Chapter 700c Health Insurance
Table of Content
“Evidence-based standard” means the conscientious, explicit and judicious use of the current greatest evidence primarily based on an general systematic evaluation of medical analysis when making determinations in regards to the care of individual sufferers. “Emergency medical condition” means a medical situation manifesting itself by acute signs of sufficient severity, including severe pain, such that a prudent layperson with a mean data of health and drugs, appearing moderately, would have believed that the absence of instant medical attention would lead to severe impairment to bodily functions or serious dysfunction of a bodily organ or half, or would place the individual's health or, with respect to a pregnant woman, the well being of the woman or her unborn youngster, in severe jeopardy. The commissioner may adopt laws, in accordance with the provisions of chapter 54, as he deems necessary to effect the purposes of sections 38a-577 to 38a-590, inclusive. No proof of protection or modification thereto shall be issued or delivered to any individual until a replica of the type of evidence of protection or amendment thereto has been filed with the commissioner for his approval. Premium charges for any given plan might range by actuarially justified differences in plan design, and actuarially justified amounts to reflect the policy's supplier network and administrative expense variations that might be reasonably allocated to such coverage.
The information on the department's Internet website shall reference the availability and common eligibility requirements of programs administered by the Department of Social Services, including, but not limited to, the Medicaid program and HUSKY A and B, medical insurance coverage offered by the Comptroller under subsection of section 5-259, and different medical insurance protection supplied via native, state or federal businesses or through entities licensed in this state. The commissioner shall replace the information on the web web site a minimum of quarterly. If notice is supplied by the assignee to the insurer in accordance with the provisions of part 17b-265, the insurer shall be liable to the assignee for any quantity payable to the assignee beneath the contract. Duties of a most popular provider network when offering companies pursuant to a contract with a managed care group. The health service shall retain the written records required pursuant to subdivision of this subsection for not less than six years after the request for an external evaluate or an expedited external review was received.
Casualty Producer Connecticut Particular Content Outline
The Insurance Department shall prominently display a hyperlink to the consumer report card on the division's Internet website. The information required pursuant to subsection of this section shall be consistent with the info required by the National Committee for Quality Assurance for its Health Plan Employer Data and Information Set . The commissioner could adopt laws, in accordance with chapter fifty four, to implement the provisions of this section.
The insured, or the provider with the insured's written consent, may attraction any denial of coverage for medical necessity to an exterior, independent evaluate pursuant to part 38a-591g. Such external evaluation shall be performed by a properly certified review agent whom the department has determined does not have a battle of interest relating to the scientific trial. The applicant shall signal an acknowledgment on the time of application for such policy that the corporate, society, company or heart has offered the written disclosure required beneath this subsection to the applicant. If the method of application doesn't permit for such signature at the time of application, the applicant shall signal such acknowledgment not later than at the time of supply of such policy.
State Of Connecticut
The provisions of this subsection shall not be relevant to noncontributory plans. Each group health insurance policy providing protection of the type specified in subdivisions , , , and of section 38a-469 delivered, issued for delivery, renewed, amended or continued on this state shall present protection for amino acid modified preparations and low protein modified food merchandise for the treatment of inherited metabolic diseases if the amino acid modified preparations or low protein modified food products are prescribed for the therapeutic remedy of inherited metabolic illnesses and are administered beneath the path of a physician. An insurer or health care middle shall not substitute another approval request form for the shape developed by the department, except that any insurer or health care center that has entered into an agreement to provide protection for most cancers clinical trials permitted pursuant to part 38a-504g could use the form or process established by such agreement. Nothing on this part shall prohibit or restrict a well being insurer, health care middle, hospital service company, medical service company or different entity from conducting utilization evaluation for telehealth services, supplied such utilization evaluation is carried out in the identical manner and uses the identical medical evaluation criteria as a utilization evaluate for an in-person session for the same service.
Those thinking about making use of for HUSKY benefits can learn in regards to the completely different applications and the earnings limits for each one.
