Connecticut 2023 Regular Session

Connecticut Senate Bill SB00976 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	LCO No. 3606 1 of 38
4	4
5	5	General Assembly Raised Bill No. 976
6	6	January Session, 2023
7	7	LCO No. 3606
8	8
9	9
10	10	Referred to Committee on INSURANCE AND REAL ESTATE
11	11
12	12
13	13	Introduced by:
14	14	(INS)
15	15
16	16
17	17
18	18	AN ACT CONCERNING HEALTH COVERAGE MANDATES FOR
19	19	CERTAIN HEALTH CONDITIONS.
20	20	Be it enacted by the Senate and House of Representatives in General
21	21	Assembly convened:
22	22
23	23	Section 1. Section 38a-1 of the general statutes is repealed and the 1
24	24	following is substituted in lieu thereof (Effective January 1, 2024): 2
25	25	Terms used in this title and sections 2 to 46, inclusive, of this act, 3
26	26	unless it appears from the context to the contrary, shall have a scope and 4
27	27	meaning as set forth in this section. 5
28	28	(1) "Affiliate" or "affiliated" means a person that directly, or indirectly 6
29	29	through one or more intermediaries, controls, is controlled by or is 7
30	30	under common control with another person. 8
31	31	(2) "Alien insurer" means any insurer that has been chartered by or 9
32	32	organized or constituted within or under the laws of any jurisdiction or 10
33	33	country without the United States. 11
34	34	(3) "Annuities" means all agreements to make periodical payments 12
35	35	where the making or continuance of all or some of the series of the 13
36	36	payments, or the amount of the payment, is dependent upon the 14 Raised Bill No. 976
37	37
38	38
39	39
40	40	LCO No. 3606 2 of 38
41	41
42	42	continuance of human life or is for a specified term of years. This 15
43	43	definition does not apply to payments made under a policy of life 16
44	44	insurance. 17
45	45	(4) "Commissioner" means the Insurance Commissioner. 18
46	46	(5) "Control", "controlled by" or "under common control with" means 19
47	47	the possession, direct or indirect, of the power to direct or cause the 20
48	48	direction of the management and policies of a person, whether through 21
49	49	the ownership of voting securities, by contract other than a commercial 22
50	50	contract for goods or nonmanagement services, or otherwise, unless the 23
51	51	power is the result of an official position with the person. 24
52	52	(6) "Domestic insurer" means any insurer that has been chartered by, 25
53	53	incorporated, organized or constituted within or under the laws of this 26
54	54	state. 27
55	55	(7) "Domestic surplus lines insurer" means any domestic insurer that 28
56	56	has been authorized by the commissioner to write surplus lines 29
57	57	insurance. 30
58	58	(8) "Foreign country" means any jurisdiction not in any state, district 31
59	59	or territory of the United States. 32
60	60	(9) "Foreign insurer" means any insurer that has been chartered by or 33
61	61	organized or constituted within or under the laws of another state or a 34
62	62	territory of the United States. 35
63	63	(10) "Insolvency" or "insolvent" means, for any insurer, that it is 36
64	64	unable to pay its obligations when they are due, or when its admitted 37
65	65	assets do not exceed its liabilities plus the greater of: (A) Capital and 38
66	66	surplus required by law for its organization and continued operation; 39
67	67	or (B) the total par or stated value of its authorized and issued capital 40
68	68	stock. For purposes of this subdivision "liabilities" shall include but not 41
69	69	be limited to reserves required by statute or by regulations adopted by 42
70	70	the commissioner in accordance with the provisions of chapter 54 or 43
71	71	specific requirements imposed by the commissioner upon a subject 44 Raised Bill No. 976
72	72
73	73
74	74
75	75	LCO No. 3606 3 of 38
76	76
77	77	company at the time of admission or subsequent thereto. 45
78	78	(11) "Insurance" means any agreement to pay a sum of money, 46
79	79	provide services or any other thing of value on the happening of a 47
80	80	particular event or contingency or to provide indemnity for loss in 48
81	81	respect to a specified subject by specified perils in return for a 49
82	82	consideration. In any contract of insurance, an insured shall have an 50
83	83	interest which is subject to a risk of loss through destruction or 51
84	84	impairment of that interest, which risk is assumed by the insurer and 52
85	85	such assumption shall be part of a general scheme to distribute losses 53
86	86	among a large group of persons bearing similar risks in return for a 54
87	87	ratable contribution or other consideration. 55
88	88	(12) "Insurer" or "insurance company" includes any person or 56
89	89	combination of persons doing any kind or form of insurance business 57
90	90	other than a fraternal benefit society, and shall include a receiver of any 58
91	91	insurer when the context reasonably permits. 59
92	92	(13) "Insured" means a person to whom or for whose benefit an 60
93	93	insurer makes a promise in an insurance policy. The term includes 61
94	94	policyholders, subscribers, members and beneficiaries. This definition 62
95	95	applies only to the provisions of this title and does not define the 63
96	96	meaning of this word as used in insurance policies or certificates. 64
97	97	(14) "Life insurance" means insurance on human lives and insurances 65
98	98	pertaining to or connected with human life. The business of life 66
99	99	insurance includes granting endowment benefits, granting additional 67
100	100	benefits in the event of death by accident or accidental means, granting 68
101	101	additional benefits in the event of the total and permanent disability of 69
102	102	the insured, and providing optional methods of settlement of proceeds. 70
103	103	Life insurance includes burial contracts to the extent provided by 71
104	104	section 38a-464. 72
105	105	(15) "Mutual insurer" means any insurer without capital stock, the 73
106	106	managing directors or officers of which are elected by its members. 74
107	107	(16) "Person" means an individual, a corporation, a partnership, a 75 Raised Bill No. 976
108	108
109	109
110	110
111	111	LCO No. 3606 4 of 38
112	112
113	113	limited liability company, an association, a joint stock company, a 76
114	114	business trust, an unincorporated organization or other legal entity. 77
115	115	(17) "Policy" means any document, including attached endorsements 78
116	116	and riders, purporting to be an enforceable contract, which 79
117	117	memorializes in writing some or all of the terms of an insurance 80
118	118	contract. 81
119	119	(18) "State" means any state, district, or territory of the United States. 82
120	120	(19) "Subsidiary" of a specified person means an affiliate controlled 83
121	121	by the person directly, or indirectly through one or more intermediaries. 84
122	122	(20) "Unauthorized insurer" or "nonadmitted insurer" means an 85
123	123	insurer that has not been granted a certificate of authority by the 86
124	124	commissioner to transact the business of insurance in this state or an 87
125	125	insurer transacting business not authorized by a valid certificate. 88
126	126	(21) "United States" means the United States of America, its territories 89
127	127	and possessions, the Commonwealth of Puerto Rico and the District of 90
128	128	Columbia. 91
129	129	Sec. 2. (NEW) (Effective January 1, 2024) Each individual health 92
130	130	insurance policy providing coverage of the type specified in 93
131	131	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 94
132	132	statutes delivered, issued for delivery, renewed, amended or continued 95
133	133	in this state on or after January 1, 2024, shall provide coverage for 96
134	134	treatment of postpartum depression. 97
135	135	Sec. 3. (NEW) (Effective January 1, 2024) Each group health insurance 98
136	136	policy providing coverage of the type specified in subdivisions (1), (2), 99
137	137	(4), (11) and (12) of section 38a-469 of the general statutes delivered, 100
138	138	issued for delivery, renewed, amended or continued in this state on or 101
139	139	after January 1, 2024, shall provide coverage for treatment of 102
140	140	postpartum depression. 103
141	141	Sec. 4. (NEW) (Effective January 1, 2024) Each individual health 104
142	142	insurance policy providing coverage of the type specified in 105 Raised Bill No. 976
143	143
144	144
145	145
146	146	LCO No. 3606 5 of 38
147	147
148	148	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 106
149	149	statutes delivered, issued for delivery, renewed, amended or continued 107
150	150	in this state on or after January 1, 2024, shall provide coverage for 108
151	151	physical therapy services rendered by a physical therapist licensed 109
152	152	under section 20-73 of the general statutes. 110
153	153	Sec. 5. (NEW) (Effective January 1, 2024) Each group health insurance 111
154	154	policy providing coverage of the type specified in subdivisions (1), (2), 112
155	155	(4), (11) and (12) of section 38a-469 of the general statutes delivered, 113
156	156	issued for delivery, renewed, amended or continued in this state on or 114
157	157	after January 1, 2024, shall provide coverage for physical therapy 115
158	158	services rendered by a physical therapist licensed under section 20-73 of 116
159	159	the general statutes. 117
160	160	Sec. 6. (NEW) (Effective January 1, 2024) (a) For the purposes of this 118
161	161	section: 119
162	162	(1) "Body mass index" means the number calculated by dividing an 120
163	163	individual's weight in kilograms by the individual's height in meters 121
164	164	squared; and 122
165	165	(2) "Severe obesity" means a body mass index that is: 123
166	166	(A) Greater than forty; or 124
167	167	(B) Thirty-five or more if an individual has been diagnosed with a 125
168	168	comorbid disease or condition, including, but not limited to, a 126
169	169	cardiopulmonary condition, diabetes, hypertension or sleep apnea. 127
170	170	(b) Each individual health insurance policy providing coverage of the 128
