Connecticut 2010 Regular Session

Connecticut House Bill HB05009 Compare Versions

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11 General Assembly Raised Bill No. 5009
22 February Session, 2010 LCO No. 28
3- *_____HB05009APP___041310____*
3+ *_____HB05009INS___021710____*
44 Referred to Committee on Insurance and Real Estate
55 Introduced by:
66 (INS)
77
88 General Assembly
99
1010 Raised Bill No. 5009
1111
1212 February Session, 2010
1313
1414 LCO No. 28
1515
16-*_____HB05009APP___041310____*
16+*_____HB05009INS___021710____*
1717
1818 Referred to Committee on Insurance and Real Estate
1919
2020 Introduced by:
2121
2222 (INS)
2323
2424 AN ACT CONCERNING WELLNESS PROGRAMS AND EXPANSION OF HEALTH INSURANCE COVERAGE.
2525
2626 Be it enacted by the Senate and House of Representatives in General Assembly convened:
2727
2828 Section 1. Section 38a-492j of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2011):
2929
3030 Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state [on or after October 1, 2000,] that provides coverage for ostomy surgery shall include coverage, up to [one] five thousand dollars annually, for medically necessary appliances and supplies relating to an ostomy including, but not limited to, collection devices, irrigation equipment and supplies, skin barriers and skin protectors. As used in this section, "ostomy" includes colostomy, ileostomy and urostomy. Payments under this section shall not be applied to any policy maximums for durable medical equipment. Nothing in this section shall be deemed to decrease policy benefits in excess of the limits in this section.
3131
3232 Sec. 2. Section 38a-518j of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2011):
3333
3434 Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state [on or after October 1, 2000,] that provides coverage for ostomy surgery shall include coverage, up to [one] five thousand dollars annually, for medically necessary appliances and supplies relating to an ostomy including, but not limited to, collection devices, irrigation equipment and supplies, skin barriers and skin protectors. As used in this section, "ostomy" includes colostomy, ileostomy and urostomy. Payments under this section shall not be applied to any policy maximums for durable medical equipment. Nothing in this section shall be deemed to decrease policy benefits in excess of the limits in this section.
3535
3636 Sec. 3. (NEW) (Effective January 1, 2011) (a) As used in this section, "prosthetic device" means an artificial limb device to replace, in whole or in part, an arm or a leg, including a device that contains a microprocessor if such microprocessor-equipped device is determined by the insured's or enrollee's health care provider to be medically necessary. "Prosthetic device" does not include a device that is designed exclusively for athletic purposes.
3737
3838 (b) (1) Each individual health insurance policy providing coverage of the types specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for prosthetic devices that is at least equivalent to that provided under Medicare. Such coverage may be limited to a prosthetic device that is determined by the insured's or enrollee's health care provider to be the most appropriate to meet the medical needs of the insured or enrollee. Such prosthetic device shall not be considered durable medical equipment under such policy.
3939
4040 (2) Such policy shall provide coverage for the medically necessary repair or replacement of a prosthetic device, as determined by the insured's or enrollee's health care provider, unless such repair or replacement is necessitated by misuse or loss.
4141
4242 (3) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for a prosthetic device that is more restrictive than that imposed on substantially all other benefits provided under such policy, except that a high deductible health plan, as that term is used in subsection (f) of section 38a-493 of the general statutes, shall not be subject to the deductible limits set forth in this subdivision or under Medicare pursuant to subdivision (1) of this subsection.
4343
4444 (c) An individual health insurance policy may require prior authorization for prosthetic devices, provided it is required in the same manner and to the same extent as is required for other covered benefits under such policy.
4545
4646 (d) An insured or enrollee may appeal a denial of coverage for or repair or replacement of a prosthetic device to the Insurance Commissioner for an external, independent review pursuant to section 38a-478n of the general statutes.
4747
4848 Sec. 4. (NEW) (Effective January 1, 2011) (a) As used in this section, "prosthetic device" means an artificial limb device to replace, in whole or in part, an arm or a leg, including a device that contains a microprocessor if such microprocessor-equipped device is determined by the insured's or enrollee's health care provider to be medically necessary. "Prosthetic device" does not include a device that is designed exclusively for athletic purposes.
