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General Assembly Raised Bill No. 976
January Session, 2023
LCO No. 3606
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING HEALTH COVERAGE MANDATES FOR
CERTAIN HEALTH CONDITIONS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 38a-1 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective January 1, 2024): 2
Terms used in this title and sections 2 to 46, inclusive, of this act, 3
unless it appears from the context to the contrary, shall have a scope and 4
meaning as set forth in this section. 5
(1) "Affiliate" or "affiliated" means a person that directly, or indirectly 6
through one or more intermediaries, controls, is controlled by or is 7
under common control with another person. 8
(2) "Alien insurer" means any insurer that has been chartered by or 9
organized or constituted within or under the laws of any jurisdiction or 10
country without the United States. 11
(3) "Annuities" means all agreements to make periodical payments 12
where the making or continuance of all or some of the series of the 13
payments, or the amount of the payment, is dependent upon the 14 Raised Bill No. 976
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continuance of human life or is for a specified term of years. This 15
definition does not apply to payments made under a policy of life 16
insurance. 17
(4) "Commissioner" means the Insurance Commissioner. 18
(5) "Control", "controlled by" or "under common control with" means 19
the possession, direct or indirect, of the power to direct or cause the 20
direction of the management and policies of a person, whether through 21
the ownership of voting securities, by contract other than a commercial 22
contract for goods or nonmanagement services, or otherwise, unless the 23
power is the result of an official position with the person. 24
(6) "Domestic insurer" means any insurer that has been chartered by, 25
incorporated, organized or constituted within or under the laws of this 26
state. 27
(7) "Domestic surplus lines insurer" means any domestic insurer that 28
has been authorized by the commissioner to write surplus lines 29
insurance. 30
(8) "Foreign country" means any jurisdiction not in any state, district 31
or territory of the United States. 32
(9) "Foreign insurer" means any insurer that has been chartered by or 33
organized or constituted within or under the laws of another state or a 34
territory of the United States. 35
(10) "Insolvency" or "insolvent" means, for any insurer, that it is 36
unable to pay its obligations when they are due, or when its admitted 37
assets do not exceed its liabilities plus the greater of: (A) Capital and 38
surplus required by law for its organization and continued operation; 39
or (B) the total par or stated value of its authorized and issued capital 40
stock. For purposes of this subdivision "liabilities" shall include but not 41
be limited to reserves required by statute or by regulations adopted by 42
the commissioner in accordance with the provisions of chapter 54 or 43
specific requirements imposed by the commissioner upon a subject 44 Raised Bill No. 976
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company at the time of admission or subsequent thereto. 45
(11) "Insurance" means any agreement to pay a sum of money, 46
provide services or any other thing of value on the happening of a 47
particular event or contingency or to provide indemnity for loss in 48
respect to a specified subject by specified perils in return for a 49
consideration. In any contract of insurance, an insured shall have an 50
interest which is subject to a risk of loss through destruction or 51
impairment of that interest, which risk is assumed by the insurer and 52
such assumption shall be part of a general scheme to distribute losses 53
among a large group of persons bearing similar risks in return for a 54
ratable contribution or other consideration. 55
(12) "Insurer" or "insurance company" includes any person or 56
combination of persons doing any kind or form of insurance business 57
other than a fraternal benefit society, and shall include a receiver of any 58
insurer when the context reasonably permits. 59
(13) "Insured" means a person to whom or for whose benefit an 60
insurer makes a promise in an insurance policy. The term includes 61
policyholders, subscribers, members and beneficiaries. This definition 62
applies only to the provisions of this title and does not define the 63
meaning of this word as used in insurance policies or certificates. 64
(14) "Life insurance" means insurance on human lives and insurances 65
pertaining to or connected with human life. The business of life 66
insurance includes granting endowment benefits, granting additional 67
benefits in the event of death by accident or accidental means, granting 68
additional benefits in the event of the total and permanent disability of 69
the insured, and providing optional methods of settlement of proceeds. 70
Life insurance includes burial contracts to the extent provided by 71
section 38a-464. 72
(15) "Mutual insurer" means any insurer without capital stock, the 73
managing directors or officers of which are elected by its members. 74
(16) "Person" means an individual, a corporation, a partnership, a 75 Raised Bill No. 976
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limited liability company, an association, a joint stock company, a 76
business trust, an unincorporated organization or other legal entity. 77
(17) "Policy" means any document, including attached endorsements 78
and riders, purporting to be an enforceable contract, which 79
memorializes in writing some or all of the terms of an insurance 80
contract. 81
(18) "State" means any state, district, or territory of the United States. 82
(19) "Subsidiary" of a specified person means an affiliate controlled 83
by the person directly, or indirectly through one or more intermediaries. 84
(20) "Unauthorized insurer" or "nonadmitted insurer" means an 85
insurer that has not been granted a certificate of authority by the 86
commissioner to transact the business of insurance in this state or an 87
insurer transacting business not authorized by a valid certificate. 88
(21) "United States" means the United States of America, its territories 89
and possessions, the Commonwealth of Puerto Rico and the District of 90
Columbia. 91
Sec. 2. (NEW) (Effective January 1, 2024) Each individual health 92
insurance policy providing coverage of the type specified in 93
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 94
statutes delivered, issued for delivery, renewed, amended or continued 95
in this state on or after January 1, 2024, shall provide coverage for 96
treatment of postpartum depression. 97
Sec. 3. (NEW) (Effective January 1, 2024) Each group health insurance 98
policy providing coverage of the type specified in subdivisions (1), (2), 99
(4), (11) and (12) of section 38a-469 of the general statutes delivered, 100
issued for delivery, renewed, amended or continued in this state on or 101
after January 1, 2024, shall provide coverage for treatment of 102
postpartum depression. 103
Sec. 4. (NEW) (Effective January 1, 2024) Each individual health 104
insurance policy providing coverage of the type specified in 105 Raised Bill No. 976
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subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 106
statutes delivered, issued for delivery, renewed, amended or continued 107
in this state on or after January 1, 2024, shall provide coverage for 108
physical therapy services rendered by a physical therapist licensed 109
under section 20-73 of the general statutes. 110
Sec. 5. (NEW) (Effective January 1, 2024) Each group health insurance 111
policy providing coverage of the type specified in subdivisions (1), (2), 112
(4), (11) and (12) of section 38a-469 of the general statutes delivered, 113
issued for delivery, renewed, amended or continued in this state on or 114
after January 1, 2024, shall provide coverage for physical therapy 115
services rendered by a physical therapist licensed under section 20-73 of 116
the general statutes. 117
Sec. 6. (NEW) (Effective January 1, 2024) (a) For the purposes of this 118
section: 119
(1) "Body mass index" means the number calculated by dividing an 120
individual's weight in kilograms by the individual's height in meters 121
squared; and 122
(2) "Severe obesity" means a body mass index that is: 123
(A) Greater than forty; or 124
(B) Thirty-five or more if an individual has been diagnosed with a 125
comorbid disease or condition, including, but not limited to, a 126
cardiopulmonary condition, diabetes, hypertension or sleep apnea. 127
(b) Each individual health insurance policy providing coverage of the 128
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 129
of the general statutes delivered, issued for delivery, renewed, amended 130
or continued in this state on or after January 1, 2024, shall provide 131
coverage for: 132
(1) Each surgical procedure that is: 133
(A) Performed to treat severe obesity, including, but not limited to, 134 Raised Bill No. 976
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gastric bypass surgery, sleeve gastrectomy and duodenal switch 135
surgery; 136
(B) Recognized by the National Institutes of Health, American Society 137
for Metabolic and Bariatric Surgery and American College of Surgeons 138
as providing long-term weight loss; and 139