171	171	type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 129
172	172	of the general statutes delivered, issued for delivery, renewed, amended 130
173	173	or continued in this state on or after January 1, 2024, shall provide 131
174	174	coverage for: 132
175	175	(1) Each surgical procedure that is: 133
176	176	(A) Performed to treat severe obesity, including, but not limited to, 134 Raised Bill No. 976
177	177
178	178
179	179
180	180	LCO No. 3606 6 of 38
181	181
182	182	gastric bypass surgery, sleeve gastrectomy and duodenal switch 135
183	183	surgery; 136
184	184	(B) Recognized by the National Institutes of Health, American Society 137
185	185	for Metabolic and Bariatric Surgery and American College of Surgeons 138
186	186	as providing long-term weight loss; and 139
187	187	(C) Consistent with treatment guidelines issued by the National 140
188	188	Institutes of Health as applied to the insured; and 141
189	189	(2) Each outpatient prescription drug that is approved by the federal 142
190	190	Food and Drug Administration to treat severe obesity provided such 143
191	191	policy includes coverage for outpatient prescription drugs. 144
192	192	(c) The benefits required by subsection (b) of this section shall be 145
193	193	subject to the same terms and conditions that apply to all other benefits 146
194	194	covered under a policy that is subject to this section. 147
195	195	Sec. 7. (NEW) (Effective January 1, 2024) (a) For the purposes of this 148
196	196	section: 149
197	197	(1) "Body mass index" means the number calculated by dividing an 150
198	198	individual's weight in kilograms by the individual's height in meters 151
199	199	squared; and 152
200	200	(2) "Severe obesity" means a body mass index that is: 153
201	201	(A) Greater than forty; or 154
202	202	(B) Thirty-five or more if an individual has been diagnosed with a 155
203	203	comorbid disease or condition, including, but not limited to, a 156
204	204	cardiopulmonary condition, diabetes, hypertension or sleep apnea. 157
205	205	(b) Each group health insurance policy providing coverage of the 158
206	206	type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 159
207	207	of the general statutes delivered, issued for delivery, renewed, amended 160
208	208	or continued in this state on or after January 1, 2024, shall provide 161
209	209	coverage for: 162 Raised Bill No. 976
210	210
211	211
212	212
213	213	LCO No. 3606 7 of 38
214	214
215	215	(1) Each surgical procedure that is: 163
216	216	(A) Performed to treat severe obesity, including, but not limited to, 164
217	217	gastric bypass surgery, sleeve gastrectomy and duodenal switch 165
218	218	surgery; 166
219	219	(B) Recognized by the National Institutes of Health, American Society 167
220	220	for Metabolic and Bariatric Surgery and American College of Surgeons 168
221	221	as providing long-term weight loss; and 169
222	222	(C) Consistent with treatment guidelines issued by the National 170
223	223	Institutes of Health as applied to the insured; and 171
224	224	(2) Each outpatient prescription drug that is approved by the federal 172
225	225	Food and Drug Administration to treat severe obesity provided such 173
226	226	policy includes coverage for outpatient prescription drugs. 174
227	227	(c) The benefits required by subsection (b) of this section shall be 175
228	228	subject to the same terms and conditions that apply to all other benefits 176
229	229	covered under a policy that is subject to this section. 177
230	230	Sec. 8. (NEW) (Effective January 1, 2024) (a) For the purposes of this 178
231	231	section: 179
232	232	(1) "Body mass index" means the number calculated by dividing a 180
233	233	Medicaid beneficiary's weight in kilograms by the Medicaid 181
234	234	beneficiary's height in meters squared; and 182
235	235	(2) "Severe obesity" means a body mass index that is: 183
236	236	(A) Greater than forty; or 184
237	237	(B) Thirty-five or more if a Medicaid beneficiary has been diagnosed 185
238	238	with a comorbid disease or condition, including, but not limited to, a 186
239	239	cardiopulmonary condition, diabetes, hypertension or sleep apnea. 187
240	240	(b) The Commissioner of Social Services shall provide Medicaid 188
241	241	reimbursement for: 189 Raised Bill No. 976
242	242
243	243
244	244
245	245	LCO No. 3606 8 of 38
246	246
247	247	(1) Each surgical procedure that is: 190
248	248	(A) Performed to treat severe obesity, including, but not limited to, 191
249	249	gastric bypass surgery, sleeve gastrectomy and duodenal switch 192
250	250	surgery; 193
251	251	(B) Recognized by the National Institutes of Health, American Society 194
252	252	for Metabolic and Bariatric Surgery and American College of Surgeons 195
253	253	as providing long-term weight loss; and 196
254	254	(C) Consistent with treatment guidelines issued by the National 197
255	255	Institutes of Health as applied to the Medicaid beneficiary; and 198
256	256	(2) Each outpatient prescription drug that is approved by the federal 199
257	257	Food and Drug Administration to treat severe obesity. 200
258	258	(c) The Commissioner of Social Services shall seek federal approval 201
259	259	of a Medicaid state plan amendment or Medicaid waiver, if necessary, 202
260	260	to implement the provisions of this section. Any submission of a 203
261	261	Medicaid state plan amendment or Medicaid waiver shall be in 204
262	262	accordance with the provisions of section 17b-8 of the general statutes. 205
263	263	(d) The Commissioner of Social Services shall adopt regulations, in 206
264	264	accordance with chapter 54 of the general statutes, to implement the 207
265	265	provisions of this section. The Commissioner of Social Services may 208
266	266	adopt policies or procedures to implement the provisions of this section 209
267	267	while in the process of adopting regulations, provided such policies or 210
268	268	procedures are posted on the Internet web site of the Department of 211
269	269	Social Services and on the eRegulations System prior to the adoption of 212
270	270	such policies or procedures. 213
271	271	Sec. 9. Subsection (a) of section 38a-503e of the general statutes is 214
272	272	repealed and the following is substituted in lieu thereof (Effective January 215
273	273	1, 2024): 216
274	274	(a) Each individual health insurance policy providing coverage of the 217
275	275	type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 218
276	276	delivered, issued for delivery, renewed, amended or continued in this 219 Raised Bill No. 976
277	277
278	278
279	279
280	280	LCO No. 3606 9 of 38
281	281
282	282	state shall provide coverage for the following benefits and services: 220
283	283	(1) All contraceptive drugs, including, but not limited to, all over-the-221
284	284	counter contraceptive drugs and emergency contraceptive drugs, 222
285	285	approved by the federal Food and Drug Administration. Such policy 223
286	286	may require an insured to use, prior to using a contraceptive drug 224
287	287	prescribed to the insured, a contraceptive drug that the federal Food and 225
288	288	Drug Administration has designated as therapeutically equivalent to 226
289	289	the contraceptive drug prescribed to the insured, unless otherwise 227
290	290	determined by the insured's prescribing health care provider. 228
291	291	(2) All contraceptive devices and products, excluding all over-the-229
292	292	counter contraceptive devices and products, approved by the federal 230
293	293	Food and Drug Administration. Such policy may require an insured to 231
294	294	use, prior to using a contraceptive device or product prescribed to the 232
295	295	insured, a contraceptive device or product that the federal Food and 233
296	296	Drug Administration has designated as therapeutically equivalent to 234
297	297	the contraceptive device or product prescribed to the insured, unless 235
298	298	otherwise determined by the insured's prescribing health care provider. 236
299	299	(3) If a contraceptive drug, device or product described in subdivision 237
300	300	(1) or (2) of this subsection is prescribed by a licensed physician, 238
301	301	physician assistant or advanced practice registered nurse, a twelve-239
302	302	month supply of such contraceptive drug, device or product dispensed 240
303	303	at one time or at multiple times, unless the insured or the insured's 241
304	304	prescribing health care provider requests less than a twelve-month 242
305	305	supply of such contraceptive drug, device or product. No insured shall 243
306	306	be entitled to receive a twelve-month supply of a contraceptive drug, 244
307	307	device or product pursuant to this subdivision more than once during 245
308	308	any policy year. 246
309	309	(4) All sterilization methods approved by the federal Food and Drug 247
310	310	Administration for women. 248
311	311	(5) Routine follow-up care concerning contraceptive drugs, devices 249
312	312	and products approved by the federal Food and Drug Administration. 250 Raised Bill No. 976
313	313
314	314
315	315
316	316	LCO No. 3606 10 of 38
317	317
318	318	(6) Counseling in (A) contraceptive drugs, devices and products 251
319	319	approved by the federal Food and Drug Administration, and (B) the 252
320	320	proper use of contraceptive drugs, devices and products approved by 253
321	321	the federal Food and Drug Administration. 254
322	322	Sec. 10. Subsection (a) of section 38a-530e of the general statutes is 255
323	323	repealed and the following is substituted in lieu thereof (Effective January 256
324	324	1, 2024): 257
325	325	(a) Each group health insurance policy providing coverage of the type 258
326	326	specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 259
327	327	delivered, issued for delivery, renewed, amended or continued in this 260
328	328	state shall provide coverage for the following benefits and services: 261
329	329	(1) All contraceptive drugs, including, but not limited to, all over-the-262