Connecticut & Us Healthcare Price Drivers Discussion Board
No dentist or group of dentists could establish, function or administer a dental plan organization, or offer to sell, or solicit offers to purchase, or receive advance or periodic consideration along side any dental plan organization, on or after October 1, 1988, with out obtaining and maintaining a certificates of authority pursuant to sections 38a-577 to 38a-590, inclusive. The board of administrators of the Connecticut Small Employer Health Reinsurance Pool shall set up, topic to the approval of the Insurance Commissioner, a regular household health assertion to be used by small employer carriers to discover out whether to cede lives to the reinsurance pool. Not later than ninety days after approval by the Insurance Commissioner of the family health statement, the board shall require each small employer provider, as a condition of transacting such enterprise in this state, to use the statement for such plans and preparations.
If the commissioner revokes the certificates of authority, the dental plan organization shall proceed to dissolve its structure immediately following the efficient date of the order of revocation, and shall conduct no further business except as could also be essential to the orderly conclusion of the affairs of the dental plan organization. The commissioner by written order might allow such additional operation of the dental plan organization as he finds to be in one of the best curiosity of enrollees to the tip that enrollees shall be afforded the greatest practical alternative to acquire continuing dental plan protection. No dental plan group, except licensed as an insurer, could use in its name, evidence of protection or literature any of the phrases “insurance”, “assurance”, “casualty”, “surety”, “mutual” or another words descriptive of the insurance coverage, casualty or surety enterprise or deceptively just like the name or description of any insurer licensed to do business in this state.
Connecticut Insurance Division (cid) Web Site
A dental plan group shall set up and keep a complaint system to supply cheap procedures for the resolution of written complaints initiated by enrollees regarding dental plan providers. The dental plan group shall keep information of all written complaints initiated by enrollees. The expenses incurred in making any examination pursuant to this section shall be assessed towards and paid by the dental plan group so examined.
Each well being provider shall ensure that acceptable personnel have operational responsibility for the activities of the health service's utilization review program. Sections 38a-591a to 38a-591n, inclusive, shall apply to any well being carrier providing a well being profit plan and that gives or performs utilization evaluate including potential, concurrent or retrospective review profit determinations, and any utilization evaluate firm or designee of a well being service that performs utilization evaluation on the well being provider's behalf, including prospective, concurrent or retrospective review benefit determinations. “Rescission” means a cancellation or discontinuance of protection under a well being benefit plan that has a retroactive effect. “Rescission” does not embody a cancellation or discontinuance of protection under a health profit plan if such cancellation or discontinuance has a potential impact only, or such cancellation or discontinuance is efficient retroactively to the extent it's attributable to the covered individual's failure to well timed pay required premiums or contributions in course of the price of such coverage.
Particular Person Health Insurance
An superior follow registered nurse licensed underneath the provisions of chapter 378. No coverage provision which isn't subject to section 38a-483 shall make a coverage, or any portion thereof, much less favorable the least bit to the insured or the beneficiary than the provisions thereof which are subject to sections 38a-481 to 38a-488, inclusive. Any one that has been diagnosed with a situation that creates a life expectancy in that person of less than two years and who has been denied an otherwise lined process, treatment or drug on the grounds that it is experimental could request an expedited attraction as provided in part 38a-591e and should attraction a denial thereof to the Insurance Commissioner in accordance with the procedures established in part 38a-591g. The commissioner might make such affordable guidelines and regulations regarding the procedure for the submitting or submission of policies subject to sections 38a-481 to 38a-488, inclusive, as are needed, proper or advisable to the administration of mentioned sections. This provision shall not abridge another authority granted the commissioner by legislation.
No policy described in subsection of this section shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the advantages and providers required underneath mentioned subsection. Nothing on this part shall preclude a policy that gives the protection required beneath subsection of this part and makes use of a supplier network from imposing cost-sharing necessities for any benefit or service required under stated subsection that is delivered by an out-of-network provider. No group medical well being insurance policy offering coverage of the kind laid out in subdivisions , , , , , and of part 38a-469, delivered, issued for supply or renewed on this state, on or after October 1, 1996, shall direct or require an enrollee to acquire approval from the insurer or health care center prior to calling a local prehospital emergency medical service system whenever such enrollee is confronted with a life or limb threatening emergency. No such coverage shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the advantages and companies required beneath subsection of this part.
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