Group Health Insurance | Midpage38a-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-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-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-518nConn. Gen. Stat. § 38a-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-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-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-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.