330	330	counter contraceptive drugs and emergency contraceptive drugs, 263
331	331	approved by the federal Food and Drug Administration. Such policy 264
332	332	may require an insured to use, prior to using a contraceptive drug 265
333	333	prescribed to the insured, a contraceptive drug that the federal Food and 266
334	334	Drug Administration has designated as therapeutically equivalent to 267
335	335	the contraceptive drug prescribed to the insured, unless otherwise 268
336	336	determined by the insured's prescribing health care provider. 269
337	337	(2) All contraceptive devices and products, excluding all over-the-270
338	338	counter contraceptive devices and products, approved by the federal 271
339	339	Food and Drug Administration. Such policy may require an insured to 272
340	340	use, prior to using a contraceptive device or product prescribed to the 273
341	341	insured, a contraceptive device or product that the federal Food and 274
342	342	Drug Administration has designated as therapeutically equivalent to 275
343	343	the contraceptive device or product prescribed to the insured, unless 276
344	344	otherwise determined by the insured's prescribing health care provider. 277
345	345	(3) If a contraceptive drug, device or product described in subdivision 278
346	346	(1) or (2) of this subsection is prescribed by a licensed physician, 279
347	347	physician assistant or advanced practice registered nurse, a twelve-280
348	348	month supply of such contraceptive drug, device or product dispensed 281
349	349	at one time or at multiple times, unless the insured or the insured's 282 Raised Bill No. 976
350	350
351	351
352	352
353	353	LCO No. 3606 11 of 38
354	354
355	355	prescribing health care provider requests less than a twelve-month 283
356	356	supply of such contraceptive drug, device or product. No insured shall 284
357	357	be entitled to receive a twelve-month supply of a contraceptive drug, 285
358	358	device or product pursuant to this subdivision more than once during 286
359	359	any policy year. 287
360	360	(4) All sterilization methods approved by the federal Food and Drug 288
361	361	Administration for women. 289
362	362	(5) Routine follow-up care concerning contraceptive drugs, devices 290
363	363	and products approved by the federal Food and Drug Administration. 291
364	364	(6) Counseling in (A) contraceptive drugs, devices and products 292
365	365	approved by the federal Food and Drug Administration, and (B) the 293
366	366	proper use of contraceptive drugs, devices and products approved by 294
367	367	the federal Food and Drug Administration. 295
368	368	Sec. 11. (NEW) (Effective January 1, 2024) Each individual health 296
369	369	insurance policy providing coverage of the type specified in 297
370	370	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 298
371	371	statutes delivered, issued for delivery, renewed, amended or continued 299
372	372	in this state on or after January 1, 2024, shall provide coverage for: (1) 300
373	373	Motorized wheelchairs, including, but not limited to, used motorized 301
374	374	wheelchairs; (2) repairs to motorized wheelchairs; and (3) replacement 302
375	375	batteries for motorized wheelchairs. 303
376	376	Sec. 12. (NEW) (Effective January 1, 2024) Each group health insurance 304
377	377	policy providing coverage of the type specified in subdivisions (1), (2), 305
378	378	(4), (11) and (12) of section 38a-469 of the general statutes delivered, 306
379	379	issued for delivery, renewed, amended or continued in this state on or 307
380	380	after January 1, 2024, shall provide coverage for: (1) Motorized 308
381	381	wheelchairs, including, but not limited to, used motorized wheelchairs; 309
382	382	(2) repairs to motorized wheelchairs; and (3) replacement batteries for 310
383	383	motorized wheelchairs. 311
384	384	Sec. 13. (NEW) (Effective January 1, 2024) Each individual health 312
385	385	insurance policy providing coverage of the type specified in 313 Raised Bill No. 976
386	386
387	387
388	388
389	389	LCO No. 3606 12 of 38
390	390
391	391	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 314
392	392	statutes delivered, issued for delivery, renewed, amended or continued 315
393	393	in this state on or after January 1, 2024, shall provide coverage for 316
394	394	medical foods for individuals diagnosed with phenylketonuria. 317
395	395	Sec. 14. (NEW) (Effective January 1, 2024) Each group health insurance 318
396	396	policy providing coverage of the type specified in subdivisions (1), (2), 319
397	397	(4), (11) and (12) of section 38a-469 of the general statutes delivered, 320
398	398	issued for delivery, renewed, amended or continued in this state on or 321
399	399	after January 1, 2024, shall provide coverage for medical foods for 322
400	400	individuals diagnosed with phenylketonuria. 323
401	401	Sec. 15. (NEW) (Effective January 1, 2024) Each individual health 324
402	402	insurance policy providing coverage of the type specified in 325
403	403	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 326
404	404	statutes delivered, issued for delivery, renewed, amended or continued 327
405	405	in this state on or after January 1, 2024, shall provide coverage for: (1) A 328
406	406	unilateral cochlear implant, and unilateral cochlear implant surgery, for 329
407	407	an insured who has been diagnosed with unilateral hearing loss; and (2) 330
408	408	bilateral cochlear implants and bilateral cochlear implant surgery for an 331
409	409	insured who has been diagnosed with bilateral hearing loss. 332
410	410	Sec. 16. (NEW) (Effective January 1, 2024) Each group health insurance 333
411	411	policy providing coverage of the type specified in subdivisions (1), (2), 334
412	412	(4), (11) and (12) of section 38a-469 of the general statutes delivered, 335
413	413	issued for delivery, renewed, amended or continued in this state on or 336
414	414	after January 1, 2024, shall provide coverage for: (1) A unilateral 337
415	415	cochlear implant, and unilateral cochlear implant surgery, for an 338
416	416	insured who has been diagnosed with unilateral hearing loss; and (2) 339
417	417	bilateral cochlear implants and bilateral cochlear implant surgery for an 340
418	418	insured who has been diagnosed with bilateral hearing loss. 341
419	419	Sec. 17. (NEW) (Effective January 1, 2024) Each individual health 342
420	420	insurance policy providing coverage of the type specified in 343
421	421	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 344
422	422	statutes delivered, issued for delivery, renewed, amended or continued 345 Raised Bill No. 976
423	423
424	424
425	425
426	426	LCO No. 3606 13 of 38
427	427
428	428	in this state on or after January 1, 2024, shall provide coverage for equine 346
429	429	therapy for an insured who is a veteran. For the purposes of this section, 347
430	430	"veteran" has the same meaning as provided in section 27-103 of the 348
431	431	general statutes. 349
432	432	Sec. 18. (NEW) (Effective January 1, 2024) Each group health insurance 350
433	433	policy providing coverage of the type specified in subdivisions (1), (2), 351
434	434	(4), (11) and (12) of section 38a-469 of the general statutes delivered, 352
435	435	issued for delivery, renewed, amended or continued in this state on or 353
436	436	after January 1, 2024, shall provide coverage for equine therapy for an 354
437	437	insured who is a veteran. For the purposes of this section, "veteran" has 355
438	438	the same meaning as provided in section 27-103 of the general statutes. 356
439	439	Sec. 19. (NEW) (Effective January 1, 2024) Each individual health 357
440	440	insurance policy providing coverage of the type specified in 358
441	441	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 359
442	442	statutes delivered, issued for delivery, renewed, amended or continued 360
443	443	in this state on or after January 1, 2024, shall provide coverage to self-361
444	444	employed farmers. For the purposes of this section, "farmer" means any 362
445	445	person engaged in agricultural production as a trade or business. 363
446	446	Sec. 20. (NEW) (Effective January 1, 2024) Each group health insurance 364
447	447	policy providing coverage of the type specified in subdivisions (1), (2), 365
448	448	(4), (11) and (12) of section 38a-469 of the general statutes delivered, 366
449	449	issued for delivery, renewed, amended or continued in this state on or 367
450	450	after January 1, 2024, shall provide coverage to self-employed farmers. 368
451	451	For the purposes of this section, "farmer" means any person engaged in 369
452	452	agricultural production as a trade or business. 370
453	453	Sec. 21. (NEW) (Effective January 1, 2024) Each individual health 371
454	454	insurance policy providing coverage of the type specified in 372
455	455	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 373
456	456	statutes delivered, issued for delivery, renewed, amended or continued 374
457	457	in this state on or after January 1, 2024, shall provide coverage for peer 375
458	458	support services provided by certified peer support specialists on an 376
459	459	outpatient basis. The Commissioner of Public Health shall adopt 377 Raised Bill No. 976
460	460
461	461
462	462
463	463	LCO No. 3606 14 of 38
464	464
465	465	regulations, in accordance with chapter 54 of the general statutes, to 378
466	466	establish certification and education requirements for peer support 379
467	467	specialists. 380
468	468	Sec. 22. (NEW) (Effective January 1, 2024) Each group health insurance 381
469	469	policy providing coverage of the type specified in subdivisions (1), (2), 382
470	470	(4), (11) and (12) of section 38a-469 of the general statutes delivered, 383
471	471	issued for delivery, renewed, amended or continued in this state on or 384
472	472	after January 1, 2024, shall provide coverage for peer support services 385
473	473	provided by certified peer support specialists on an outpatient basis. 386