4949
5050 (b) (1) Each group health insurance policy providing coverage of the types specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for prosthetic devices that is at least equivalent to that provided under Medicare. Such coverage may be limited to a prosthetic device that is determined by the insured's or enrollee's health care provider to be the most appropriate to meet the medical needs of the insured or enrollee. Such prosthetic device shall not be considered durable medical equipment under such policy.
5151
5252 (2) Such policy shall provide coverage for the medically necessary repair or replacement of a prosthetic device, as determined by the insured's or enrollee's health care provider, unless such repair or replacement is necessitated by misuse or loss.
5353
5454 (3) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for a prosthetic device that is more restrictive than that imposed on substantially all other benefits provided under such policy, except that a high deductible health plan, as that term is used in subsection (f) of section 38a-520 of the general statutes, shall not be subject to the deductible limits set forth in this subdivision or under Medicare pursuant to subdivision (1) of this subsection.
5555
5656 (c) A group health insurance policy may require prior authorization for prosthetic devices, provided it is required in the same manner and to the same extent as is required for other covered benefits under such policy.
5757
5858 (d) An insured or enrollee may appeal a denial of coverage for or repair or replacement of a prosthetic device to the Insurance Commissioner for an external, independent review pursuant to section 38a-478n of the general statutes.
5959
6060 Sec. 5. Section 38a-490b of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2011):
6161
6262 Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state [on or after October 1, 2001,] shall provide coverage for hearing aids for children [twelve] eighteen years of age or younger. Such hearing aids shall be considered durable medical equipment under the policy and the policy may limit the hearing aid benefit to one thousand dollars within a twenty-four-month period.
6363
6464 Sec. 6. Section 38a-516b of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2011):
6565
6666 Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state [on or after October 1, 2001,] shall provide coverage for hearing aids for children [twelve] eighteen years of age or younger. Such hearing aids shall be considered durable medical equipment under the policy and the policy may limit the hearing aid benefit to one thousand dollars within a twenty-four-month period.
6767
6868 Sec. 7. Section 38a-504 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2011):
6969
7070 (a) Each insurance company, hospital service corporation, medical service corporation, health care center or fraternal benefit society [which] that delivers, [or] issues for delivery, renews, amends or continues in this state individual health insurance policies providing coverage of the type specified in subdivisions (1), (2), (4), (10), (11) and (12) of section 38a-469, shall provide coverage under such policies for the surgical removal of tumors and treatment of leukemia, including outpatient chemotherapy, reconstructive surgery, cost of any nondental prosthesis including any maxillo-facial prosthesis used to replace anatomic structures lost during treatment for head and neck tumors or additional appliances essential for the support of such prosthesis, outpatient chemotherapy following surgical procedure in connection with the treatment of tumors, and a wig if prescribed by (1) a licensed oncologist for a patient who suffers hair loss as a result of chemotherapy, or (2) a licensed physician or a licensed advanced practice registered nurse for a patient who suffers hair loss due to a diagnosed medical condition of alopecia areata other than as a result of androgenetic alopecia. Such benefits shall be subject to the same terms and conditions applicable to all other benefits under such policies.
7171
7272 (b) Except as provided in subsection (c) of this section, the coverage required by subsection (a) of this section shall provide at least a yearly benefit of five hundred dollars for the surgical removal of tumors, five hundred dollars for reconstructive surgery, five hundred dollars for outpatient chemotherapy, three hundred fifty dollars for a wig and three hundred dollars for a nondental prosthesis, except that for purposes of the surgical removal of breasts due to tumors the yearly benefit for such prosthesis shall be at least three hundred dollars for each breast removed.
7373
7474 (c) The coverage required by subsection (a) of this section shall provide benefits for the reasonable costs of reconstructive surgery on each breast on which a mastectomy has been performed, and reconstructive surgery on a nondiseased breast to produce a symmetrical appearance. Such benefits shall be subject to the same terms and conditions applicable to all other benefits under such policies. For the purposes of this subsection, reconstructive surgery includes, but is not limited to, augmentation mammoplasty, reduction mammoplasty and mastopexy.
