty-one years of age or younger.38a-518tMandatory coverage for prosthetic devices.38a-518uCoverage for psychotropic drugs. Standards re availability.38a-518vMandatory coverage for hospice services in the home through a hospice care program to the extent provided for inpatient hospice services.38a-518wMedically necessary wheelchair repairs, replacements. Coverage requirements.38a-518xMandatory coverage of coronary calcium scans.38a-519(Formerly Sec. 38-174j). Offset proviso prohibited in certain policies. Required disclosures for group long-term disability policies.38a-520Mandatory coverage for home health care. Deductibles. Exception from deductible limits for medical savings accounts. Archer MSAs and health savings accounts.38a-521Home health care by recognized nonmedical systems.38a-522Medicare supplement policies. Coverage of home health aide service.38a-523(Formerly Sec. 38-174p). Group hospital or medical insurance coverage for comprehensive rehabilitation services.38a-524Coverage for occupational therapy.38a-525Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider.38a-525aPrior authorization prohibited for certain 9-1-1 emergency calls or transporting enrollee to a hospital by ambulance when medically necessary. Denial of payment to ambulance provider responding to 9-1-1 local prehospital emergency medical service system call prohibited on basis that enrollee did not obtain approval prior to calling such system or transporting such enrollee when medically necessary by ambulance to a hospital.38a-525bMandatory coverage for mobile field hospital.38a-525cDenial of coverage prohibited for health care services rendered to persons with an elevated blood alcohol content.38a-526Coverage for services of physician assistants and certain nurses.38a-526aCoverage for telehealth services.38a-527Mandatory coverage for partners, sole proprietors and corporate officers for work-related injuries.38a-528Group 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-528aGroup short-term care policies. Approval of rates and forms. Disclosures. Regulations.38a-529Mandatory coverage for services provided by the Healthcare Center maintained by the Department of Veterans Affairs.38a-530Mandatory 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 information included in report.38a-530aMandatory coverage for breast cancer survivors.38a-530bCarriers to permit direct access to obstetrician-gynecologist.38a-530cMandatory coverage for maternity care. Interhospital transfer of newborn infant and mother.38a-530dMandatory coverage for mastectomy care. Termination of provider contract prohibited.38a-530eMandatory coverage for contraceptives and sterilization.38a-530fMandatory coverage for certain health benefits and services for women, infants, children and adolescents and certain evidence-based items or services for individuals.38a-530gMandatory coverage for ovarian cancer screening and monitoring.38a-531(Formerly Sec. 38-174hh). Mandatory coverage for employees of certain employers. Approval of policy forms.38a-532(Formerly Sec. 38-262a). Assignment of incidents of ownership under group life, health or accident policy.38a-533(Formerly Sec. 38-262b). Mandatory coverage for the treatment of medical complications of alcoholism.38a-534Coverage for services performed by chiropractors.38a-535Mandatory coverage for preventive pediatric care and blood lead screening and risk assessment.38a-535aNotification of individual coverage and benefits of a noncustodial parent to a custodial parent, when. Regulations.38a-536Mandatory coverage for infertility diagnosis and treatment. Limitations.38a-537(Formerly Sec. 38-262c). Notice of cancellation or discontinuation to covered employees. Fine. Notice of transfer of coverage. Failure to procure coverage.38a-538(Formerly Sec. 38-262d). Continuation of benefits under group employee health plans.38a-539(Formerly Sec. 38-262f). Group hospital or medical expense insurance policy coverage for treatment of alcoholism on an outpatient basis.38a-540(Formerly Sec. 38-262g). Duplication of coverage under group health insurance policies.38a-541(Formerly Sec. 38-262h). Group health policy to allow spouse coverage as both employee and dependent, when. Effect of collective bargaining agreements.38a-542Mandatory coverage for treatment of tumors and leukemia. Mandatory coverage for reconstructive surgery, prosthesis, chemotherapy and wigs. Orally administered anticancer medications.38a-542aCoverage for routine patient care costs associated with certain clinical trials.38a-542bClinical trial criteria.38a-542cEvidence and information re eligibility for clinical trial. No coverage required for otherwise reimbursable costs.38a-542dClinical trials: Routine patient care costs.38a-542eClinical trials: Billing. Payments.38a-542fClinical trials: Standardized forms. Time frame for coverage determinations. Appeals. Regulations.38a-542gClinical trials: Submission and certification of policy forms.38a-543(Formerly Sec. 38-262j). Reduction of payments on basis of Medicare eligibility.38a-544Prescription drug coverage. Mail order pharmacies. Step