LCO No. 5470 1 of 4
General Assembly Committee Bill No. 327
January Session, 2019
LCO No. 5470
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT REQUIRING HEA LTH INSURANCE COVERAGE F OR
MEDICALLY NECESSARY AMBULANCE SERVICES A T AN IN-
NETWORK LEVEL AND PR OHIBITING BALANCE BILLING FOR SUCH
SERVICES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subsections (a) and (b) of section 20-7f of the general 1
statutes are repealed and the following is substituted in lieu thereof 2
(Effective January 1, 2020): 3
(a) For purposes of this section: 4
(1) "Request payment" includes, but is not limited to, submitting a 5
bill for services not actually owed or submitting for such services an 6
invoice or other communication detailing the cost of the services that is 7
not clearly marked with the phrase "This is not a bill". 8
(2) "Health care provider" means a person licensed to provide health 9
care services under chapters 370 to 373, inclusive, chapters 375 to 383b, 10
inclusive, chapters 384a to [384c] 384d, inclusive, or chapter 400j. 11
(3) "Enrollee" means a person who has contracted for or who 12
Committee Bill No. 327
LCO No. 5470 2 of 4
participates in a health care plan for such enrollee or such enrollee's 13
eligible dependents. 14
(4) "Coinsurance, copayment, deductible or other out-of-pocket 15
expense" means the portion of a charge for services covered by a health 16
care plan that, under the plan's terms, it is the obligation of the enrollee 17
to pay. 18
(5) "Health care plan" has the same meaning as provided in 19
subsection (a) of section 38a-477aa. 20
(6) "Health carrier" has the same meaning as provided in subsection 21
(a) of section 38a-477aa. 22
(7) "Emergency services" has the same meaning as provided in 23
subsection (a) of section 38a-477aa. 24
(8) "Medically necessary ambulance services" has the same meaning 25
as that term is used in sections 38a-498 and 38a-525, as amended by 26
this act. 27
(b) It shall be an unfair trade practice in violation of chapter 735a for 28
any health care provider to request payment from an enrollee, other 29
than a coinsurance, copayment, deductible or other out-of-pocket 30
expense, for (1) health care services or a facility fee, as defined in 31
section 19a-508c, covered under a health care plan, (2) emergency 32
services covered under a health care plan and rendered by an out-of-33
network health care provider, [or] (3) a surprise bill, as defined in 34
section 38a-477aa, or (4) medically necessary ambulance services in an 35
amount that exceeds the amount allowed under section 38a-498 or 38a-36
525, as amended by this act. 37
Sec. 2. Subsection (a) of section 38a-498 of the general statutes is 38
repealed and the following is substituted in lieu thereof (Effective 39
January 1, 2020): 40
(a) Each individual health insurance policy providing coverage of 41
Committee Bill No. 327
LCO No. 5470 3 of 4
the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of 42
section 38a-469 delivered, issued for delivery, renewed, amended or 43
continued in this state shall provide coverage for medically necessary 44
ambulance services for persons covered by the policy at an in-network 45
level, including, but not limited to, at an in-network level of cost-46
sharing. The hospital policy shall be primary if a person is covered 47
under more than one policy. The policy shall, as a minimum 48
requirement, cover such services whenever any person covered by the 49
contract is transported when medically necessary by ambulance to a 50
hospital. Such benefits shall be subject to any policy provision which 51
applies to other services covered by such policies, except that such 52
benefits shall be covered at an in-network level, including, but not 53
limited to, at an in-network level of cost-sharing. Notwithstanding any 54
other provision of this section, such policies shall not be required to 55
provide benefits in excess of the maximum allowable rate established 56
by the Department of Public Health in accordance with section 19a-57
177. 58
Sec. 3. Subsection (a) of section 38a-525 of the general statutes is 59
repealed and the following is substituted in lieu thereof (Effective 60
January 1, 2020): 61
(a) Each group health insurance policy providing coverage of the 62
type specified in subdivisions (1), (2), (4), (6), (11) and (12) of section 63
38a-469 delivered, issued for delivery, renewed, amended or continued 64
in this state shall provide coverage for medically necessary ambulance 65
services for persons covered by the policy at an in-network level, 66
including, but not limited to, at an in-network level of cost-sharing. 67
The hospital policy shall be primary if a person is covered under more 68
than one policy. The policy shall, as a minimum requirement, cover 69
such services whenever any person covered by the contract is 70
transported when medically necessary by ambulance to a hospital. 71
Such benefits shall be subject to any policy provision which applies to 72
other services covered by such policies, except that such benefits shall 73
be covered at an in-network level, including, but not limited to, at an 74
Committee Bill No. 327
LCO No. 5470 4 of 4
in-network level of cost-sharing. Notwithstanding any other provision 75
of this section, such policies shall not be required to provide benefits in 76
excess of the maximum allowable rate established by the Department 77
of Public Health in accordance with section 19a-177. 78
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2020 20-7f(a) and (b)
Sec. 2 January 1, 2020 38a-498(a)
Sec. 3 January 1, 2020 38a-525(a)
Statement of Purpose:
To require health insurance coverage for medically necessary
ambulance services at an in-network level, including, but not limited
to, at an in-network level of cost sharing, and prohibit balance billing
for such services.
[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. 327