7575
7676 Sec. 8. Section 38a-542 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2011):
7777
7878 (a) Each insurance company, hospital service corporation, medical service corporation, health care center or fraternal benefit society [which] that delivers, [or] issues for delivery, renews, amends or continues in this state group health insurance policies providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 shall provide coverage under such policies for treatment of leukemia, including outpatient chemotherapy, reconstructive surgery, cost of any nondental prosthesis, including any maxillo-facial prosthesis used to replace anatomic structures lost during treatment for head and neck tumors or additional appliances essential for the support of such prosthesis, outpatient chemotherapy following surgical procedures in connection with the treatment of tumors, a wig if prescribed by (1) a licensed oncologist for a patient who suffers hair loss as a result of chemotherapy, or (2) a licensed physician or a licensed advanced practice registered nurse for a patient who suffers hair loss due to a diagnosed medical condition of alopecia areata other than as a result of androgenetic alopecia, and costs of removal of any breast implant which was implanted on or before July 1, 1994, without regard to the purpose of such implantation, which removal is determined to be medically necessary. Such benefits shall be subject to the same terms and conditions applicable to all other benefits under such policies.
7979
8080 (b) Except as provided in subsection (c) of this section, the coverage required by subsection (a) of this section shall provide at least a yearly benefit of one thousand dollars for the costs of removal of any breast implant, five hundred dollars for the surgical removal of tumors, five hundred dollars for reconstructive surgery, five hundred dollars for outpatient chemotherapy, three hundred fifty dollars for a wig and three hundred dollars for a nondental prosthesis, except that for purposes of the surgical removal of breasts due to tumors the yearly benefit for such prosthesis shall be at least three hundred dollars for each breast removed.
8181
8282 (c) The coverage required by subsection (a) of this section shall provide benefits for the reasonable costs of reconstructive surgery on each breast on which a mastectomy has been performed, and reconstructive surgery on a nondiseased breast to produce a symmetrical appearance. Such benefits shall be subject to the same terms and conditions applicable to all other benefits under such policies. For the purposes of this subsection, reconstructive surgery includes, but is not limited to, augmentation mammoplasty, reduction mammoplasty and mastopexy.
8383
8484 Sec. 9. (NEW) (Effective January 1, 2011) (a) Subject to the provisions of subsection (b) of this section, each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, amended, renewed or continued in this state shall provide coverage for expenses arising from human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B and DR antigens for utilization in bone marrow transplantation.
8585
8686 (b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for such testing in excess of twenty per cent of the cost for such testing per year. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 of the general statutes.
8787
8888 (c) Such policy shall:
8989
9090 (1) Require that such testing be performed in a facility (A) accredited by the American Society for Histocompatibility and Immunogenetics, or its successor, and (B) certified under the Clinical Laboratory Improvement Act of 1967, 42 USC Section 263a, as amended from time to time; and
9191
9292 (2) Limit coverage to individuals who, at the time of such testing, complete and sign an informed consent form that also authorizes the results of the test to be used for participation in the National Marrow Donor Program.
9393
9494 (d) Such policy may limit such coverage to a lifetime maximum benefit of one testing.
9595
9696 Sec. 10. (NEW) (Effective January 1, 2011) (a) Subject to the provisions of subsection (b) of this section, each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, amended, renewed or continued in this state shall provide coverage for expenses arising from human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B and DR antigens for utilization in bone marrow transplantation.
9797
9898 (b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for such testing in excess of twenty per cent of the cost for such testing per year. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-520 of the general statutes.
9999
100100 (c) Such policy shall:
101101
102102 (1) Require that such testing be performed in a facility (A) accredited by the American Society for Histocompatibility and Immunogenetics, or its successor, and (B) certified under the Clinical Laboratory Improvement Act of 1967, 42 USC Section 263a, as amended from time to time; and
103103
104104 (2) Limit coverage to individuals who, at the time of such testing, complete and sign an informed consent form that also authorizes the results of the test to be used for participation in the National Marrow Donor Program.
105105
106106 (d) Such policy may limit such coverage to a lifetime maximum benefit of one testing.
