Individual Health Insurance | MidpageIndividual Health Insurance
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-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-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.