474	474	The Commissioner of Public Health shall adopt regulations, in 387
475	475	accordance with chapter 54 of the general statutes, to establish 388
476	476	certification and education requirements for peer support specialists. 389
477	477	Sec. 23. Section 38a-504 of the general statutes is repealed and the 390
478	478	following is substituted in lieu thereof (Effective January 1, 2024): 391
479	479	(a) Each insurance company, hospital service corporation, medical 392
480	480	service corporation, health care center or fraternal benefit society that 393
481	481	delivers, issues for delivery, renews, amends or continues in this state 394
482	482	individual health insurance policies providing coverage of the type 395
483	483	specified in subdivisions (1), (2), (4), [(10),] (11) and (12) of section 38a-396
484	484	469, shall provide coverage under such policies for the surgical removal 397
485	485	of tumors and treatment of leukemia, including outpatient 398
486	486	chemotherapy, reconstructive surgery, cost of any nondental prosthesis 399
487	487	including any maxillo-facial prosthesis used to replace anatomic 400
488	488	structures lost during treatment for head and neck tumors or additional 401
489	489	appliances essential for the support of such prosthesis, outpatient 402
490	490	chemotherapy following surgical procedure in connection with the 403
491	491	treatment of tumors, and a wig if prescribed by a licensed oncologist for 404
492	492	a patient who suffers hair loss as a result of chemotherapy. Such benefits 405
493	493	shall be subject to the same terms and conditions applicable to all other 406
494	494	benefits under such policies. 407
495	495	(b) Except as provided in subsection (c) of this section, the coverage 408
496	496	required by subsection (a) of this section shall provide at least a yearly 409 Raised Bill No. 976
497	497
498	498
499	499
500	500	LCO No. 3606 15 of 38
501	501
502	502	benefit of five hundred dollars for the surgical removal of tumors, five 410
503	503	hundred dollars for reconstructive surgery, five hundred dollars for 411
504	504	outpatient chemotherapy, three hundred fifty dollars for a wig and 412
505	505	three hundred dollars for a nondental prosthesis, except that for 413
506	506	purposes of the surgical removal of breasts due to tumors the yearly 414
507	507	benefit for such prosthesis shall be at least three hundred dollars for 415
508	508	each breast removed. 416
509	509	(c) The coverage required by subsection (a) of this section shall 417
510	510	provide benefits for the reasonable costs of reconstructive surgery on 418
511	511	each breast on which a mastectomy has been performed, and 419
512	512	reconstructive surgery on a nondiseased breast to produce a 420
513	513	symmetrical appearance. Such benefits shall be subject to the same 421
514	514	terms and conditions applicable to all other benefits under such policies. 422
515	515	For the purposes of this subsection, [reconstructive surgery] 423
516	516	"reconstructive surgery" includes, but is not limited to, augmentation 424
517	517	mammoplasty, reduction mammoplasty and mastopexy. 425
518	518	(d) (1) Each policy of the type specified in subsection (a) of this section 426
519	519	that provides coverage for intravenously administered and orally 427
520	520	administered anticancer medications used to kill or slow the growth of 428
521	521	cancerous cells that are prescribed by a prescribing practitioner, as 429
522	522	defined in section 20-571, shall provide coverage for orally administered 430
523	523	anticancer medications on a basis that is no less favorable than 431
524	524	intravenously administered anticancer medications. 432
525	525	(2) No insurance company, hospital service corporation, medical 433
526	526	service corporation, health care center or fraternal benefit society that 434
527	527	delivers, issues for delivery, renews, amends or continues in this state a 435
528	528	policy of the type specified in subsection (a) of this section shall 436
529	529	reclassify such anticancer medications or increase the coinsurance, 437
530	530	copayment, deductible or other out-of-pocket expense imposed under 438
531	531	such policy for such medications to achieve compliance with this 439
532	532	subsection. 440
533	533	(e) The coverage required by subsection (a) of this section shall 441 Raised Bill No. 976
534	534
535	535
536	536
537	537	LCO No. 3606 16 of 38
538	538
539	539	provide benefits for the reasonable costs of nipple reconstruction 442
540	540	surgery and nipple tattooing on each breast on which a breast 443
541	541	reconstructive surgery has been performed for a medically necessary 444
542	542	purpose, including, but not limited to, prophylactic mastectomies. Such 445
543	543	benefits shall be subject to the same terms and conditions applicable to 446
544	544	all other benefits under such policies. For the purposes of this 447
545	545	subsection, "reconstructive surgery" includes, but is not limited to, 448
546	546	augmentation mammoplasty, reduction mammoplasty and mastopexy. 449
547	547	Sec. 24. Section 38a-542 of the general statutes is repealed and the 450
548	548	following is substituted in lieu thereof (Effective January 1, 2024): 451
549	549	(a) Each insurance company, hospital service corporation, medical 452
550	550	service corporation, health care center or fraternal benefit society that 453
551	551	delivers, issues for delivery, renews, amends or continues in this state 454
552	552	group health insurance policies providing coverage of the type specified 455
553	553	in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 shall provide 456
554	554	coverage under such policies for treatment of leukemia, including 457
555	555	outpatient chemotherapy, reconstructive surgery, cost of any nondental 458
556	556	prosthesis, including any maxillo-facial prosthesis used to replace 459
557	557	anatomic structures lost during treatment for head and neck tumors or 460
558	558	additional appliances essential for the support of such prosthesis, 461
559	559	outpatient chemotherapy following surgical procedures in connection 462
560	560	with the treatment of tumors, a wig if prescribed by a licensed 463
561	561	oncologist for a patient who suffers hair loss as a result of 464
562	562	chemotherapy, and costs of removal of any breast implant which was 465
563	563	implanted on or before July 1, 1994, without regard to the purpose of 466
564	564	such implantation, which removal is determined to be medically 467
565	565	necessary. Such benefits shall be subject to the same terms and 468
566	566	conditions applicable to all other benefits under such policies. 469
567	567	(b) Except as provided in subsection (c) of this section, the coverage 470
568	568	required by subsection (a) of this section shall provide at least a yearly 471
569	569	benefit of one thousand dollars for the costs of removal of any breast 472
570	570	implant, five hundred dollars for the surgical removal of tumors, five 473
571	571	hundred dollars for reconstructive surgery, five hundred dollars for 474 Raised Bill No. 976
572	572
573	573
574	574
575	575	LCO No. 3606 17 of 38
576	576
577	577	outpatient chemotherapy, three hundred fifty dollars for a wig and 475
578	578	three hundred dollars for a nondental prosthesis, except that for 476
579	579	purposes of the surgical removal of breasts due to tumors the yearly 477
580	580	benefit for such prosthesis shall be at least three hundred dollars for 478
581	581	each breast removed. 479
582	582	(c) The coverage required by subsection (a) of this section shall 480
583	583	provide benefits for the reasonable costs of reconstructive surgery on 481
584	584	each breast on which a mastectomy has been performed, and 482
585	585	reconstructive surgery on a nondiseased breast to produce a 483
586	586	symmetrical appearance. Such benefits shall be subject to the same 484
587	587	terms and conditions applicable to all other benefits under such policies. 485
588	588	For the purposes of this subsection, [reconstructive surgery] 486
589	589	"reconstructive surgery" includes, but is not limited to, augmentation 487
590	590	mammoplasty, reduction mammoplasty and mastopexy. 488
591	591	(d) (1) Each policy of the type specified in subsection (a) of this section 489
592	592	that provides coverage for intravenously administered and orally 490
593	593	administered anticancer medications used to kill or slow the growth of 491
594	594	cancerous cells that are prescribed by a prescribing practitioner, as 492
595	595	defined in section 20-571, shall provide coverage for orally administered 493
596	596	anticancer medications on a basis that is no less favorable than 494
597	597	intravenously administered anticancer medications. 495
598	598	(2) No insurance company, hospital service corporation, medical 496
599	599	service corporation, health care center or fraternal benefit society that 497
600	600	delivers, issues for delivery, renews, amends or continues in this state a 498
601	601	policy of the type specified in subsection (a) of this section shall 499
602	602	reclassify such anticancer medications or increase the coinsurance, 500
603	603	copayment, deductible or other out-of-pocket expense imposed under 501
604	604	such policy for such medications to achieve compliance with this 502
605	605	subsection. 503
606	606	(e) The coverage required by subsection (a) of this section shall 504
607	607	provide benefits for the reasonable costs of nipple reconstruction 505
608	608	surgery and nipple tattooing on each breast on which a breast 506 Raised Bill No. 976
609	609
610	610
611	611
612	612	LCO No. 3606 18 of 38
613	613
614	614	reconstructive surgery has been performed for a medically necessary 507
615	615	purpose, including, but not limited to, prophylactic mastectomies. Such 508
616	616	benefits shall be subject to the same terms and conditions applicable to 509
617	617	all other benefits under such policies. For the purposes of this 510