107107
108108 Sec. 11. Section 38a-492k of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2011):
109109
110110 (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state [on or after October 1, 2001,] shall provide coverage for colorectal cancer screening, including, but not limited to, (1) an annual fecal occult blood test, and (2) colonoscopy, flexible sigmoidoscopy or radiologic imaging, in accordance with the recommendations established by the American College of Gastroenterology, after consultation with the American Cancer Society, based on the ages, family histories and frequencies provided in the recommendations. [Benefits] Except as specified in subsection (b) of this section, benefits under this section shall be subject to the same terms and conditions applicable to all other benefits under such policies.
111111
112112 (b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for any additional colonoscopy ordered in a policy year by a physician for an insured. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493.
113113
114114 Sec. 12. Section 38a-518k of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2011):
115115
116116 (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state [on or after October 1, 2001,] shall provide coverage for colorectal cancer screening, including, but not limited to, (1) an annual fecal occult blood test, and (2) colonoscopy, flexible sigmoidoscopy or radiologic imaging, in accordance with the recommendations established by the American College of Gastroenterology, after consultation with the American Cancer Society, based on the ages, family histories and frequencies provided in the recommendations. [Benefits] Except as specified in subsection (b) of this section, benefits under this section shall be subject to the same terms and conditions applicable to all other benefits under such policies.
117117
118118 (b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for any additional colonoscopy ordered in a policy year by a physician for an insured. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-520.
119119
120120 Sec. 13. (NEW) (Effective January 1, 2011) (a) Any insurer, health care center, hospital service corporation, medical service corporation, fraternal benefit society or other entity that delivers, issues for delivery, renews, amends or continues in this state a group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes shall offer a reasonably designed health behavior wellness, maintenance or improvement program that allows for a reward, a health spending account contribution, a reduction in premiums or reduced medical, prescription drug or equipment copayment, coinsurance or deductible, or a combination of these incentives, for participation in such program.
121121
122122 (b) Any such incentive or reward shall not exceed twenty per cent of the paid premiums and shall comply with all nondiscrimination requirements under the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time, or regulations adopted thereunder.
123123
124124 (c) The insured or enrollee shall provide evidence of participation in such program to the insurer, health care center or other entity set forth in subsection (a) of this section in a manner approved by the Insurance Commissioner.
125125
126126 (d) The Insurance Commissioner, in consultation with the Commissioner of Public Health, may adopt regulations, in accordance with chapter 54 of the general statutes, to establish the criteria and procedures for the approval of such health behavior wellness, maintenance or improvement programs.
127127
128128 Sec. 14. Section 38a-825 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2011):
129129
130130 [No] Except as provided in section 13 of this act, no insurance company doing business in this state, or attorney, producer or any other person shall pay or allow, or offer to pay or allow, as inducement to insurance, any rebate of premium payable on the policy, or any special favor or advantage in the dividends or other benefits to accrue thereon, or any valuable consideration or inducement not specified in the policy of insurance. [No] Except as provided in section 13 of this act, no person shall receive or accept from any company, or attorney, producer or any other person, as inducement to insurance, any such rebate of premium payable on the policy, or any special favor or advantage in the dividends or other benefit to accrue thereon, or any valuable consideration or inducement not specified in the policy of insurance. No person shall be excused from testifying or from producing any books, papers, contracts, agreements or documents, at the trial of any other person charged with the violation of any provision of this section or of section 38a-446, on the ground that such testimony or evidence may tend to incriminate him, but no person shall be prosecuted for any act concerning which he is compelled to so testify or produce documentary or other evidence, except for perjury committed in so testifying.
131131
132132 Sec. 15. Subdivision (9) of section 38a-816 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2011):
133133
134134 (9) Any violation of any one of sections 38a-358, 38a-446, 38a-447, 38a-488, 38a-825, as amended by this act, 38a-826, 38a-828 and 38a-829. None of the following practices shall be considered discrimination within the meaning of section 38a-446 or 38a-488 or a rebate within the meaning of section 38a-825: (a) Paying bonuses to policyholders or otherwise abating their premiums in whole or in part out of surplus accumulated from nonparticipating insurance, provided any such bonuses or abatement of premiums shall be fair and equitable to policyholders and for the best interests of the company and its policyholders; (b) in the case of policies issued on the industrial debit plan, making allowance to policyholders who have continuously for a specified period made premium payments directly to an office of the insurer in an amount which fairly represents the saving in collection expense; (c) readjustment of the rate of premium for a group insurance policy based on loss or expense experience, or both, at the end of the first or any subsequent policy year, which may be made retroactive for such policy year; (d) paying a reward, making a health spending account contribution, or allowing a reduction in premiums or reduced medical, prescription drug or equipment copayment, coinsurance or deductible, or a combination of these incentives to an insured or enrollee in accordance with section 13 of this act.