(C) Consistent with treatment guidelines issued by the National 140
Institutes of Health as applied to the insured; and 141
(2) Each outpatient prescription drug that is approved by the federal 142
Food and Drug Administration to treat severe obesity provided such 143
policy includes coverage for outpatient prescription drugs. 144
(c) The benefits required by subsection (b) of this section shall be 145
subject to the same terms and conditions that apply to all other benefits 146
covered under a policy that is subject to this section. 147
Sec. 7. (NEW) (Effective January 1, 2024) (a) For the purposes of this 148
section: 149
(1) "Body mass index" means the number calculated by dividing an 150
individual's weight in kilograms by the individual's height in meters 151
squared; and 152
(2) "Severe obesity" means a body mass index that is: 153
(A) Greater than forty; or 154
(B) Thirty-five or more if an individual has been diagnosed with a 155
comorbid disease or condition, including, but not limited to, a 156
cardiopulmonary condition, diabetes, hypertension or sleep apnea. 157
(b) Each group health insurance policy providing coverage of the 158
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 159
of the general statutes delivered, issued for delivery, renewed, amended 160
or continued in this state on or after January 1, 2024, shall provide 161
coverage for: 162 Raised Bill No. 976
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(1) Each surgical procedure that is: 163
(A) Performed to treat severe obesity, including, but not limited to, 164
gastric bypass surgery, sleeve gastrectomy and duodenal switch 165
surgery; 166
(B) Recognized by the National Institutes of Health, American Society 167
for Metabolic and Bariatric Surgery and American College of Surgeons 168
as providing long-term weight loss; and 169
(C) Consistent with treatment guidelines issued by the National 170
Institutes of Health as applied to the insured; and 171
(2) Each outpatient prescription drug that is approved by the federal 172
Food and Drug Administration to treat severe obesity provided such 173
policy includes coverage for outpatient prescription drugs. 174
(c) The benefits required by subsection (b) of this section shall be 175
subject to the same terms and conditions that apply to all other benefits 176
covered under a policy that is subject to this section. 177
Sec. 8. (NEW) (Effective January 1, 2024) (a) For the purposes of this 178
section: 179
(1) "Body mass index" means the number calculated by dividing a 180
Medicaid beneficiary's weight in kilograms by the Medicaid 181
beneficiary's height in meters squared; and 182
(2) "Severe obesity" means a body mass index that is: 183
(A) Greater than forty; or 184
(B) Thirty-five or more if a Medicaid beneficiary has been diagnosed 185
with a comorbid disease or condition, including, but not limited to, a 186
cardiopulmonary condition, diabetes, hypertension or sleep apnea. 187
(b) The Commissioner of Social Services shall provide Medicaid 188
reimbursement for: 189 Raised Bill No. 976
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(1) Each surgical procedure that is: 190
(A) Performed to treat severe obesity, including, but not limited to, 191
gastric bypass surgery, sleeve gastrectomy and duodenal switch 192
surgery; 193
(B) Recognized by the National Institutes of Health, American Society 194
for Metabolic and Bariatric Surgery and American College of Surgeons 195
as providing long-term weight loss; and 196
(C) Consistent with treatment guidelines issued by the National 197
Institutes of Health as applied to the Medicaid beneficiary; and 198
(2) Each outpatient prescription drug that is approved by the federal 199
Food and Drug Administration to treat severe obesity. 200
(c) The Commissioner of Social Services shall seek federal approval 201
of a Medicaid state plan amendment or Medicaid waiver, if necessary, 202
to implement the provisions of this section. Any submission of a 203
Medicaid state plan amendment or Medicaid waiver shall be in 204
accordance with the provisions of section 17b-8 of the general statutes. 205
(d) The Commissioner of Social Services shall adopt regulations, in 206
accordance with chapter 54 of the general statutes, to implement the 207
provisions of this section. The Commissioner of Social Services may 208
adopt policies or procedures to implement the provisions of this section 209
while in the process of adopting regulations, provided such policies or 210
procedures are posted on the Internet web site of the Department of 211
Social Services and on the eRegulations System prior to the adoption of 212
such policies or procedures. 213
Sec. 9. Subsection (a) of section 38a-503e of the general statutes is 214
repealed and the following is substituted in lieu thereof (Effective January 215
1, 2024): 216
(a) Each individual health insurance policy providing coverage of the 217
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 218
delivered, issued for delivery, renewed, amended or continued in this 219 Raised Bill No. 976
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state shall provide coverage for the following benefits and services: 220
(1) All contraceptive drugs, including, but not limited to, all over-the-221
counter contraceptive drugs and emergency contraceptive drugs, 222
approved by the federal Food and Drug Administration. Such policy 223
may require an insured to use, prior to using a contraceptive drug 224
prescribed to the insured, a contraceptive drug that the federal Food and 225
Drug Administration has designated as therapeutically equivalent to 226
the contraceptive drug prescribed to the insured, unless otherwise 227
determined by the insured's prescribing health care provider. 228
(2) All contraceptive devices and products, excluding all over-the-229
counter contraceptive devices and products, approved by the federal 230
Food and Drug Administration. Such policy may require an insured to 231
use, prior to using a contraceptive device or product prescribed to the 232
insured, a contraceptive device or product that the federal Food and 233
Drug Administration has designated as therapeutically equivalent to 234
the contraceptive device or product prescribed to the insured, unless 235
otherwise determined by the insured's prescribing health care provider. 236
(3) If a contraceptive drug, device or product described in subdivision 237
(1) or (2) of this subsection is prescribed by a licensed physician, 238
physician assistant or advanced practice registered nurse, a twelve-239
month supply of such contraceptive drug, device or product dispensed 240
at one time or at multiple times, unless the insured or the insured's 241
prescribing health care provider requests less than a twelve-month 242
supply of such contraceptive drug, device or product. No insured shall 243
be entitled to receive a twelve-month supply of a contraceptive drug, 244
device or product pursuant to this subdivision more than once during 245
any policy year. 246
(4) All sterilization methods approved by the federal Food and Drug 247
Administration for women. 248
(5) Routine follow-up care concerning contraceptive drugs, devices 249
and products approved by the federal Food and Drug Administration. 250 Raised Bill No. 976
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(6) Counseling in (A) contraceptive drugs, devices and products 251
approved by the federal Food and Drug Administration, and (B) the 252
proper use of contraceptive drugs, devices and products approved by 253
the federal Food and Drug Administration. 254
Sec. 10. Subsection (a) of section 38a-530e of the general statutes is 255
repealed and the following is substituted in lieu thereof (Effective January 256
1, 2024): 257
(a) Each group health insurance policy providing coverage of the type 258
specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 259
delivered, issued for delivery, renewed, amended or continued in this 260
state shall provide coverage for the following benefits and services: 261
(1) All contraceptive drugs, including, but not limited to, all over-the-262
counter contraceptive drugs and emergency contraceptive drugs, 263
approved by the federal Food and Drug Administration. Such policy 264
may require an insured to use, prior to using a contraceptive drug 265
prescribed to the insured, a contraceptive drug that the federal Food and 266
Drug Administration has designated as therapeutically equivalent to 267
the contraceptive drug prescribed to the insured, unless otherwise 268
determined by the insured's prescribing health care provider. 269
(2) All contraceptive devices and products, excluding all over-the-270
counter contraceptive devices and products, approved by the federal 271
Food and Drug Administration. Such policy may require an insured to 272
use, prior to using a contraceptive device or product prescribed to the 273
insured, a contraceptive device or product that the federal Food and 274
Drug Administration has designated as therapeutically equivalent to 275
the contraceptive device or product prescribed to the insured, unless 276
otherwise determined by the insured's prescribing health care provider. 277
(3) If a contraceptive drug, device or product described in subdivision 278
(1) or (2) of this subsection is prescribed by a licensed physician, 279
physician assistant or advanced practice registered nurse, a twelve-280
month supply of such contraceptive drug, device or product dispensed 281