618	618	subsection, "reconstructive surgery" includes, but is not limited to, 511
619	619	augmentation mammoplasty, reduction mammoplasty and mastopexy. 512
620	620	Sec. 25. Section 38a-492k of the general statutes is repealed and the 513
621	621	following is substituted in lieu thereof (Effective January 1, 2024): 514
622	622	(a) Each individual health insurance policy providing coverage of the 515
623	623	type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 516
624	624	delivered, issued for delivery, amended, renewed or continued in this 517
625	625	state shall provide coverage for colorectal cancer screening and 518
626	626	diagnosis, including, but not limited to, (1) an annual fecal occult blood 519
627	627	test, and (2) colonoscopy, flexible sigmoidoscopy or radiologic imaging, 520
628	628	in accordance with the recommendations established by the American 521
629	629	Cancer Society, based on the ages, family histories and frequencies 522
630	630	provided in the recommendations. Except as specified in subsection (b) 523
631	631	of this section, benefits under this section shall be subject to the same 524
632	632	terms and conditions applicable to all other benefits under such policies. 525
633	633	(b) No such policy shall impose: 526
634	634	(1) A deductible for a procedure that a physician initially undertakes 527
635	635	as a screening or diagnostic colonoscopy or [a screening] 528
636	636	sigmoidoscopy; or 529
637	637	(2) A coinsurance, copayment, deductible or other out-of-pocket 530
638	638	expense for any additional colonoscopy ordered in a policy year by a 531
639	639	physician for an insured. The provisions of this subdivision shall not 532
640	640	apply to a high deductible health plan as that term is used in subsection 533
641	641	(f) of section 38a-493. 534
642	642	Sec. 26. Section 38a-518k of the general statutes is repealed and the 535
643	643	following is substituted in lieu thereof (Effective January 1, 2024): 536 Raised Bill No. 976
644	644
645	645
646	646
647	647	LCO No. 3606 19 of 38
648	648
649	649	(a) Each group health insurance policy providing coverage of the type 537
650	650	specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 538
651	651	delivered, issued for delivery, amended, renewed or continued in this 539
652	652	state shall provide coverage for colorectal cancer screening and 540
653	653	diagnosis, including, but not limited to, (1) an annual fecal occult blood 541
654	654	test, and (2) colonoscopy, flexible sigmoidoscopy or radiologic imaging, 542
655	655	in accordance with the recommendations established by the American 543
656	656	Cancer Society, based on the ages, family histories and frequencies 544
657	657	provided in the recommendations. Except as specified in subsection (b) 545
658	658	of this section, benefits under this section shall be subject to the same 546
659	659	terms and conditions applicable to all other benefits under such policies. 547
660	660	(b) No such policy shall impose: 548
661	661	(1) A deductible for a procedure that a physician initially undertakes 549
662	662	as a screening or diagnostic colonoscopy or [a screening] 550
663	663	sigmoidoscopy; or 551
664	664	(2) A coinsurance, copayment, deductible or other out-of-pocket 552
665	665	expense for any additional colonoscopy ordered in a policy year by a 553
666	666	physician for an insured. The provisions of this subdivision shall not 554
667	667	apply to a high deductible health plan as that term is used in subsection 555
668	668	(f) of section 38a-520. 556
669	669	Sec. 27. (NEW) (Effective January 1, 2024) (a) As used in this section: 557
670	670	(1) "Experimental fertility procedure" means a procedure for which 558
671	671	the published medical evidence is not sufficient for the American 559
672	672	Society for Reproductive Medicine, its successor organization or a 560
673	673	comparable organization to regard the procedure as established medical 561
674	674	practice; 562
675	675	(2) "Fertility diagnostic care" means procedures, products, 563
676	676	medications and services intended to provide information and 564
677	677	counseling about an individual's fertility, including laboratory 565
678	678	assessments and imaging studies; 566 Raised Bill No. 976
679	679
680	680
681	681
682	682	LCO No. 3606 20 of 38
683	683
684	684	(3) "Fertility patient" means (A) an individual or a couple 567
685	685	experiencing infertility, (B) an individual or a couple who is at increased 568
686	686	risk of transmitting a serious inheritable genetic or chromosomal 569
687	687	abnormality to a child, (C) an individual unable to achieve a pregnancy 570
688	688	as an individual or with a partner because the individual or couple does 571
689	689	not have the necessary gametes to achieve a pregnancy, or (D) an 572
690	690	individual or couple for whom fertility preservation services are 573
691	691	medically necessary; 574
692	692	(4) "Fertility preservation services" (A) means procedures, products, 575
693	693	medications and services intended to preserve fertility, consistent with 576
694	694	established medical practice and professional guidelines published by 577
695	695	the American Society for Reproductive Medicine, its successor 578
696	696	organization or a comparable organization for an individual who has a 579
697	697	medical or genetic condition or who is expected to undergo treatment 580
698	698	that may directly or indirectly cause a risk of impairment of fertility, and 581
699	699	(B) includes, but is not limited to, the procurement and cryopreservation 582
700	700	of gametes, embryos and reproductive material, and storage from the 583
701	701	time of cryopreservation until the individual reaches the age of thirty, 584
702	702	or for a period of not less than five years, whichever is later; 585
703	703	(5) "Fertility treatment" means procedures, products, genetic testing, 586
704	704	medications and services intended to achieve pregnancy that result in a 587
705	705	live birth and that are provided in a manner consistent with established 588
706	706	medical practice and professional guidelines published by the American 589
707	707	Society for Reproductive Medicine, its successor organization or a 590
708	708	comparable organization; 591
709	709	(6) "Gamete" means a sperm or egg; 592
710	710	(7) "Infertility" means (A) the presence of a condition recognized by a 593
711	711	provider as a cause of loss or impairment of fertility, (B) a couple's 594
712	712	inability to achieve pregnancy after twelve months of unprotected 595
713	713	sexual intercourse when the couple has the necessary gametes to 596
714	714	achieve pregnancy, or (C) an individual's inability to achieve pregnancy 597
715	715	after twelve months of unprotected sexual intercourse due to such 598 Raised Bill No. 976
716	716
717	717
718	718
719	719	LCO No. 3606 21 of 38
720	720
721	721	individual's age; 599
722	722	(8) "Oocyte" means an ovum or egg cell before maturation; and 600
723	723	(9) "Religious employer" means an employer that is a "qualified 601
724	724	church-controlled organization", as defined in 26 USC 3121, or a church-602
725	725	affiliated organization. 603
726	726	(b) Except as provided in subsections (e), (f) and (h) of this section, 604
727	727	each individual health insurance policy providing coverage of the type 605
728	728	specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of 606
729	729	the general statutes, delivered, issued for delivery, amended, renewed 607
730	730	or continued in this state on or after January 1, 2024, shall provide 608
731	731	coverage for: 609
732	732	(1) Fertility diagnostic care; 610
733	733	(2) Fertility treatment if the enrollee is a fertility patient; and 611
734	734	(3) Fertility preservation services. 612
735	735	(c) A policy that provides coverage for the services required under 613
736	736	this section, may not: 614
737	737	(1) Impose any limitations on coverage solely on the basis of an 615
738	738	individual's age; 616
739	739	(2) Require that a pregnancy loss suffered during the twelve-month 617
740	740	period referenced in subparagraphs (B) and (C) of subdivision (7) of 618
741	741	subsection (a) of this section initiates a new time frame for determining 619
742	742	whether an individual or couple is experiencing infertility; 620
743	743	(3) Use any prior diagnosis or fertility treatment as a basis for 621
744	744	excluding, limiting or otherwise restricting the availability of coverage 622
745	745	required under this section; 623
746	746	(4) Impose any limitations on coverage required under this section 624
747	747	based on an individual's use of donor gametes, donor embryos or 625
748	748	surrogacy; 626 Raised Bill No. 976
749	749
750	750
751	751
752	752	LCO No. 3606 22 of 38
753	753
754	754	(5) Impose any copayments, deductibles, coinsurances, benefit 627
755	755	maximums, waiting periods or other limitations on coverage that are 628
756	756	different than any maternity benefits provided by the health insurance 629
757	757	policy; 630
758	758	(6) Impose any exclusions, limitations or other restrictions on 631
759	759	coverage of fertility medications that are different from those imposed 632
760	760	on any other prescription medications; 633
761	761	(7) Impose different limitations on coverage for, provide different 634
762	762	benefits to or impose different requirements on any class of persons 635
763	763	whose rights are protected pursuant to chapter 814c of the general 636
764	764	statutes; and 637
765	765	(8) Base any limitations imposed by the policy on anything other than 638
766	766	an individual's medical history and clinical guidelines adopted by the 639
767	767	policy. 640
768	768	(d) Any clinical guidelines used for a policy subject to the 641
769	769	requirements of this section shall (1) be based on current guidelines 642
770	770	developed by the American Society for Reproductive Medicine, its 643
771	771	successor organization or a comparable organization, (2) cite with 644