135135
136136 Sec. 16. Section 38a-623 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2011):
137137
138138 No society doing business in this state shall make or permit any unfair discrimination between insured members of the same class and equal expectation of life in the premiums charged for certificates of insurance, in the dividends or other benefits payable thereon or in any other of the terms and conditions of the contracts it makes. [No] Except as provided in section 13 of this act, no society, by itself, or any other party, and no agent or solicitor, personally, or by any other party, shall offer, promise, allow, give, set off or pay, directly or indirectly, any valuable consideration or inducement to or for insurance, on any risk authorized to be taken by such society [, which] that is not specified in the certificate. [No] Except as provided in section 13 of this act, no member shall receive or accept, directly or indirectly, any rebate of premium, or part thereof, or agent's or solicitor's commission thereon, payable on any certificate or receive or accept any favor or advantage or share in the dividends or other benefits to accrue on, or any valuable consideration or inducement not specified in, the contract of insurance.
139139
140140
141141
142142
143143 This act shall take effect as follows and shall amend the following sections:
144144 Section 1 January 1, 2011 38a-492j
145145 Sec. 2 January 1, 2011 38a-518j
146146 Sec. 3 January 1, 2011 New section
147147 Sec. 4 January 1, 2011 New section
148148 Sec. 5 January 1, 2011 38a-490b
149149 Sec. 6 January 1, 2011 38a-516b
150150 Sec. 7 January 1, 2011 38a-504
151151 Sec. 8 January 1, 2011 38a-542
152152 Sec. 9 January 1, 2011 New section
153153 Sec. 10 January 1, 2011 New section
154154 Sec. 11 January 1, 2011 38a-492k
155155 Sec. 12 January 1, 2011 38a-518k
156156 Sec. 13 January 1, 2011 New section
157157 Sec. 14 January 1, 2011 38a-825
158158 Sec. 15 January 1, 2011 38a-816(9)
159159 Sec. 16 January 1, 2011 38a-623
160160
161161 This act shall take effect as follows and shall amend the following sections:
162162
163163 Section 1
164164
165165 January 1, 2011
166166
167167 38a-492j
168168
169169 Sec. 2
170170
171171 January 1, 2011
172172
173173 38a-518j
174174
175175 Sec. 3
176176
177177 January 1, 2011
178178
179179 New section
180180
181181 Sec. 4
182182
183183 January 1, 2011
184184
185185 New section
186186
187187 Sec. 5
188188
189189 January 1, 2011
190190
191191 38a-490b
192192
193193 Sec. 6
194194
195195 January 1, 2011
196196
197197 38a-516b
198198
199199 Sec. 7
200200
201201 January 1, 2011
202202
203203 38a-504
204204
205205 Sec. 8
206206
207207 January 1, 2011
208208
209209 38a-542
210210
211211 Sec. 9
212212
213213 January 1, 2011
214214
215215 New section
216216
217217 Sec. 10
218218
219219 January 1, 2011
220220
221221 New section
222222
223223 Sec. 11
224224
225225 January 1, 2011
226226
227227 38a-492k
228228
229229 Sec. 12
230230
231231 January 1, 2011
232232
233233 38a-518k
234234
235235 Sec. 13
236236
237237 January 1, 2011
238238
239239 New section
240240
241241 Sec. 14
242242
243243 January 1, 2011
244244
245245 38a-825
246246
247247 Sec. 15
248248
249249 January 1, 2011
250250
251251 38a-816(9)
252252
253253 Sec. 16
254254
255255 January 1, 2011
256256
257257 38a-623
258258
259259
260260
261261 INS Joint Favorable
262-APP Joint Favorable
263262
264263 INS
265-
266-Joint Favorable
267-
268-APP
269264
270265 Joint Favorable