at one time or at multiple times, unless the insured or the insured's 282 Raised Bill No. 976
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prescribing health care provider requests less than a twelve-month 283
supply of such contraceptive drug, device or product. No insured shall 284
be entitled to receive a twelve-month supply of a contraceptive drug, 285
device or product pursuant to this subdivision more than once during 286
any policy year. 287
(4) All sterilization methods approved by the federal Food and Drug 288
Administration for women. 289
(5) Routine follow-up care concerning contraceptive drugs, devices 290
and products approved by the federal Food and Drug Administration. 291
(6) Counseling in (A) contraceptive drugs, devices and products 292
approved by the federal Food and Drug Administration, and (B) the 293
proper use of contraceptive drugs, devices and products approved by 294
the federal Food and Drug Administration. 295
Sec. 11. (NEW) (Effective January 1, 2024) Each individual health 296
insurance policy providing coverage of the type specified in 297
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 298
statutes delivered, issued for delivery, renewed, amended or continued 299
in this state on or after January 1, 2024, shall provide coverage for: (1) 300
Motorized wheelchairs, including, but not limited to, used motorized 301
wheelchairs; (2) repairs to motorized wheelchairs; and (3) replacement 302
batteries for motorized wheelchairs. 303
Sec. 12. (NEW) (Effective January 1, 2024) Each group health insurance 304
policy providing coverage of the type specified in subdivisions (1), (2), 305
(4), (11) and (12) of section 38a-469 of the general statutes delivered, 306
issued for delivery, renewed, amended or continued in this state on or 307
after January 1, 2024, shall provide coverage for: (1) Motorized 308
wheelchairs, including, but not limited to, used motorized wheelchairs; 309
(2) repairs to motorized wheelchairs; and (3) replacement batteries for 310
motorized wheelchairs. 311
Sec. 13. (NEW) (Effective January 1, 2024) Each individual health 312
insurance policy providing coverage of the type specified in 313 Raised Bill No. 976
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subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 314
statutes delivered, issued for delivery, renewed, amended or continued 315
in this state on or after January 1, 2024, shall provide coverage for 316
medical foods for individuals diagnosed with phenylketonuria. 317
Sec. 14. (NEW) (Effective January 1, 2024) Each group health insurance 318
policy providing coverage of the type specified in subdivisions (1), (2), 319
(4), (11) and (12) of section 38a-469 of the general statutes delivered, 320
issued for delivery, renewed, amended or continued in this state on or 321
after January 1, 2024, shall provide coverage for medical foods for 322
individuals diagnosed with phenylketonuria. 323
Sec. 15. (NEW) (Effective January 1, 2024) Each individual health 324
insurance policy providing coverage of the type specified in 325
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 326
statutes delivered, issued for delivery, renewed, amended or continued 327
in this state on or after January 1, 2024, shall provide coverage for: (1) A 328
unilateral cochlear implant, and unilateral cochlear implant surgery, for 329
an insured who has been diagnosed with unilateral hearing loss; and (2) 330
bilateral cochlear implants and bilateral cochlear implant surgery for an 331
insured who has been diagnosed with bilateral hearing loss. 332
Sec. 16. (NEW) (Effective January 1, 2024) Each group health insurance 333
policy providing coverage of the type specified in subdivisions (1), (2), 334
(4), (11) and (12) of section 38a-469 of the general statutes delivered, 335
issued for delivery, renewed, amended or continued in this state on or 336
after January 1, 2024, shall provide coverage for: (1) A unilateral 337
cochlear implant, and unilateral cochlear implant surgery, for an 338
insured who has been diagnosed with unilateral hearing loss; and (2) 339
bilateral cochlear implants and bilateral cochlear implant surgery for an 340
insured who has been diagnosed with bilateral hearing loss. 341
Sec. 17. (NEW) (Effective January 1, 2024) Each individual health 342
insurance policy providing coverage of the type specified in 343
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 344
statutes delivered, issued for delivery, renewed, amended or continued 345 Raised Bill No. 976
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in this state on or after January 1, 2024, shall provide coverage for equine 346
therapy for an insured who is a veteran. For the purposes of this section, 347
"veteran" has the same meaning as provided in section 27-103 of the 348
general statutes. 349
Sec. 18. (NEW) (Effective January 1, 2024) Each group health insurance 350
policy providing coverage of the type specified in subdivisions (1), (2), 351
(4), (11) and (12) of section 38a-469 of the general statutes delivered, 352
issued for delivery, renewed, amended or continued in this state on or 353
after January 1, 2024, shall provide coverage for equine therapy for an 354
insured who is a veteran. For the purposes of this section, "veteran" has 355
the same meaning as provided in section 27-103 of the general statutes. 356
Sec. 19. (NEW) (Effective January 1, 2024) Each individual health 357
insurance policy providing coverage of the type specified in 358
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 359
statutes delivered, issued for delivery, renewed, amended or continued 360
in this state on or after January 1, 2024, shall provide coverage to self-361
employed farmers. For the purposes of this section, "farmer" means any 362
person engaged in agricultural production as a trade or business. 363
Sec. 20. (NEW) (Effective January 1, 2024) Each group health insurance 364
policy providing coverage of the type specified in subdivisions (1), (2), 365
(4), (11) and (12) of section 38a-469 of the general statutes delivered, 366
issued for delivery, renewed, amended or continued in this state on or 367
after January 1, 2024, shall provide coverage to self-employed farmers. 368
For the purposes of this section, "farmer" means any person engaged in 369
agricultural production as a trade or business. 370
Sec. 21. (NEW) (Effective January 1, 2024) Each individual health 371
insurance policy providing coverage of the type specified in 372
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 373
statutes delivered, issued for delivery, renewed, amended or continued 374
in this state on or after January 1, 2024, shall provide coverage for peer 375
support services provided by certified peer support specialists on an 376
outpatient basis. The Commissioner of Public Health shall adopt 377 Raised Bill No. 976
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regulations, in accordance with chapter 54 of the general statutes, to 378
establish certification and education requirements for peer support 379
specialists. 380
Sec. 22. (NEW) (Effective January 1, 2024) Each group health insurance 381
policy providing coverage of the type specified in subdivisions (1), (2), 382
(4), (11) and (12) of section 38a-469 of the general statutes delivered, 383
issued for delivery, renewed, amended or continued in this state on or 384
after January 1, 2024, shall provide coverage for peer support services 385
provided by certified peer support specialists on an outpatient basis. 386
The Commissioner of Public Health shall adopt regulations, in 387
accordance with chapter 54 of the general statutes, to establish 388
certification and education requirements for peer support specialists. 389
Sec. 23. Section 38a-504 of the general statutes is repealed and the 390
following is substituted in lieu thereof (Effective January 1, 2024): 391
(a) Each insurance company, hospital service corporation, medical 392
service corporation, health care center or fraternal benefit society that 393
delivers, issues for delivery, renews, amends or continues in this state 394
individual health insurance policies providing coverage of the type 395
specified in subdivisions (1), (2), (4), [(10),] (11) and (12) of section 38a-396
469, shall provide coverage under such policies for the surgical removal 397
of tumors and treatment of leukemia, including outpatient 398
chemotherapy, reconstructive surgery, cost of any nondental prosthesis 399
including any maxillo-facial prosthesis used to replace anatomic 400
structures lost during treatment for head and neck tumors or additional 401
appliances essential for the support of such prosthesis, outpatient 402
chemotherapy following surgical procedure in connection with the 403
treatment of tumors, and a wig if prescribed by a licensed oncologist for 404
a patient who suffers hair loss as a result of chemotherapy. Such benefits 405
shall be subject to the same terms and conditions applicable to all other 406
benefits under such policies. 407
(b) Except as provided in subsection (c) of this section, the coverage 408
required by subsection (a) of this section shall provide at least a yearly 409 Raised Bill No. 976
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benefit of five hundred dollars for the surgical removal of tumors, five 410
hundred dollars for reconstructive surgery, five hundred dollars for 411
outpatient chemotherapy, three hundred fifty dollars for a wig and 412