772	772	specificity any data or scientific reference relied upon, (3) be maintained 645
773	773	in written form, and (4) be made available to an individual in writing 646
774	774	upon request. 647
775	775	(e) A policy that provides coverage for the services required under 648
776	776	this section may: 649
777	777	(1) Limit such coverage to four completed oocyte retrievals, with 650
778	778	unlimited embryo transfers; 651
779	779	(2) Limit such coverage for intrauterine insemination to a lifetime 652
780	780	maximum benefit of six cycles; 653
781	781	(3) Limit coverage for in-vitro fertilization to those individuals who 654
782	782	have been unable to achieve or sustain a pregnancy to live birth through 655
783	783	less expensive and medically viable infertility treatment or procedures 656 Raised Bill No. 976
784	784
785	785
786	786
787	787	LCO No. 3606 23 of 38
788	788
789	789	covered under such policy; and 657
790	790	(4) Require that treatment or procedures that shall be covered as 658
791	791	provided in this section be performed at facilities that conform to the 659
792	792	standards and guidelines developed by the American Society of 660
793	793	Reproductive Medicine or the Society of Reproductive Endocrinology 661
794	794	and Infertility. 662
795	795	(f) Any insurance company, hospital service corporation, medical 663
796	796	service corporation or health care center may issue to a religious 664
797	797	employer an individual health insurance policy that excludes coverage 665
798	798	for methods of diagnosis and treatment for services required to be 666
799	799	covered under this section that are contrary to the religious employer's 667
800	800	bona fide religious tenets. Upon the written request of an individual 668
801	801	who states in writing that methods of diagnosis and treatment for 669
802	802	services required to be covered under this section are contrary to such 670
803	803	individual's religious or moral beliefs, any insurance company, hospital 671
804	804	service corporation, medical service corporation or health care center 672
805	805	may issue to or on behalf of the individual a policy or rider thereto that 673
806	806	excludes coverage for such methods. 674
807	807	(g) Any health insurance policy issued pursuant to subsection (b) of 675
808	808	this section shall provide written notice to each insured or prospective 676
809	809	insured the methods of diagnosis and treatment of infertility that are 677
810	810	excluded from coverage pursuant to this section. Such notice shall 678
811	811	appear, in not less than ten-point type, in the policy, application and 679
812	812	sales brochure for such policy. 680
813	813	(h) Any health insurance policy issued pursuant to subsection (b) of 681
814	814	this section shall not be required to provide coverage for: 682
815	815	(1) Any experimental fertility procedure; or 683
816	816	(2) Any nonmedical costs related to procuring gametes, donor 684
817	817	embryos or surrogacy services. 685
818	818	(i) Nothing in this section shall be construed to deny the coverage 686 Raised Bill No. 976
819	819
820	820
821	821
822	822	LCO No. 3606 24 of 38
823	823
824	824	required under this section to any individual who foregoes a particular 687
825	825	infertility treatment or procedure if the individual's physician 688
826	826	determines that such treatment or procedure is likely to be unsuccessful 689
827	827	or the individual seeks to use previously retrieved oocytes or embryos. 690
828	828	Sec. 28. (NEW) (Effective January 1, 2024) (a) As used in this section: 691
829	829	(1) "Experimental fertility procedure" means a procedure for which 692
830	830	the published medical evidence is not sufficient for the American 693
831	831	Society for Reproductive Medicine, its successor organization or a 694
832	832	comparable organization to regard the procedure as established medical 695
833	833	practice; 696
834	834	(2) "Fertility diagnostic care" means procedures, products, 697
835	835	medications and services intended to provide information and 698
836	836	counseling about an individual's fertility, including laboratory 699
837	837	assessments and imaging studies; 700
838	838	(3) "Fertility patient" means (A) an individual or a couple 701
839	839	experiencing infertility, (B) an individual or a couple who is at increased 702
840	840	risk of transmitting a serious inheritable genetic or chromosomal 703
841	841	abnormality to a child, (C) an individual unable to achieve a pregnancy 704
842	842	as an individual or with a partner because the individual or couple does 705
843	843	not have the necessary gametes to achieve a pregnancy, or (D) an 706
844	844	individual or couple for whom fertility preservation services are 707
845	845	medically necessary; 708
846	846	(4) "Fertility preservation services" (A) means procedures, products, 709
847	847	medications and services intended to preserve fertility, consistent with 710
848	848	established medical practice and professional guidelines published by 711
849	849	the American Society for Reproductive Medicine, its successor 712
850	850	organization or a comparable organization for an individual who has a 713
851	851	medical or genetic condition or who is expected to undergo treatment 714
852	852	that may directly or indirectly cause a risk of impairment of fertility, and 715
853	853	(B) includes, but is not limited to, the procurement and cryopreservation 716
854	854	of gametes, embryos and reproductive material, and storage from the 717
855	855	time of cryopreservation until the individual reaches the age of thirty, 718 Raised Bill No. 976
856	856
857	857
858	858
859	859	LCO No. 3606 25 of 38
860	860
861	861	or for a period of not less than five years, whichever is later; 719
862	862	(5) "Fertility treatment" means procedures, products, genetic testing, 720
863	863	medications and services intended to achieve pregnancy that result in a 721
864	864	live birth and that are provided in a manner consistent with established 722
865	865	medical practice and professional guidelines published by the American 723
866	866	Society for Reproductive Medicine, its successor organization or a 724
867	867	comparable organization; 725
868	868	(6) "Gamete" means a sperm or egg; 726
869	869	(7) "Infertility" means (A) the presence of a condition recognized by a 727
870	870	provider as a cause of loss or impairment of fertility, (B) a couple's 728
871	871	inability to achieve pregnancy after twelve months of unprotected 729
872	872	sexual intercourse when the couple has the necessary gametes to 730
873	873	achieve pregnancy, or (C) an individual's inability to achieve pregnancy 731
874	874	after twelve months of unprotected sexual intercourse due to such 732
875	875	individual's age; 733
876	876	(8) "Oocyte" means an ovum or egg cell before maturation; and 734
877	877	(9) "Religious employer" means an employer that is a "qualified 735
878	878	church-controlled organization", as defined in 26 USC 3121, or a church-736
879	879	affiliated organization. 737
880	880	(b) Except as provided in subsections (e), (f) and (h) of this section, 738
881	881	each group health insurance policy providing coverage of the type 739
882	882	specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of 740
883	883	the general statutes, delivered, issued for delivery, amended, renewed 741
884	884	or continued in this state on or after January 1, 2024, shall provide 742
885	885	coverage for: 743
886	886	(1) Fertility diagnostic care; 744
887	887	(2) Fertility treatment if the enrollee is a fertility patient; and 745
888	888	(3) Fertility preservation services. 746 Raised Bill No. 976
889	889
890	890
891	891
892	892	LCO No. 3606 26 of 38
893	893
894	894	(c) A policy that provides coverage for the services required under 747
895	895	this section, may not: 748
896	896	(1) Impose any limitations on coverage solely on the basis of an 749
897	897	individual's age; 750
898	898	(2) Require that a pregnancy loss suffered during the twelve-month 751
899	899	period referenced in subparagraphs (B) and (C) of subdivision (7) of 752
900	900	subsection (a) of this section initiates a new time frame for determining 753
901	901	whether an individual or couple is experiencing infertility; 754
902	902	(3) Use any prior diagnosis or fertility treatment as a basis for 755
903	903	excluding, limiting or otherwise restricting the availability of coverage 756
904	904	required under this section; 757
905	905	(4) Impose any limitations on coverage required under this section 758
906	906	based on an individual's use of donor gametes, donor embryos or 759
907	907	surrogacy; 760
908	908	(5) Impose any copayments, deductibles, coinsurances, benefit 761
909	909	maximums, waiting periods or other limitations on coverage that are 762
910	910	different than any maternity benefits provided by the health insurance 763
911	911	policy; 764
912	912	(6) Impose any exclusions, limitations or other restrictions on 765
913	913	coverage of fertility medications that are different from those imposed 766
914	914	on any other prescription medications; 767
915	915	(7) Impose different limitations on coverage for, provide different 768
916	916	benefits to or impose different requirements on any class of persons 769
917	917	whose rights are protected pursuant to chapter 814c of the general 770
918	918	statutes; and 771
919	919	(8) Base any limitations imposed by the policy on anything other than 772
920	920	an individual's medical history and clinical guidelines adopted by the 773
921	921	policy. 774
922	922	(d) Any clinical guidelines used for a policy subject to the 775 Raised Bill No. 976
923	923
924	924
925	925
926	926	LCO No. 3606 27 of 38
927	927
928	928	requirements of this section shall (1) be based on current guidelines 776
929	929	developed by the American Society for Reproductive Medicine, its 777
930	930	successor organization or a comparable organization, (2) cite with 778
