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Health Insurance: Managed Care | Midpage
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Connecticut General Statutes
Title 38a
Chapter 700c
Part Ia
Health Insurance: Managed Care
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-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-479c to 38a-479z
Conn. Gen. Stat. § 38a-479c to 38a-479z