three hundred dollars for a nondental prosthesis, except that for 413
purposes of the surgical removal of breasts due to tumors the yearly 414
benefit for such prosthesis shall be at least three hundred dollars for 415
each breast removed. 416
(c) The coverage required by subsection (a) of this section shall 417
provide benefits for the reasonable costs of reconstructive surgery on 418
each breast on which a mastectomy has been performed, and 419
reconstructive surgery on a nondiseased breast to produce a 420
symmetrical appearance. Such benefits shall be subject to the same 421
terms and conditions applicable to all other benefits under such policies. 422
For the purposes of this subsection, [reconstructive surgery] 423
"reconstructive surgery" includes, but is not limited to, augmentation 424
mammoplasty, reduction mammoplasty and mastopexy. 425
(d) (1) Each policy of the type specified in subsection (a) of this section 426
that provides coverage for intravenously administered and orally 427
administered anticancer medications used to kill or slow the growth of 428
cancerous cells that are prescribed by a prescribing practitioner, as 429
defined in section 20-571, shall provide coverage for orally administered 430
anticancer medications on a basis that is no less favorable than 431
intravenously administered anticancer medications. 432
(2) No insurance company, hospital service corporation, medical 433
service corporation, health care center or fraternal benefit society that 434
delivers, issues for delivery, renews, amends or continues in this state a 435
policy of the type specified in subsection (a) of this section shall 436
reclassify such anticancer medications or increase the coinsurance, 437
copayment, deductible or other out-of-pocket expense imposed under 438
such policy for such medications to achieve compliance with this 439
subsection. 440
(e) The coverage required by subsection (a) of this section shall 441 Raised Bill No. 976
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provide benefits for the reasonable costs of nipple reconstruction 442
surgery and nipple tattooing on each breast on which a breast 443
reconstructive surgery has been performed for a medically necessary 444
purpose, including, but not limited to, prophylactic mastectomies. Such 445
benefits shall be subject to the same terms and conditions applicable to 446
all other benefits under such policies. For the purposes of this 447
subsection, "reconstructive surgery" includes, but is not limited to, 448
augmentation mammoplasty, reduction mammoplasty and mastopexy. 449
Sec. 24. Section 38a-542 of the general statutes is repealed and the 450
following is substituted in lieu thereof (Effective January 1, 2024): 451
(a) Each insurance company, hospital service corporation, medical 452
service corporation, health care center or fraternal benefit society that 453
delivers, issues for delivery, renews, amends or continues in this state 454
group health insurance policies providing coverage of the type specified 455
in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 shall provide 456
coverage under such policies for treatment of leukemia, including 457
outpatient chemotherapy, reconstructive surgery, cost of any nondental 458
prosthesis, including any maxillo-facial prosthesis used to replace 459
anatomic structures lost during treatment for head and neck tumors or 460
additional appliances essential for the support of such prosthesis, 461
outpatient chemotherapy following surgical procedures in connection 462
with the treatment of tumors, a wig if prescribed by a licensed 463
oncologist for a patient who suffers hair loss as a result of 464
chemotherapy, and costs of removal of any breast implant which was 465
implanted on or before July 1, 1994, without regard to the purpose of 466
such implantation, which removal is determined to be medically 467
necessary. Such benefits shall be subject to the same terms and 468
conditions applicable to all other benefits under such policies. 469
(b) Except as provided in subsection (c) of this section, the coverage 470
required by subsection (a) of this section shall provide at least a yearly 471
benefit of one thousand dollars for the costs of removal of any breast 472
implant, five hundred dollars for the surgical removal of tumors, five 473
hundred dollars for reconstructive surgery, five hundred dollars for 474 Raised Bill No. 976
LCO No. 3606 17 of 38
outpatient chemotherapy, three hundred fifty dollars for a wig and 475
three hundred dollars for a nondental prosthesis, except that for 476
purposes of the surgical removal of breasts due to tumors the yearly 477
benefit for such prosthesis shall be at least three hundred dollars for 478
each breast removed. 479
(c) The coverage required by subsection (a) of this section shall 480
provide benefits for the reasonable costs of reconstructive surgery on 481
each breast on which a mastectomy has been performed, and 482
reconstructive surgery on a nondiseased breast to produce a 483
symmetrical appearance. Such benefits shall be subject to the same 484
terms and conditions applicable to all other benefits under such policies. 485
For the purposes of this subsection, [reconstructive surgery] 486
"reconstructive surgery" includes, but is not limited to, augmentation 487
mammoplasty, reduction mammoplasty and mastopexy. 488
(d) (1) Each policy of the type specified in subsection (a) of this section 489
that provides coverage for intravenously administered and orally 490
administered anticancer medications used to kill or slow the growth of 491
cancerous cells that are prescribed by a prescribing practitioner, as 492
defined in section 20-571, shall provide coverage for orally administered 493
anticancer medications on a basis that is no less favorable than 494
intravenously administered anticancer medications. 495
(2) No insurance company, hospital service corporation, medical 496
service corporation, health care center or fraternal benefit society that 497
delivers, issues for delivery, renews, amends or continues in this state a 498
policy of the type specified in subsection (a) of this section shall 499
reclassify such anticancer medications or increase the coinsurance, 500
copayment, deductible or other out-of-pocket expense imposed under 501
such policy for such medications to achieve compliance with this 502
subsection. 503
(e) The coverage required by subsection (a) of this section shall 504
provide benefits for the reasonable costs of nipple reconstruction 505
surgery and nipple tattooing on each breast on which a breast 506 Raised Bill No. 976
LCO No. 3606 18 of 38
reconstructive surgery has been performed for a medically necessary 507
purpose, including, but not limited to, prophylactic mastectomies. Such 508
benefits shall be subject to the same terms and conditions applicable to 509
all other benefits under such policies. For the purposes of this 510
subsection, "reconstructive surgery" includes, but is not limited to, 511
augmentation mammoplasty, reduction mammoplasty and mastopexy. 512
Sec. 25. Section 38a-492k of the general statutes is repealed and the 513
following is substituted in lieu thereof (Effective January 1, 2024): 514
(a) Each individual health insurance policy providing coverage of the 515
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 516
delivered, issued for delivery, amended, renewed or continued in this 517
state shall provide coverage for colorectal cancer screening and 518
diagnosis, including, but not limited to, (1) an annual fecal occult blood 519
test, and (2) colonoscopy, flexible sigmoidoscopy or radiologic imaging, 520
in accordance with the recommendations established by the American 521
Cancer Society, based on the ages, family histories and frequencies 522
provided in the recommendations. Except as specified in subsection (b) 523
of this section, benefits under this section shall be subject to the same 524
terms and conditions applicable to all other benefits under such policies. 525
(b) No such policy shall impose: 526
(1) A deductible for a procedure that a physician initially undertakes 527
as a screening or diagnostic colonoscopy or [a screening] 528
sigmoidoscopy; or 529
(2) A coinsurance, copayment, deductible or other out-of-pocket 530
expense for any additional colonoscopy ordered in a policy year by a 531
physician for an insured. The provisions of this subdivision shall not 532
apply to a high deductible health plan as that term is used in subsection 533
(f) of section 38a-493. 534
Sec. 26. Section 38a-518k of the general statutes is repealed and the 535
following is substituted in lieu thereof (Effective January 1, 2024): 536 Raised Bill No. 976
LCO No. 3606 19 of 38
(a) Each group health insurance policy providing coverage of the type 537
specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 538
delivered, issued for delivery, amended, renewed or continued in this 539
state shall provide coverage for colorectal cancer screening and 540
diagnosis, including, but not limited to, (1) an annual fecal occult blood 541
test, and (2) colonoscopy, flexible sigmoidoscopy or radiologic imaging, 542
in accordance with the recommendations established by the American 543
Cancer Society, based on the ages, family histories and frequencies 544
provided in the recommendations. Except as specified in subsection (b) 545
of this section, benefits under this section shall be subject to the same 546