931	931	specificity any data or scientific reference relied upon, (3) be maintained 779
932	932	in written form, and (4) be made available to an individual in writing 780
933	933	upon request. 781
934	934	(e) A policy that provides coverage for the services required under 782
935	935	this section may: 783
936	936	(1) Limit such coverage to four completed oocyte retrievals, with 784
937	937	unlimited embryo transfers; 785
938	938	(2) Limit such coverage for intrauterine insemination to a lifetime 786
939	939	maximum benefit of six cycles; 787
940	940	(3) Limit coverage for in-vitro fertilization to those individuals who 788
941	941	have been unable to achieve or sustain a pregnancy to live birth through 789
942	942	less expensive and medically viable infertility treatment or procedures 790
943	943	covered under such policy; and 791
944	944	(4) Require that treatment or procedures that shall be covered as 792
945	945	provided in this section be performed at facilities that conform to the 793
946	946	standards and guidelines developed by the American Society of 794
947	947	Reproductive Medicine or the Society of Reproductive Endocrinology 795
948	948	and Infertility. 796
949	949	(f) Any insurance company, hospital service corporation, medical 797
950	950	service corporation or health care center may issue to a religious 798
951	951	employer an individual health insurance policy that excludes coverage 799
952	952	for methods of diagnosis and treatment for services required to be 800
953	953	covered under this section that are contrary to the religious employer's 801
954	954	bona fide religious tenets. Upon the written request of an individual 802
955	955	who states in writing that methods of diagnosis and treatment for 803
956	956	services required to be covered under this section are contrary to such 804
957	957	individual's religious or moral beliefs, any insurance company, hospital 805
958	958	service corporation, medical service corporation or health care center 806 Raised Bill No. 976
959	959
960	960
961	961
962	962	LCO No. 3606 28 of 38
963	963
964	964	may issue to or on behalf of the individual a policy or rider thereto that 807
965	965	excludes coverage for such methods. 808
966	966	(g) Any health insurance policy issued pursuant to subsection (b) of 809
967	967	this section shall provide written notice to each insured or prospective 810
968	968	insured the methods of diagnosis and treatment of infertility that are 811
969	969	excluded from coverage pursuant to this section. Such notice shall 812
970	970	appear, in not less than ten-point type, in the policy, application and 813
971	971	sales brochure for such policy. 814
972	972	(h) Any health insurance policy issued pursuant to subsection (b) of 815
973	973	this section shall not be required to provide coverage for: 816
974	974	(1) Any experimental fertility procedure; or 817
975	975	(2) Any nonmedical costs related to procuring gametes, donor 818
976	976	embryos or surrogacy services. 819
977	977	(i) Nothing in this section shall be construed to deny the coverage 820
978	978	required under this section to any individual who foregoes a particular 821
979	979	infertility treatment or procedure if the individual's physician 822
980	980	determines that such treatment or procedure is likely to be unsuccessful 823
981	981	or the individual seeks to use previously retrieved oocytes or embryos. 824
982	982	Sec. 29. (NEW) (Effective January 1, 2024) (a) Each individual health 825
983	983	insurance policy providing coverage of the type specified in 826
984	984	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 827
985	985	statutes delivered, issued for delivery, renewed, amended or continued 828
986	986	in this state on or after January 1, 2024, shall provide coverage for not 829
987	987	less than one generic opioid antagonist and device. For purposes of this 830
988	988	section, "opioid antagonist" means naloxone hydrochloride or any other 831
989	989	similarly acting and equally safe drug approved by the federal Food and 832
990	990	Drug Administration for the treatment of a drug overdose. 833
991	991	(b) No policy described in subsection (a) of this section shall impose 834
992	992	a coinsurance, copayment, deductible or other out-of-pocket expense for 835
993	993	the generic opioid antagonist and device that such policy is required to 836 Raised Bill No. 976
994	994
995	995
996	996
997	997	LCO No. 3606 29 of 38
998	998
999	999	cover pursuant to subsection (a) of this section. 837
1000	1000	Sec. 30. (NEW) (Effective January 1, 2024) (a) Each group health 838
1001	1001	insurance policy providing coverage of the type specified in 839
1002	1002	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 840
1003	1003	statutes delivered, issued for delivery, renewed, amended or continued 841
1004	1004	in this state on or after January 1, 2024, shall provide coverage for not 842
1005	1005	less than one generic opioid antagonist and device. For purposes of this 843
1006	1006	section, "opioid antagonist" means naloxone hydrochloride or any other 844
1007	1007	similarly acting and equally safe drug approved by the federal Food and 845
1008	1008	Drug Administration for the treatment of a drug overdose. 846
1009	1009	(b) No policy described in subsection (a) of this section shall impose 847
1010	1010	a coinsurance, copayment, deductible or other out-of-pocket expense for 848
1011	1011	the generic opioid antagonist and device that such policy is required to 849
1012	1012	cover pursuant to subsection (a) of this section. 850
1013	1013	Sec. 31. (NEW) (Effective January 1, 2024) Each individual health 851
1014	1014	insurance policy providing coverage of the type specified in 852
1015	1015	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 853
1016	1016	statutes delivered, issued for delivery, renewed, amended or continued 854
1017	1017	in this state on or after January 1, 2024, shall provide coverage for the 855
1018	1018	purchase of any trained service animal that is specially trained to assist 856
1019	1019	blind, deaf or mobility impaired persons or persons with a disability 857
1020	1020	that is other than physical, including, but not limited to, anxiety 858
1021	1021	disorders and post-traumatic stress disorder, provided the insured's 859
1022	1022	treating health care provider certifies in writing that such trained service 860
1023	1023	animal is medically necessary. Any such trained service animal shall be 861
1024	1024	purchased from a nonprofit organization that is established for the 862
1025	1025	training of such service animals. For the purposes of this section, 863
1026	1026	"service animal" has the same meaning as provided in 28 CFR 35.104, as 864
1027	1027	amended from time to time, and includes a service animal in training. 865
1028	1028	Sec. 32. (NEW) (Effective January 1, 2024) Each group health insurance 866
1029	1029	policy providing coverage of the type specified in subdivisions (1), (2), 867
1030	1030	(4), (11) and (12) of section 38a-469 of the general statutes delivered, 868 Raised Bill No. 976
1031	1031
1032	1032
1033	1033
1034	1034	LCO No. 3606 30 of 38
1035	1035
1036	1036	issued for delivery, renewed, amended or continued in this state on or 869
1037	1037	after January 1, 2024, shall provide coverage for the purchase of any 870
1038	1038	trained service animal that is specially trained to assist blind, deaf or 871
1039	1039	mobility impaired persons or persons with a disability that is other than 872
1040	1040	physical, including, but not limited to, anxiety disorders and post-873
1041	1041	traumatic stress disorder, provided the insured's treating health care 874
1042	1042	provider certifies in writing that such trained service animal is 875
1043	1043	medically necessary. Any such trained service animal shall be 876
1044	1044	purchased from a nonprofit organization that is established for the 877
1045	1045	training of such service animals. For the purposes of this section, 878
1046	1046	"service animal" has the same meaning as provided in 28 CFR 35.104, as 879
1047	1047	amended from time to time, and includes a service animal in training. 880
1048	1048	Sec. 33. (NEW) (Effective January 1, 2024) Each individual health 881
1049	1049	insurance policy providing coverage of the type specified in 882
1050	1050	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 883
1051	1051	statutes delivered, issued for delivery, renewed, amended or continued 884
1052	1052	in this state on or after January 1, 2024, shall provide coverage for 885
1053	1053	vaginal, cervical and uterine medical procedures, including, but not 886
1054	1054	limited to, loop electrosurgical excision procedure, colposcopy, ablation 887
1055	1055	and intrauterine device insertion. 888
1056	1056	Sec. 34. (NEW) (Effective January 1, 2024) Each group health insurance 889
1057	1057	policy providing coverage of the type specified in subdivisions (1), (2), 890
1058	1058	(4), (11) and (12) of section 38a-469 of the general statutes delivered, 891
1059	1059	issued for delivery, renewed, amended or continued in this state on or 892
1060	1060	after January 1, 2024, shall provide coverage for vaginal, cervical and 893
1061	1061	uterine medical procedures, including, but not limited to, loop 894
1062	1062	electrosurgical excision procedure, colposcopy, ablation and 895
1063	1063	intrauterine device insertion. 896
1064	1064	Sec. 35. (NEW) (Effective January 1, 2024) (a) Each individual health 897
1065	1065	insurance policy providing coverage of the type specified in 898
1066	1066	subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 of the 899
1067	1067	general statutes delivered, issued for delivery, renewed, amended or 900
1068	1068	continued in this state on or after January 1, 2024, that includes coverage 901 Raised Bill No. 976
1069	1069
1070	1070
1071	1071
1072	1072	LCO No. 3606 31 of 38
1073	1073
1074	1074	for outpatient prescription drugs shall provide coverage for not less 902
