O F F I C E O F L E G I S L A T I V E R E S E A R C H
P U B L I C A C T S U M M A R Y
Page 1
PA 21-22—sHB 6389
Insurance and Real Estate Committee
AN ACT CONCERNING EX PLANATIONS OF BENEFI TS
SUMMARY: This act requires certain health insurance carriers and their third-
party administrators (TPAs) to (1) provide an explanation of benefits (EOBs) to
covered individuals for benefits they receive and (2) allow covered individuals,
who may legally consent to receive covered medical services, to make a specific
written selection about whether and how to receive the EOBs (see
BACKGROUND). The act requires health insurance carriers and TPAs to
disclose EOB delivery options to covered individuals in plain language, and
display or print them clearly and conspicuously in all coverage documents,
privacy communications, EOBs, and Internet websites made available to
Connecticut consumers.
It prohibits a health insurance carrier from requiring a covered individual to
waive his or her right to limit disclosure under the act as a precondition to issuing,
delivering, renewing, amending, or continuing a policy. The act specifies that it
does not limit a covered individual’s or policy holder’s ability to request an
adverse determination review.
The act applies to insurers, health care centers (i.e., HMOs), hospital and
medical service corporations, fraternal benefit societies, and any other entity that
delivers, issues, renews, amends, or continues a health insurance policy in
Connecticut (i.e., “health insurance carriers”) that cover (1) basic hospital
expenses; (2) basic medical-surgical expenses; (3) major medical expenses; or (4)
hospital or medical services, including those provided under an HMO plan. It also
applies to TPAs providing services to these health insurance carriers.
It also makes conforming and technical changes.
EFFECTIVE DATE: January 1, 2023
EXPLANATION OF BENEF ITS (EOBs)
Delivery Method
The act requires health insurance carriers and TPAs to issue EOBs to
consumers, but it also allows covered individuals who may legally consent to
receiving covered services to (1) specify how EOBs are delivered or (2) opt out of
receiving them entirely.
Health insurance carriers and TPAs must allow a legally consenting consumer
who is a covered individual to specify in writing that EOBs must be delivered
solely to him or her by:
1. mailing it to his or her address or any other specified address or
2. making it available electronically and notifying him or her electronically O L R P U B L I C A C T S U M M A R Y
Page 2 of 2
of its availability, including by e-mail or other electronic means, in
compliance with certain federal privacy laws (e.g., through a patient
portal).
Under the act, the consumer’s choice remains valid until he or she specifies
another method in writing to the carrier. The health insurance carrier or TPA must
comply with a consumer’s written request for a specific delivery method within
three business days after receiving it. Additionally, it must provide written
confirmation of receipt and, if contacted by the consumer, advise on the status of
his or her selection.
Opting Out
Covered individuals who can legally consent to benefits may specify, in
writing, that the health insurance carrier or TPA not issue an EOB. In such a case,
the carrier or TPA cannot require the covered individual to explain this decision
unless required by law or pursuant to a court order.
Disclosures
Additionally, the act requires health insurance carriers and TPAs to make
available to consumers a statement disclosing that any covered individual who
can legally consent to receiving covered benefits may specify that the carrier (1)
not issue EOBs concerning him or her or (2) issue them only to the consumer
using the method he or she chooses.
The statement must be in an easily readable, accessible, and understandable
format and include a space for the consumer to provide a mailing or email
address.
Under the act, the disclosure statement described above must be included in
the benefits information that carriers must provide upon enrollment and that both
carriers and the Connecticut Health Insurance Exchange (Access Health CT) must
make available on their websites.
BACKGROUND
Medical Consent
Generally, adults may legally consent to medical procedures. By law, a minor
may legally receive certain medical examinations or treatment without his or her
parent’s consent, including sexually transmitted disease testing (CGS § 19a-216)
and alcohol or drug dependence treatment (CGS § 17a-688).