terms and conditions applicable to all other benefits under such policies. 547
(b) No such policy shall impose: 548
(1) A deductible for a procedure that a physician initially undertakes 549
as a screening or diagnostic colonoscopy or [a screening] 550
sigmoidoscopy; or 551
(2) A coinsurance, copayment, deductible or other out-of-pocket 552
expense for any additional colonoscopy ordered in a policy year by a 553
physician for an insured. The provisions of this subdivision shall not 554
apply to a high deductible health plan as that term is used in subsection 555
(f) of section 38a-520. 556
Sec. 27. (NEW) (Effective January 1, 2024) (a) As used in this section: 557
(1) "Experimental fertility procedure" means a procedure for which 558
the published medical evidence is not sufficient for the American 559
Society for Reproductive Medicine, its successor organization or a 560
comparable organization to regard the procedure as established medical 561
practice; 562
(2) "Fertility diagnostic care" means procedures, products, 563
medications and services intended to provide information and 564
counseling about an individual's fertility, including laboratory 565
assessments and imaging studies; 566 Raised Bill No. 976
LCO No. 3606 20 of 38
(3) "Fertility patient" means (A) an individual or a couple 567
experiencing infertility, (B) an individual or a couple who is at increased 568
risk of transmitting a serious inheritable genetic or chromosomal 569
abnormality to a child, (C) an individual unable to achieve a pregnancy 570
as an individual or with a partner because the individual or couple does 571
not have the necessary gametes to achieve a pregnancy, or (D) an 572
individual or couple for whom fertility preservation services are 573
medically necessary; 574
(4) "Fertility preservation services" (A) means procedures, products, 575
medications and services intended to preserve fertility, consistent with 576
established medical practice and professional guidelines published by 577
the American Society for Reproductive Medicine, its successor 578
organization or a comparable organization for an individual who has a 579
medical or genetic condition or who is expected to undergo treatment 580
that may directly or indirectly cause a risk of impairment of fertility, and 581
(B) includes, but is not limited to, the procurement and cryopreservation 582
of gametes, embryos and reproductive material, and storage from the 583
time of cryopreservation until the individual reaches the age of thirty, 584
or for a period of not less than five years, whichever is later; 585
(5) "Fertility treatment" means procedures, products, genetic testing, 586
medications and services intended to achieve pregnancy that result in a 587
live birth and that are provided in a manner consistent with established 588
medical practice and professional guidelines published by the American 589
Society for Reproductive Medicine, its successor organization or a 590
comparable organization; 591
(6) "Gamete" means a sperm or egg; 592
(7) "Infertility" means (A) the presence of a condition recognized by a 593
provider as a cause of loss or impairment of fertility, (B) a couple's 594
inability to achieve pregnancy after twelve months of unprotected 595
sexual intercourse when the couple has the necessary gametes to 596
achieve pregnancy, or (C) an individual's inability to achieve pregnancy 597
after twelve months of unprotected sexual intercourse due to such 598 Raised Bill No. 976
LCO No. 3606 21 of 38
individual's age; 599
(8) "Oocyte" means an ovum or egg cell before maturation; and 600
(9) "Religious employer" means an employer that is a "qualified 601
church-controlled organization", as defined in 26 USC 3121, or a church-602
affiliated organization. 603
(b) Except as provided in subsections (e), (f) and (h) of this section, 604
each individual health insurance policy providing coverage of the type 605
specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of 606
the general statutes, delivered, issued for delivery, amended, renewed 607
or continued in this state on or after January 1, 2024, shall provide 608
coverage for: 609
(1) Fertility diagnostic care; 610
(2) Fertility treatment if the enrollee is a fertility patient; and 611
(3) Fertility preservation services. 612
(c) A policy that provides coverage for the services required under 613
this section, may not: 614
(1) Impose any limitations on coverage solely on the basis of an 615
individual's age; 616
(2) Require that a pregnancy loss suffered during the twelve-month 617
period referenced in subparagraphs (B) and (C) of subdivision (7) of 618
subsection (a) of this section initiates a new time frame for determining 619
whether an individual or couple is experiencing infertility; 620
(3) Use any prior diagnosis or fertility treatment as a basis for 621
excluding, limiting or otherwise restricting the availability of coverage 622
required under this section; 623
(4) Impose any limitations on coverage required under this section 624
based on an individual's use of donor gametes, donor embryos or 625
surrogacy; 626 Raised Bill No. 976
LCO No. 3606 22 of 38
(5) Impose any copayments, deductibles, coinsurances, benefit 627
maximums, waiting periods or other limitations on coverage that are 628
different than any maternity benefits provided by the health insurance 629
policy; 630
(6) Impose any exclusions, limitations or other restrictions on 631
coverage of fertility medications that are different from those imposed 632
on any other prescription medications; 633
(7) Impose different limitations on coverage for, provide different 634
benefits to or impose different requirements on any class of persons 635
whose rights are protected pursuant to chapter 814c of the general 636
statutes; and 637
(8) Base any limitations imposed by the policy on anything other than 638
an individual's medical history and clinical guidelines adopted by the 639
policy. 640
(d) Any clinical guidelines used for a policy subject to the 641
requirements of this section shall (1) be based on current guidelines 642
developed by the American Society for Reproductive Medicine, its 643
successor organization or a comparable organization, (2) cite with 644
specificity any data or scientific reference relied upon, (3) be maintained 645
in written form, and (4) be made available to an individual in writing 646
upon request. 647
(e) A policy that provides coverage for the services required under 648
this section may: 649
(1) Limit such coverage to four completed oocyte retrievals, with 650
unlimited embryo transfers; 651
(2) Limit such coverage for intrauterine insemination to a lifetime 652
maximum benefit of six cycles; 653
(3) Limit coverage for in-vitro fertilization to those individuals who 654
have been unable to achieve or sustain a pregnancy to live birth through 655
less expensive and medically viable infertility treatment or procedures 656 Raised Bill No. 976
LCO No. 3606 23 of 38
covered under such policy; and 657
(4) Require that treatment or procedures that shall be covered as 658
provided in this section be performed at facilities that conform to the 659
standards and guidelines developed by the American Society of 660
Reproductive Medicine or the Society of Reproductive Endocrinology 661
and Infertility. 662
(f) Any insurance company, hospital service corporation, medical 663
service corporation or health care center may issue to a religious 664
employer an individual health insurance policy that excludes coverage 665
for methods of diagnosis and treatment for services required to be 666
covered under this section that are contrary to the religious employer's 667
bona fide religious tenets. Upon the written request of an individual 668
who states in writing that methods of diagnosis and treatment for 669
services required to be covered under this section are contrary to such 670
individual's religious or moral beliefs, any insurance company, hospital 671
service corporation, medical service corporation or health care center 672
may issue to or on behalf of the individual a policy or rider thereto that 673
excludes coverage for such methods. 674
(g) Any health insurance policy issued pursuant to subsection (b) of 675
this section shall provide written notice to each insured or prospective 676
insured the methods of diagnosis and treatment of infertility that are 677
excluded from coverage pursuant to this section. Such notice shall 678
appear, in not less than ten-point type, in the policy, application and 679
sales brochure for such policy. 680
(h) Any health insurance policy issued pursuant to subsection (b) of 681
this section shall not be required to provide coverage for: 682
(1) Any experimental fertility procedure; or 683
(2) Any nonmedical costs related to procuring gametes, donor 684
embryos or surrogacy services. 685
(i) Nothing in this section shall be construed to deny the coverage 686 Raised Bill No. 976
LCO No. 3606 24 of 38
required under this section to any individual who foregoes a particular 687
infertility treatment or procedure if the individual's physician 688
determines that such treatment or procedure is likely to be unsuccessful 689
or the individual seeks to use previously retrieved oocytes or embryos. 690
Sec. 28. (NEW) (Effective January 1, 2024) (a) As used in this section: 691
(1) "Experimental fertility procedure" means a procedure for which 692
the published medical evidence is not sufficient for the American 693
