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General Assembly Committee Bill No. 31
January Session, 2019
LCO No. 5389
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING SU RPRISE MEDICAL BILLS FOR
LABORATORY SERVICES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subsection (a) of section 38a-477aa of the general statutes 1
is repealed and the following is substituted in lieu thereof (Effective 2
January 1, 2020): 3
(a) As used in this section: 4
(1) "Emergency condition" has the same meaning as "emergency 5
medical condition", as provided in section 38a-591a; 6
(2) "Emergency services" means, with respect to an emergency 7
condition, (A) a medical screening examination as required under 8
Section 1867 of the Social Security Act, as amended from time to time, 9
that is within the capability of a hospital emergency department, 10
including ancillary services routinely available to such department to 11
evaluate such condition, and (B) such further medical examinations 12
and treatment required under said Section 1867 to stabilize such 13
individual, that are within the capability of the hospital staff and 14
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facilities; 15
(3) "Health care plan" means an individual or a group health 16
insurance policy or health benefit plan that provides coverage of the 17
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-18
469; 19
(4) "Health care provider" means an individual licensed to provide 20
health care services under chapters 370 to 373, inclusive, chapters 375 21
to 383b, inclusive, and chapters 384a to 384c, inclusive; 22
(5) "Health carrier" means an insurance company, health care center, 23
hospital service corporation, medical service corporation, fraternal 24
benefit society or other entity that delivers, issues for delivery, renews, 25
amends or continues a health care plan in this state; 26
(6) (A) "Surprise bill" means a bill for health care services, other than 27
emergency services, received by an insured for services rendered by an 28
out-of-network health care provider, where such services were 29
rendered by (i) such out-of-network provider at an in-network facility, 30
during a service or procedure performed by an in-network provider or 31
during a service or procedure previously approved or authorized by 32
the health carrier and the insured did not knowingly elect to obtain 33
such services from such out-of-network provider, or (ii) a clinical 34
laboratory, as defined in section 19a-30, that is an out-of-network 35
provider, upon the referral of an in-network provider. 36
(B) "Surprise bill" does not include a bill for health care services 37
received by an insured when an in-network health care provider was 38
available to render such services and the insured knowingly elected to 39
obtain such services from another health care provider who was out-40
of-network. 41
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2020 38a-477aa(a)
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Statement of Purpose:
To expand the definition of "surprise bill" to include bills for
nonemergency health care services rendered by out-of-network clinical
laboratories upon the referral of in-network providers.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
not underlined.]
Co-Sponsors: SEN. LOONEY, 11th Dist.
S.B. 31