CT
Connecticut Senate Bill SB00838

Connecticut 2019 Regular Session

Connecticut Senate Bill SB00838 Compare Versions

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7+General Assembly Substitute Bill No. 838
8+January Session, 2019
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4-Substitute Senate Bill No. 838
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6-Public Act No. 19-201
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9-AN ACT CONCERNING VI SION PLANS, OPTOMETR ISTS AND
10-OPHTHALMOLOGISTS.
14+AN ACT CONCERNING RE QUIRED HEALTH INSURA NCE
15+COVERAGE AND COST -SHARING FOR MAMMOGRAMS AND
16+BREAST ULTRASOUNDS.
1117 Be it enacted by the Senate and House of Representatives in General
1218 Assembly convened:
1319
14-Section 1. Section 38a-472h of the general statutes is repealed and
15-the following is substituted in lieu thereof (Effective January 1, 2020):
16-(a) No insurer, health care center, fraternal benefit society, hospital
17-service corporation, medical service corporation or other entity
18-delivering, issuing for delivery, renewing, amending or continuing:
19-(1) An individual or a group dental plan in this state shall include in
20-any contract with a dentist licensed pursuant to chapter 379 that is
21-entered into, renewed or amended on or after January 1, 2012, any
22-provision that requires such dentist to accept as payment an amount
23-set by such insurer, center, society, corporation or entity for services or
24-procedures provided to an insured or enrollee that are not covered
25-benefits under such insured's or enrollee's plan; or
26-(2) An individual or a group vision plan in this state shall include in
27-any contract with an optometrist licensed pursuant to chapter 380 or
28-an ophthalmologist licensed pursuant to chapter 370 that is entered
29-into, renewed or amended on or after January 1, [2016] 2020, any
30-provision that requires such optometrist or ophthalmologist to accept Substitute Senate Bill No. 838
20+Section 1. Subsections (b) and (c) of section 38a-503 of the general 1
21+statutes are repealed and the following is substituted in lieu thereof 2
22+(Effective January 1, 2020): 3
23+(b) (1) Each individual health insurance policy providing coverage 4
24+of the type specified in subdivisions (1), (2), (4), (10), (11) and (12) of 5
25+section 38a-469 delivered, issued for delivery, renewed, amended or 6
26+continued in this state shall provide benefits for mammograms to any 7
27+woman covered under the policy that are at least equal to the 8
28+following minimum requirements: (A) A baseline mammogram, which 9
29+may be provided by breast tomosynthesis at the option of the woman 10
30+covered under the policy, for any woman who is thirty-five to thirty-11
31+nine years of age, inclusive; and (B) a mammogram, which may be 12
32+provided by breast tomosynthesis at the option of the woman covered 13
33+under the policy, every year for any woman who is forty years of age 14
34+or older. 15
35+(2) Such policy shall provide additional benefits for: 16
36+(A) Comprehensive ultrasound screening of an entire breast or 17 Substitute Bill No. 838
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34-as payment an amount set by such insurer, center, society, corporation
35-or entity for services, [or] procedures or products provided to an
36-insured or enrollee that are not covered benefits under such insured's
37-or enrollee's plan.
38-(b) No dentist [or optometrist] shall charge more for services or
39-procedures that are not covered benefits than such dentist's [or
40-optometrist's] usual and customary rate for such services or
41-procedures, and no optometrist or ophthalmologist shall charge more
42-for services, procedures or products that are not covered benefits than
43-such optometrist's or ophthalmologist's usual and customary rate for
44-such services, procedures or products.
45-(c) (1) Each evidence of coverage for an individual or a group dental
46-plan shall include the following statement:
47-"IMPORTANT: If you opt to receive dental services or procedures
48-that are not covered benefits under this plan, a participating dental
49-provider may charge you his or her usual and customary rate for such
50-services or procedures. Prior to providing you with dental services or
51-procedures that are not covered benefits, the dental provider should
52-provide you with a treatment plan that includes each anticipated
53-service or procedure to be provided and the estimated cost of each
54-such service or procedure. To fully understand your coverage, you
55-may wish to review your evidence of coverage document."
56-(2) Each evidence of coverage for an individual or a group vision
57-plan shall include the following statement:
58-"IMPORTANT: If you opt to receive optometric or ophthalmologic
59-services, [or] procedures or products that are not covered benefits
60-under this plan, a participating optometrist or ophthalmologist may
61-charge you his or her usual and customary rate for such services, [or]
62-procedures or products. Prior to providing you with optometric or Substitute Senate Bill No. 838
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43+breasts if: [a] (i) A mammogram demonstrates heterogeneous or dense 18
44+breast tissue based on the Breast Imaging Reporting and Data System 19
45+established by the American College of Radiology; [or if] (ii) a woman 20
46+is believed to be at increased risk for breast cancer due to (I) family 21
47+history or prior personal history of breast cancer, (II) positive genetic 22
48+testing, or (III) other indications as determined by a woman's physician 23
49+or advanced practice registered nurse; or (iii) such screening is 24
50+recommended by a woman's treating physician for a woman who (I) is 25
51+forty years of age or older, (II) has a family history or prior personal 26
52+history of breast cancer, or (III) has a prior personal history of breast 27
53+disease diagnosed through biopsy as benign; and 28
54+(B) Magnetic resonance imaging of an entire breast or breasts in 29
55+accordance with guidelines established by the American Cancer 30
56+Society. 31
57+(c) Benefits under this section shall be subject to any policy 32
58+provisions that apply to other services covered by such policy, except 33
59+that no such policy shall impose a coinsurance, copayment, [that 34