Society for Reproductive Medicine, its successor organization or a 694
comparable organization to regard the procedure as established medical 695
practice; 696
(2) "Fertility diagnostic care" means procedures, products, 697
medications and services intended to provide information and 698
counseling about an individual's fertility, including laboratory 699
assessments and imaging studies; 700
(3) "Fertility patient" means (A) an individual or a couple 701
experiencing infertility, (B) an individual or a couple who is at increased 702
risk of transmitting a serious inheritable genetic or chromosomal 703
abnormality to a child, (C) an individual unable to achieve a pregnancy 704
as an individual or with a partner because the individual or couple does 705
not have the necessary gametes to achieve a pregnancy, or (D) an 706
individual or couple for whom fertility preservation services are 707
medically necessary; 708
(4) "Fertility preservation services" (A) means procedures, products, 709
medications and services intended to preserve fertility, consistent with 710
established medical practice and professional guidelines published by 711
the American Society for Reproductive Medicine, its successor 712
organization or a comparable organization for an individual who has a 713
medical or genetic condition or who is expected to undergo treatment 714
that may directly or indirectly cause a risk of impairment of fertility, and 715
(B) includes, but is not limited to, the procurement and cryopreservation 716
of gametes, embryos and reproductive material, and storage from the 717
time of cryopreservation until the individual reaches the age of thirty, 718 Raised Bill No. 976
LCO No. 3606 25 of 38
or for a period of not less than five years, whichever is later; 719
(5) "Fertility treatment" means procedures, products, genetic testing, 720
medications and services intended to achieve pregnancy that result in a 721
live birth and that are provided in a manner consistent with established 722
medical practice and professional guidelines published by the American 723
Society for Reproductive Medicine, its successor organization or a 724
comparable organization; 725
(6) "Gamete" means a sperm or egg; 726
(7) "Infertility" means (A) the presence of a condition recognized by a 727
provider as a cause of loss or impairment of fertility, (B) a couple's 728
inability to achieve pregnancy after twelve months of unprotected 729
sexual intercourse when the couple has the necessary gametes to 730
achieve pregnancy, or (C) an individual's inability to achieve pregnancy 731
after twelve months of unprotected sexual intercourse due to such 732
individual's age; 733
(8) "Oocyte" means an ovum or egg cell before maturation; and 734
(9) "Religious employer" means an employer that is a "qualified 735
church-controlled organization", as defined in 26 USC 3121, or a church-736
affiliated organization. 737
(b) Except as provided in subsections (e), (f) and (h) of this section, 738
each group health insurance policy providing coverage of the type 739
specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of 740
the general statutes, delivered, issued for delivery, amended, renewed 741
or continued in this state on or after January 1, 2024, shall provide 742
coverage for: 743
(1) Fertility diagnostic care; 744
(2) Fertility treatment if the enrollee is a fertility patient; and 745
(3) Fertility preservation services. 746 Raised Bill No. 976
LCO No. 3606 26 of 38
(c) A policy that provides coverage for the services required under 747
this section, may not: 748
(1) Impose any limitations on coverage solely on the basis of an 749
individual's age; 750
(2) Require that a pregnancy loss suffered during the twelve-month 751
period referenced in subparagraphs (B) and (C) of subdivision (7) of 752
subsection (a) of this section initiates a new time frame for determining 753
whether an individual or couple is experiencing infertility; 754
(3) Use any prior diagnosis or fertility treatment as a basis for 755
excluding, limiting or otherwise restricting the availability of coverage 756
required under this section; 757
(4) Impose any limitations on coverage required under this section 758
based on an individual's use of donor gametes, donor embryos or 759
surrogacy; 760
(5) Impose any copayments, deductibles, coinsurances, benefit 761
maximums, waiting periods or other limitations on coverage that are 762
different than any maternity benefits provided by the health insurance 763
policy; 764
(6) Impose any exclusions, limitations or other restrictions on 765
coverage of fertility medications that are different from those imposed 766
on any other prescription medications; 767
(7) Impose different limitations on coverage for, provide different 768
benefits to or impose different requirements on any class of persons 769
whose rights are protected pursuant to chapter 814c of the general 770
statutes; and 771
(8) Base any limitations imposed by the policy on anything other than 772
an individual's medical history and clinical guidelines adopted by the 773
policy. 774
(d) Any clinical guidelines used for a policy subject to the 775 Raised Bill No. 976
LCO No. 3606 27 of 38
requirements of this section shall (1) be based on current guidelines 776
developed by the American Society for Reproductive Medicine, its 777
successor organization or a comparable organization, (2) cite with 778
specificity any data or scientific reference relied upon, (3) be maintained 779
in written form, and (4) be made available to an individual in writing 780
upon request. 781
(e) A policy that provides coverage for the services required under 782
this section may: 783
(1) Limit such coverage to four completed oocyte retrievals, with 784
unlimited embryo transfers; 785
(2) Limit such coverage for intrauterine insemination to a lifetime 786
maximum benefit of six cycles; 787
(3) Limit coverage for in-vitro fertilization to those individuals who 788
have been unable to achieve or sustain a pregnancy to live birth through 789
less expensive and medically viable infertility treatment or procedures 790
covered under such policy; and 791
(4) Require that treatment or procedures that shall be covered as 792
provided in this section be performed at facilities that conform to the 793
standards and guidelines developed by the American Society of 794
Reproductive Medicine or the Society of Reproductive Endocrinology 795
and Infertility. 796
(f) Any insurance company, hospital service corporation, medical 797
service corporation or health care center may issue to a religious 798
employer an individual health insurance policy that excludes coverage 799
for methods of diagnosis and treatment for services required to be 800
covered under this section that are contrary to the religious employer's 801
bona fide religious tenets. Upon the written request of an individual 802
who states in writing that methods of diagnosis and treatment for 803
services required to be covered under this section are contrary to such 804
individual's religious or moral beliefs, any insurance company, hospital 805
service corporation, medical service corporation or health care center 806 Raised Bill No. 976
LCO No. 3606 28 of 38
may issue to or on behalf of the individual a policy or rider thereto that 807
excludes coverage for such methods. 808
(g) Any health insurance policy issued pursuant to subsection (b) of 809
this section shall provide written notice to each insured or prospective 810
insured the methods of diagnosis and treatment of infertility that are 811
excluded from coverage pursuant to this section. Such notice shall 812
appear, in not less than ten-point type, in the policy, application and 813
sales brochure for such policy. 814
(h) Any health insurance policy issued pursuant to subsection (b) of 815
this section shall not be required to provide coverage for: 816
(1) Any experimental fertility procedure; or 817
(2) Any nonmedical costs related to procuring gametes, donor 818
embryos or surrogacy services. 819
(i) Nothing in this section shall be construed to deny the coverage 820
required under this section to any individual who foregoes a particular 821
infertility treatment or procedure if the individual's physician 822
determines that such treatment or procedure is likely to be unsuccessful 823
or the individual seeks to use previously retrieved oocytes or embryos. 824
Sec. 29. (NEW) (Effective January 1, 2024) (a) Each individual health 825
insurance policy providing coverage of the type specified in 826
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 827
statutes delivered, issued for delivery, renewed, amended or continued 828
in this state on or after January 1, 2024, shall provide coverage for not 829
less than one generic opioid antagonist and device. For purposes of this 830
section, "opioid antagonist" means naloxone hydrochloride or any other 831
similarly acting and equally safe drug approved by the federal Food and 832
Drug Administration for the treatment of a drug overdose. 833
(b) No policy described in subsection (a) of this section shall impose 834
a coinsurance, copayment, deductible or other out-of-pocket expense for 835
the generic opioid antagonist and device that such policy is required to 836 Raised Bill No. 976
LCO No. 3606 29 of 38
cover pursuant to subsection (a) of this section. 837
Sec. 30. (NEW) (Effective January 1, 2024) (a) Each group health 838