therapy use.38a-544aPrescription drug coverage. Synchronized refills.38a-544bPrescription drug coverage. Prior authorization for naloxone hydrochloride or similar drug not required.38a-545(Formerly Sec. 38-262k). Group dental health insurance plans. Alternative coverage option.38a-546(Formerly Sec. 38-379). Discontinuation and replacement of group health insurance policy. Regulations.38a-547Termination 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-548Penalty.38a-549Coverage for adopted children.38a-550Copayments re in-network imaging services.38a-550aCopayments re in-network physical therapy services and in-network occupational therapy services.38a-551(Formerly Sec. 38-371). Definitions.38a-552(Formerly Sec. 38-372). Provision of service to certain low-income individuals.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 eligibility under group comprehensive health care plans; coverage for stepchildren; continuation of benefits under group plans; Insurance Commissioner's authority to coordinate benefits. Additional requirements for individual comprehensive health care plans; carrier obligations concerning termination of coverage.38a-556(Formerly Sec. 38-376). Health Reinsurance Association. Board of directors. Powers and authority. Rates. Net loss assessment. Immunity from liability.38a-556aConnecticut Clearinghouse.38a-557(Formerly Sec. 38-377). Hospital service corporations and medical service corporations. Residual market mechanism. Insurance Commissioner's powers concerning such mechanisms.38a-558(Formerly Sec. 38-380). Office of Health Care Access.38a-559(Formerly Sec. 38-381). Commissioner of Social Services. Contract authority concerning Medicaid programs.38a-560Small employer grouping for health insurance coverage.38a-561 to 38a-56338a-561 to 38a-56338a-564Definitions.38a-565Special health care plans.38a-566Health insurance plans or insurance arrangements covering employees of a small employer. Trusts. Trade associations.38a-567Provisions of small employer plans and arrangements.38a-568Coverage under small employer health care plans and arrangements. Approval by commissioner.38a-569Connecticut Small Employer Health Reinsurance Pool.38a-570 to 38a-572Issuance 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 certain low-income persons.38a-573Validity of separate provisions.38a-574Standard family health statement.38a-575 and 38a-57638a-575 and 38a-57638a-577(Formerly Sec. 38-174ii). Consumer dental health plans. Definitions.38a-578(Formerly Sec. 38-174jj). Certificate of authority. Application requirements.38a-579(Formerly Sec. 38-174kk). Certificate of authority. Standards for issuance and renewal.38a-580(Formerly Sec. 38-174ll). General surplus required.38a-581(Formerly Sec. 38-174mm). Evidence of coverage to be provided to enrollees. Approval by commissioner.38a-582(Formerly Sec. 38-174nn). Schedule of charges. Approval by commissioner. Appeal of disapproval.38a-583(Formerly Sec. 38-174oo). Records. Commissioner's power to examine; maintenance; preservation.38a-584(Formerly Sec. 38-174pp). Complaint system.38a-585(Formerly Sec. 38-174qq). Requirements re filing of annual reports with commissioner.38a-586(Formerly Sec. 38-174rr). False or misleading advertising or solicitation and deceptive evidence of coverage prohibited.38a-587(Formerly Sec. 38-174ss). Suspension or revocation of certificate of authority. Hearing. Appeal.38a-588(Formerly Sec. 38-174tt). Penalty. Insolvency.38a-589(Formerly Sec. 38-174uu). Confidentiality.38a-590(Formerly Sec. 38-174vv). Commissioner's power to adopt regulations.38a-591Compliance with the Patient Protection and Affordable Care Act. Regulations.38a-591a*(See end of section for amended version of subdivision (7) and effective date.) Definitions.38a-591bHealth carrier responsibilities re utilization review.38a-591cUtilization review criteria and procedures.38a-591dUtilization review and benefit determinations. Urgent care requests. Information provided in notice of adverse determination.38a-591eInternal grievance process of adverse determinations based on medical necessity. Expedited review of adverse determinations of urgent care requests.38a-591fInternal grievance process of adverse determinations not based on medical necessity.38a-591gExternal reviews and expedited external reviews.38a-591hRecord-keeping requirements. Report to commissioner upon request.38a-591iRegulations.38a-591jUtilization review companies: Licensure. Fees. Investigation of grievances. Duties.38a-591kViolations. Notice and hearing. Penalties. Appeal.38a-591lIndependent review organizations conducting external reviews and expedited external reviews.38a-591mIndependent review organizations: Conflicts of interest. Liability. Record-keeping requirements. Report to commissioner upon request.38a-591nDocuments, communications, information and evidence provided to covered person or covered person's authorized representative upon request.38a-591oRestrictions applicable to prospective or concurrent review of certain recurring prescription drugs. Exceptions.38a-592 to 38a-59438a-592 to 38a-594