60+exceeds a maximum of twenty dollars for an ultrasound screening 35
61+under subparagraph (A) of subdivision (2) of subsection (b) of this 36
62+section] deductible or other out-of-pocket expense for such benefits. 37
63+The provisions of this subsection shall apply to a high deductible plan, 38
64+as that term is used in subsection (f) of section 38a-493, to the 39
65+maximum extent permitted by federal law, except if such plan is used 40
66+to establish a medical savings account or an Archer MSA pursuant to 41
67+Section 220 of the Internal Revenue Code of 1986 or any subsequent 42
68+corresponding internal revenue code of the United States, as amended 43
69+from time to time, or a health savings account pursuant to Section 223 44
70+of said Internal Revenue Code, as amended from time to time, the 45
71+provisions of this subsection shall apply to such plan to the maximum 46
72+extent that (1) is permitted by federal law, and (2) does not disqualify 47
73+such account for the deduction allowed under said Section 220 or 223, 48
74+as applicable. 49
75+Sec. 2. Subsections (b) and (c) of section 38a-530 of the general 50 Substitute Bill No. 838
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66-ophthalmologic services, [or] procedures or products that are not
67-covered benefits, the optometrist or ophthalmologist should provide
68-you with a treatment plan that includes each anticipated service, [or]
69-procedure or product to be provided and the estimated cost of each
70-such service, [or] procedure or product. To fully understand your
71-coverage, you may wish to review your evidence of coverage
72-document."
73-(d) Each dentist, [and] optometrist and ophthalmologist shall post,
74-in a conspicuous place, a notice stating that services, [or] procedures or
75-products, as applicable, that are not covered benefits under an
76-insurance policy or plan might not be offered at a discounted rate.
77-(e) The provisions of this section shall not apply to:
78-(1) [a] A self-insured plan that covers (A) dental services or
79-procedures, or (B) optometric or ophthalmologic services, [or]
80-procedures or products;
81-(2) [a] A contract that is incorporated in or derived from a collective
82-bargaining agreement or in which some or all of the material terms are
83-subject to a collective bargaining process; [.]
84-(3) A contract that is derived from a multiemployer plan, as defined
85-in Section 3 of the Employee Retirement Income Security Act of 1974,
86-as amended from time to time; or
87-(4) A network of ophthalmologists or optometrists, or both, when
88-servicing a plan or contract described in subdivision (1), (2) or (3) of
89-this subsection.
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82+statutes are repealed and the following is substituted in lieu thereof 51
83+(Effective January 1, 2020): 52
84+(b) (1) Each group health insurance policy providing coverage of the 53
85+type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-54
86+469 delivered, issued for delivery, renewed, amended or continued in 55
87+this state shall provide benefits for mammograms to any woman 56
88+covered under the policy that are at least equal to the following 57
89+minimum requirements: (A) A baseline mammogram, which may be 58
90+provided by breast tomosynthesis at the option of the woman covered 59
91+under the policy, for any woman who is thirty-five to thirty-nine years 60
92+of age, inclusive; and (B) a mammogram, which may be provided by 61
93+breast tomosynthesis at the option of the woman covered under the 62
94+policy, every year for any woman who is forty years of age or older. 63
95+(2) Such policy shall provide additional benefits for: 64
96+(A) Comprehensive ultrasound screening of an entire breast or 65
97+breasts if: [a] (i) A mammogram demonstrates heterogeneous or dense 66
98+breast tissue based on the Breast Imaging Reporting and Data System 67
99+established by the American College of Radiology; [or if] (ii) a woman 68
100+is believed to be at increased risk for breast cancer due to (I) family 69
101+history or prior personal history of breast cancer, (II) positive genetic 70
102+testing, or (III) other indications as determined by a woman's physician 71
103+or advanced practice registered nurse; or (iii) such screening is 72
104+recommended by a woman's treating physician for a woman who (I) is 73
105+forty years of age or older, (II) has a family history or prior personal 74
106+history of breast cancer, or (III) has a prior personal history of breast 75
107+disease diagnosed through biopsy as benign; and 76
108+(B) Magnetic resonance imaging of an entire breast or breasts in 77
109+accordance with guidelines established by the American Cancer 78
110+Society. 79
111+(c) Benefits under this section shall be subject to any policy 80
112+provisions that apply to other services covered by such policy, except 81 Substitute Bill No. 838
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119+that no such policy shall impose a coinsurance, copayment, [that 82
120+exceeds a maximum of twenty dollars for an ultrasound screening 83
121+under subparagraph (A) of subdivision (2) of subsection (b) of this 84
122+section] deductible or other out-of-pocket expense for such benefits. 85
123+The provisions of this subsection shall apply to a high deductible plan, 86
124+as that term is used in subsection (f) of section 38a-520, to the 87
125+maximum extent permitted by federal law, except if such plan is used 88
126+to establish a medical savings account or an Archer MSA pursuant to 89
127+Section 220 of the Internal Revenue Code of 1986 or any subsequent 90
128+corresponding internal revenue code of the United States, as amended 91
129+from time to time, or a health savings account pursuant to Section 223 92
130+of said Internal Revenue Code, as amended from time to time, the 93
131+provisions of this subsection shall apply to such plan to the maximum 94
132+extent that (1) is permitted by federal law, and (2) does not disqualify 95
133+such account for the deduction allowed under said Section 220 or 223, 96
134+as applicable. 97
135+This act shall take effect as follows and shall amend the following
136+sections:
137+
138+Section 1 January 1, 2020 38a-503(b) and (c)
139+Sec. 2 January 1, 2020 38a-530(b) and (c)
140+
141+INS Joint Favorable Subst.
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