insurance policy providing coverage of the type specified in 839
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 840
statutes delivered, issued for delivery, renewed, amended or continued 841
in this state on or after January 1, 2024, shall provide coverage for not 842
less than one generic opioid antagonist and device. For purposes of this 843
section, "opioid antagonist" means naloxone hydrochloride or any other 844
similarly acting and equally safe drug approved by the federal Food and 845
Drug Administration for the treatment of a drug overdose. 846
(b) No policy described in subsection (a) of this section shall impose 847
a coinsurance, copayment, deductible or other out-of-pocket expense for 848
the generic opioid antagonist and device that such policy is required to 849
cover pursuant to subsection (a) of this section. 850
Sec. 31. (NEW) (Effective January 1, 2024) Each individual health 851
insurance policy providing coverage of the type specified in 852
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 853
statutes delivered, issued for delivery, renewed, amended or continued 854
in this state on or after January 1, 2024, shall provide coverage for the 855
purchase of any trained service animal that is specially trained to assist 856
blind, deaf or mobility impaired persons or persons with a disability 857
that is other than physical, including, but not limited to, anxiety 858
disorders and post-traumatic stress disorder, provided the insured's 859
treating health care provider certifies in writing that such trained service 860
animal is medically necessary. Any such trained service animal shall be 861
purchased from a nonprofit organization that is established for the 862
training of such service animals. For the purposes of this section, 863
"service animal" has the same meaning as provided in 28 CFR 35.104, as 864
amended from time to time, and includes a service animal in training. 865
Sec. 32. (NEW) (Effective January 1, 2024) Each group health insurance 866
policy providing coverage of the type specified in subdivisions (1), (2), 867
(4), (11) and (12) of section 38a-469 of the general statutes delivered, 868 Raised Bill No. 976
LCO No. 3606 30 of 38
issued for delivery, renewed, amended or continued in this state on or 869
after January 1, 2024, shall provide coverage for the purchase of any 870
trained service animal that is specially trained to assist blind, deaf or 871
mobility impaired persons or persons with a disability that is other than 872
physical, including, but not limited to, anxiety disorders and post-873
traumatic stress disorder, provided the insured's treating health care 874
provider certifies in writing that such trained service animal is 875
medically necessary. Any such trained service animal shall be 876
purchased from a nonprofit organization that is established for the 877
training of such service animals. For the purposes of this section, 878
"service animal" has the same meaning as provided in 28 CFR 35.104, as 879
amended from time to time, and includes a service animal in training. 880
Sec. 33. (NEW) (Effective January 1, 2024) Each individual health 881
insurance policy providing coverage of the type specified in 882
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 883
statutes delivered, issued for delivery, renewed, amended or continued 884
in this state on or after January 1, 2024, shall provide coverage for 885
vaginal, cervical and uterine medical procedures, including, but not 886
limited to, loop electrosurgical excision procedure, colposcopy, ablation 887
and intrauterine device insertion. 888
Sec. 34. (NEW) (Effective January 1, 2024) Each group health insurance 889
policy providing coverage of the type specified in subdivisions (1), (2), 890
(4), (11) and (12) of section 38a-469 of the general statutes delivered, 891
issued for delivery, renewed, amended or continued in this state on or 892
after January 1, 2024, shall provide coverage for vaginal, cervical and 893
uterine medical procedures, including, but not limited to, loop 894
electrosurgical excision procedure, colposcopy, ablation and 895
intrauterine device insertion. 896
Sec. 35. (NEW) (Effective January 1, 2024) (a) Each individual health 897
insurance policy providing coverage of the type specified in 898
subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 of the 899
general statutes delivered, issued for delivery, renewed, amended or 900
continued in this state on or after January 1, 2024, that includes coverage 901 Raised Bill No. 976
LCO No. 3606 31 of 38
for outpatient prescription drugs shall provide coverage for not less 902
than one epinephrine cartridge dual-pack injector. For the purposes of 903
this section and sections 36 and 38 of this act, "epinephrine cartridge 904
injector" means a dual-pack containing automatic, prefilled cartridge 905
injectors or similar automatic injectable equipment used to deliver 906
epinephrine in a standard dose for an emergency first aid response to 907
allergic reactions. 908
(b) No policy described in subsection (a) of this section shall impose 909
a coinsurance, copayment, deductible or other out-of-pocket expense for 910
the epinephrine cartridge injector that such policy is required to cover 911
pursuant to said subsection (a) in an amount that exceeds twenty-five 912
dollars. The provisions of this subsection shall apply to a high 913
deductible health plan, as that term is used in subsection (f) of section 914
38a-493 of the general statutes, to the maximum extent permitted by 915
federal law, except if such plan is used to establish a medical savings 916
account or an Archer MSA pursuant to Section 220 of the Internal 917
Revenue Code of 1986, or any subsequent corresponding internal 918
revenue code of the United States, as amended from time to time, or a 919
health savings account pursuant to Section 223 of said Internal Revenue 920
Code, as amended from time to time. The provisions of this subsection 921
shall apply to such high deductible health plans to the maximum extent 922
that (1) is permitted by federal law, and (2) does not disqualify such 923
account for the deduction allowed under Section 220 or 223, of the 924
Internal Revenue Code of 1986, as applicable. 925
Sec. 36. (NEW) (Effective January 1, 2024) (a) Each group health 926
insurance policy providing coverage of the type specified in 927
subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 of the 928
general statutes delivered, issued for delivery, renewed, amended or 929
continued in this state on or after January 1, 2024, that includes coverage 930
for outpatient prescription drugs shall provide coverage for not less 931
than one epinephrine cartridge injector. 932
(b) No policy described in subsection (a) of this section shall impose 933
a coinsurance, copayment, deductible or other out-of-pocket expense for 934 Raised Bill No. 976
LCO No. 3606 32 of 38
the epinephrine cartridge injector that such policy is required to cover 935
pursuant to said subsection (a) in an amount that exceeds twenty-five 936
dollars. The provisions of this subsection shall apply to a high 937
deductible health plan, as that term is used in subsection (f) of section 938
38a-520 of the general statutes, to the maximum extent permitted by 939
federal law, except if such plan is used to establish a medical savings 940
account or an Archer MSA pursuant to Section 220 of the Internal 941
Revenue Code of 1986, or any subsequent corresponding internal 942
revenue code of the United States, as amended from time to time, or a 943
health savings account pursuant to Section 223 of said Internal Revenue 944
Code, as amended from time to time. The provisions of this subsection 945
shall apply to such high deductible health plans to the maximum extent 946
that (1) is permitted by federal law, and (2) does not disqualify such 947
account for the deduction allowed under Section 220 or 223, of said 948
Internal Revenue Code of 1986, as applicable. 949
Sec. 37. Section 38a-479ooo of the general statutes is repealed and the 950
following is substituted in lieu thereof (Effective January 1, 2024): 951
For the purposes of this part and section 38 of this act: 952
(1) "Commissioner" means the Insurance Commissioner. 953
(2) "Department" means the Insurance Department. 954
(3) "Drug" has the same meaning as provided in section 21a-92. 955
(4) "Health care plan" means an individual or a group health 956
insurance policy that provides coverage of the types specified in 957
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 and includes 958
coverage for outpatient prescription drugs. 959
(5) "Health carrier" means an insurance company, health care center, 960
hospital service corporation, medical service corporation, fraternal 961
benefit society or other entity that delivers, issues for delivery, renews, 962
amends or continues a health care plan in this state. 963
(6) "Person" has the same meaning as provided in section 38a-1, as 964 Raised Bill No. 976
LCO No. 3606 33 of 38
amended by this act. 965
(7) "Pharmacist" has the same meaning as provided in section 38a-966
479aaa. 967
(8) "Pharmacist services" has the same meaning as provided in section 968
38a-479aaa. 969
(9) "Pharmacy" has the same meaning as provided in section 38a-970
479aaa. 971
(10) "Pharmacy benefits manager" or "manager" means any person 972
that administers the prescription drug, prescription device, pharmacist 973
services or prescription drug and device and pharmacist services 974
portion of a health care plan on behalf of a health carrier. 975
(11) (A) "Rebate" means a discount or concession, which affects the 976
price of an outpatient prescription drug, that a pharmaceutical 977
manufacturer directly provides to a (i) health carrier for an outpatient 978
prescription drug manufactured by the pharmaceutical manufacturer, 979
or (ii) pharmacy benefits manager after the manager processes a claim 980
from a pharmacy or a pharmacist for an outpatient prescription drug 981
manufactured by the pharmaceutical manufacturer. 982
(B) "Rebate" does not mean a bona fide service fee, as such term is 983
defined in Section 447.502 of Title 42 of the Code of Federal Regulations, 984
as amended from time to time. 985
(12) "Specialty drug" means a prescription outpatient specialty drug 986
covered under the Medicare Part D program established pursuant to 987
Public Law 108-173, the Medicare Prescription Drug, Improvement, and 988
Modernization Act of 2003, as amended from time to time, that exceeds 989
the specialty tier cost threshold established by the Centers for Medicare 990
and Medicaid Services. 991
Sec. 38. (NEW) (Effective January 1, 2024) On or after January 1, 2024, 992
each contract entered into between a health carrier and a pharmacy 993
benefits manager that requires the pharmacy benefits manager to 994 Raised Bill No. 976
LCO No. 3606 34 of 38
administer the prescription drug, prescription device, pharmacist 995
services or prescription drug and device and pharmacist services 996
portion of a health care plan on behalf of the health carrier shall, if the 997
pharmacy benefits manager utilizes a tiered prescription drug 998
formulary, require the pharmacy benefits manager to include not less 999
than one covered epinephrine cartridge injector in the cost-sharing tier 1000
that imposes the lowest coinsurance, copayment, deductible or other 1001
out-of-pocket expense for covered prescription drugs. 1002
Sec. 39. (NEW) (Effective January 1, 2024) Each individual health 1003
insurance policy providing coverage of the type specified in 1004
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 1005
statutes delivered, issued for delivery, renewed, amended or continued 1006
in this state on or after January 1, 2024, shall provide coverage for rapid 1007
whole genome sequencing for any critically ill child (1) when ordered 1008
by such child's health care provider, and (2) when clinical criteria are 1009
met. 1010
Sec. 40. (NEW) (Effective January 1, 2024) Each group health insurance 1011
policy providing coverage of the type specified in subdivisions (1), (2), 1012
(4), (11) and (12) of section 38a-469 of the general statutes delivered, 1013
issued for delivery, renewed, amended or continued in this state on or 1014
after January 1, 2024, shall provide coverage for rapid whole genome 1015
sequencing for any critically ill child (1) when ordered by such child's 1016
health care provider, and (2) when clinical criteria are met. 1017
Sec. 41. (NEW) (Effective January 1, 2024) Each individual health 1018
insurance policy providing coverage of the type specified in 1019
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 1020
statutes delivered, issued for delivery, renewed, amended or continued 1021
in this state on or after January 1, 2024, shall provide coverage for 1022
prenatal care, postpartum care and costs associated with neonatal 1023
intensive care unit stays. 1024
Sec. 42. (NEW) (Effective January 1, 2024) Each group health insurance 1025
policy providing coverage of the type specified in subdivisions (1), (2), 1026 Raised Bill No. 976
LCO No. 3606 35 of 38
(4), (11) and (12) of section 38a-469 of the general statutes delivered, 1027
issued for delivery, renewed, amended or continued in this state on or 1028
after January 1, 2024, shall provide coverage for prenatal care, 1029
postpartum care and costs associated with neonatal intensive care unit 1030
stays. 1031
Sec. 43. (NEW) (Effective January 1, 2024) Each individual health 1032
insurance policy providing coverage of the type specified in 1033
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 1034
statutes delivered, issued for delivery, renewed, amended or continued 1035
in this state on or after January 1, 2024, shall provide coverage for 1036
gambling disorder treatment. For the purposes of this section, 1037
"gambling disorder" has the same meaning as provided in the most 1038
recent edition of the American Psychiatric Association's "Diagnostic and 1039
Statistical Manual of Mental Disorders". 1040
Sec. 44. (NEW) (Effective January 1, 2024) Each group health insurance 1041
policy providing coverage of the type specified in subdivisions (1), (2), 1042
(4), (11) and (12) of section 38a-469 of the general statutes delivered, 1043
issued for delivery, renewed, amended or continued in this state on or 1044
after January 1, 2024, shall provide coverage for gambling disorder 1045
treatment. For the purposes of this section, "gambling disorder" has the 1046
same meaning as provided in the most recent edition of the American 1047
Psychiatric Association's "Diagnostic and Statistical Manual of Mental 1048
Disorders". 1049
Sec. 45. (NEW) (Effective January 1, 2024) (a) As used in this section: 1050
(1) "Biomarker" means a characteristic, including, but not limited to, 1051
a gene mutation or protein expression that can be objectively measured 1052
and evaluated as an indicator of normal biological processes, pathogenic 1053
processes or pharmacologic responses to a specific therapeutic 1054
intervention for a disease or condition. 1055
(2) "Biomarker testing" means the analysis of a patient's tissue, blood 1056
or other biospecimen for the presence of a biomarker, including, but not 1057
limited to, tests for a single substance, tests for multiple substances, 1058 Raised Bill No. 976
LCO No. 3606 36 of 38
diseases or conditions and whole genome sequencing. 1059
(b) Each individual health insurance policy providing coverage of the 1060
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 1061
of the general statutes delivered, issued for delivery, renewed, amended 1062
or continued in this state on or after January 1, 2024, shall provide 1063
coverage for biomarker testing for the purpose of diagnosis, treatment, 1064
appropriate management or ongoing monitoring of an insured's disease 1065
or condition. 1066
Sec. 46. (NEW) (Effective January 1, 2024) (a) As used in this section: 1067
(1) "Biomarker" means a characteristic, including, but not limited to, 1068
a gene mutation or protein expression that can be objectively measured 1069
and evaluated as an indicator of normal biological processes, pathogenic 1070
processes or pharmacologic responses to a specific therapeutic 1071
intervention for a disease or condition. 1072
(2) "Biomarker testing" means the analysis of a patient's tissue, blood 1073
or other biospecimen for the presence of a biomarker, including, but not 1074
limited to, tests for a single substance, tests for multiple substances, 1075
diseases or conditions and whole genome sequencing. 1076
(b) Each group health insurance policy providing coverage of the 1077
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 1078
of the general statutes delivered, issued for delivery, renewed, amended 1079
or continued in this state on or after January 1, 2024, shall provide 1080
coverage for biomarker testing for the purpose of diagnosis, treatment, 1081
appropriate management or ongoing monitoring of an insured's disease 1082
or condition. 1083
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2024 38a-1
Sec. 2 January 1, 2024 New section
Sec. 3 January 1, 2024 New section
Sec. 4 January 1, 2024 New section Raised Bill No. 976
LCO No. 3606 37 of 38
Sec. 5 January 1, 2024 New section
Sec. 6 January 1, 2024 New section
Sec. 7 January 1, 2024 New section
Sec. 8 January 1, 2024 New section
Sec. 9 January 1, 2024 38a-503e(a)
Sec. 10 January 1, 2024 38a-530e(a)
Sec. 11 January 1, 2024 New section
Sec. 12 January 1, 2024 New section
Sec. 13 January 1, 2024 New section
Sec. 14 January 1, 2024 New section
Sec. 15 January 1, 2024 New section
Sec. 16 January 1, 2024 New section
Sec. 17 January 1, 2024 New section
Sec. 18 January 1, 2024 New section
Sec. 19 January 1, 2024 New section
Sec. 20 January 1, 2024 New section
Sec. 21 January 1, 2024 New section
Sec. 22 January 1, 2024 New section
Sec. 23 January 1, 2024 38a-504
Sec. 24 January 1, 2024 38a-542
Sec. 25 January 1, 2024 38a-492k
Sec. 26 January 1, 2024 38a-518k
Sec. 27 January 1, 2024 New section
Sec. 28 January 1, 2024 New section
Sec. 29 January 1, 2024 New section
Sec. 30 January 1, 2024 New section
Sec. 31 January 1, 2024 New section
Sec. 32 January 1, 2024 New section
Sec. 33 January 1, 2024 New section
Sec. 34 January 1, 2024 New section
Sec. 35 January 1, 2024 New section
Sec. 36 January 1, 2024 New section
Sec. 37 January 1, 2024 38a-479ooo
Sec. 38 January 1, 2024 New section
Sec. 39 January 1, 2024 New section
Sec. 40 January 1, 2024 New section
Sec. 41 January 1, 2024 New section
Sec. 42 January 1, 2024 New section
Sec. 43 January 1, 2024 New section
Sec. 44 January 1, 2024 New section
Sec. 45 January 1, 2024 New section Raised Bill No. 976
LCO No. 3606 38 of 38
Sec. 46 January 1, 2024 New section
Statement of Purpose:
To require certain health insurance coverage for individual and group
health insurance policies in this state.
[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.]