1075	1075	than one epinephrine cartridge dual-pack injector. For the purposes of 903
1076	1076	this section and sections 36 and 38 of this act, "epinephrine cartridge 904
1077	1077	injector" means a dual-pack containing automatic, prefilled cartridge 905
1078	1078	injectors or similar automatic injectable equipment used to deliver 906
1079	1079	epinephrine in a standard dose for an emergency first aid response to 907
1080	1080	allergic reactions. 908
1081	1081	(b) No policy described in subsection (a) of this section shall impose 909
1082	1082	a coinsurance, copayment, deductible or other out-of-pocket expense for 910
1083	1083	the epinephrine cartridge injector that such policy is required to cover 911
1084	1084	pursuant to said subsection (a) in an amount that exceeds twenty-five 912
1085	1085	dollars. The provisions of this subsection shall apply to a high 913
1086	1086	deductible health plan, as that term is used in subsection (f) of section 914
1087	1087	38a-493 of the general statutes, to the maximum extent permitted by 915
1088	1088	federal law, except if such plan is used to establish a medical savings 916
1089	1089	account or an Archer MSA pursuant to Section 220 of the Internal 917
1090	1090	Revenue Code of 1986, or any subsequent corresponding internal 918
1091	1091	revenue code of the United States, as amended from time to time, or a 919
1092	1092	health savings account pursuant to Section 223 of said Internal Revenue 920
1093	1093	Code, as amended from time to time. The provisions of this subsection 921
1094	1094	shall apply to such high deductible health plans to the maximum extent 922
1095	1095	that (1) is permitted by federal law, and (2) does not disqualify such 923
1096	1096	account for the deduction allowed under Section 220 or 223, of the 924
1097	1097	Internal Revenue Code of 1986, as applicable. 925
1098	1098	Sec. 36. (NEW) (Effective January 1, 2024) (a) Each group health 926
1099	1099	insurance policy providing coverage of the type specified in 927
1100	1100	subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 of the 928
1101	1101	general statutes delivered, issued for delivery, renewed, amended or 929
1102	1102	continued in this state on or after January 1, 2024, that includes coverage 930
1103	1103	for outpatient prescription drugs shall provide coverage for not less 931
1104	1104	than one epinephrine cartridge injector. 932
1105	1105	(b) No policy described in subsection (a) of this section shall impose 933
1106	1106	a coinsurance, copayment, deductible or other out-of-pocket expense for 934 Raised Bill No. 976
1107	1107
1108	1108
1109	1109
1110	1110	LCO No. 3606 32 of 38
1111	1111
1112	1112	the epinephrine cartridge injector that such policy is required to cover 935
1113	1113	pursuant to said subsection (a) in an amount that exceeds twenty-five 936
1114	1114	dollars. The provisions of this subsection shall apply to a high 937
1115	1115	deductible health plan, as that term is used in subsection (f) of section 938
1116	1116	38a-520 of the general statutes, to the maximum extent permitted by 939
1117	1117	federal law, except if such plan is used to establish a medical savings 940
1118	1118	account or an Archer MSA pursuant to Section 220 of the Internal 941
1119	1119	Revenue Code of 1986, or any subsequent corresponding internal 942
1120	1120	revenue code of the United States, as amended from time to time, or a 943
1121	1121	health savings account pursuant to Section 223 of said Internal Revenue 944
1122	1122	Code, as amended from time to time. The provisions of this subsection 945
1123	1123	shall apply to such high deductible health plans to the maximum extent 946
1124	1124	that (1) is permitted by federal law, and (2) does not disqualify such 947
1125	1125	account for the deduction allowed under Section 220 or 223, of said 948
1126	1126	Internal Revenue Code of 1986, as applicable. 949
1127	1127	Sec. 37. Section 38a-479ooo of the general statutes is repealed and the 950
1128	1128	following is substituted in lieu thereof (Effective January 1, 2024): 951
1129	1129	For the purposes of this part and section 38 of this act: 952
1130	1130	(1) "Commissioner" means the Insurance Commissioner. 953
1131	1131	(2) "Department" means the Insurance Department. 954
1132	1132	(3) "Drug" has the same meaning as provided in section 21a-92. 955
1133	1133	(4) "Health care plan" means an individual or a group health 956
1134	1134	insurance policy that provides coverage of the types specified in 957
1135	1135	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 and includes 958
1136	1136	coverage for outpatient prescription drugs. 959
1137	1137	(5) "Health carrier" means an insurance company, health care center, 960
1138	1138	hospital service corporation, medical service corporation, fraternal 961
1139	1139	benefit society or other entity that delivers, issues for delivery, renews, 962
1140	1140	amends or continues a health care plan in this state. 963
1141	1141	(6) "Person" has the same meaning as provided in section 38a-1, as 964 Raised Bill No. 976
1142	1142
1143	1143
1144	1144
1145	1145	LCO No. 3606 33 of 38
1146	1146
1147	1147	amended by this act. 965
1148	1148	(7) "Pharmacist" has the same meaning as provided in section 38a-966
1149	1149	479aaa. 967
1150	1150	(8) "Pharmacist services" has the same meaning as provided in section 968
1151	1151	38a-479aaa. 969
1152	1152	(9) "Pharmacy" has the same meaning as provided in section 38a-970
1153	1153	479aaa. 971
1154	1154	(10) "Pharmacy benefits manager" or "manager" means any person 972
1155	1155	that administers the prescription drug, prescription device, pharmacist 973
1156	1156	services or prescription drug and device and pharmacist services 974
1157	1157	portion of a health care plan on behalf of a health carrier. 975
1158	1158	(11) (A) "Rebate" means a discount or concession, which affects the 976
1159	1159	price of an outpatient prescription drug, that a pharmaceutical 977
1160	1160	manufacturer directly provides to a (i) health carrier for an outpatient 978
1161	1161	prescription drug manufactured by the pharmaceutical manufacturer, 979
1162	1162	or (ii) pharmacy benefits manager after the manager processes a claim 980
1163	1163	from a pharmacy or a pharmacist for an outpatient prescription drug 981
1164	1164	manufactured by the pharmaceutical manufacturer. 982
1165	1165	(B) "Rebate" does not mean a bona fide service fee, as such term is 983
1166	1166	defined in Section 447.502 of Title 42 of the Code of Federal Regulations, 984
1167	1167	as amended from time to time. 985
1168	1168	(12) "Specialty drug" means a prescription outpatient specialty drug 986
1169	1169	covered under the Medicare Part D program established pursuant to 987
1170	1170	Public Law 108-173, the Medicare Prescription Drug, Improvement, and 988
1171	1171	Modernization Act of 2003, as amended from time to time, that exceeds 989
1172	1172	the specialty tier cost threshold established by the Centers for Medicare 990
1173	1173	and Medicaid Services. 991
1174	1174	Sec. 38. (NEW) (Effective January 1, 2024) On or after January 1, 2024, 992
1175	1175	each contract entered into between a health carrier and a pharmacy 993
1176	1176	benefits manager that requires the pharmacy benefits manager to 994 Raised Bill No. 976
1177	1177
1178	1178
1179	1179
1180	1180	LCO No. 3606 34 of 38
1181	1181
1182	1182	administer the prescription drug, prescription device, pharmacist 995
1183	1183	services or prescription drug and device and pharmacist services 996
1184	1184	portion of a health care plan on behalf of the health carrier shall, if the 997
1185	1185	pharmacy benefits manager utilizes a tiered prescription drug 998
1186	1186	formulary, require the pharmacy benefits manager to include not less 999
1187	1187	than one covered epinephrine cartridge injector in the cost-sharing tier 1000
1188	1188	that imposes the lowest coinsurance, copayment, deductible or other 1001
1189	1189	out-of-pocket expense for covered prescription drugs. 1002
1190	1190	Sec. 39. (NEW) (Effective January 1, 2024) Each individual health 1003
1191	1191	insurance policy providing coverage of the type specified in 1004
1192	1192	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 1005
1193	1193	statutes delivered, issued for delivery, renewed, amended or continued 1006
1194	1194	in this state on or after January 1, 2024, shall provide coverage for rapid 1007
1195	1195	whole genome sequencing for any critically ill child (1) when ordered 1008
1196	1196	by such child's health care provider, and (2) when clinical criteria are 1009
1197	1197	met. 1010
1198	1198	Sec. 40. (NEW) (Effective January 1, 2024) Each group health insurance 1011
1199	1199	policy providing coverage of the type specified in subdivisions (1), (2), 1012
1200	1200	(4), (11) and (12) of section 38a-469 of the general statutes delivered, 1013
1201	1201	issued for delivery, renewed, amended or continued in this state on or 1014
1202	1202	after January 1, 2024, shall provide coverage for rapid whole genome 1015
1203	1203	sequencing for any critically ill child (1) when ordered by such child's 1016
1204	1204	health care provider, and (2) when clinical criteria are met. 1017
1205	1205	Sec. 41. (NEW) (Effective January 1, 2024) Each individual health 1018
1206	1206	insurance policy providing coverage of the type specified in 1019
1207	1207	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 1020
1208	1208	statutes delivered, issued for delivery, renewed, amended or continued 1021
1209	1209	in this state on or after January 1, 2024, shall provide coverage for 1022
1210	1210	prenatal care, postpartum care and costs associated with neonatal 1023
1211	1211	intensive care unit stays. 1024
1212	1212	Sec. 42. (NEW) (Effective January 1, 2024) Each group health insurance 1025
1213	1213	policy providing coverage of the type specified in subdivisions (1), (2), 1026 Raised Bill No. 976
1214	1214
1215	1215
1216	1216
1217	1217	LCO No. 3606 35 of 38
1218	1218
1219	1219	(4), (11) and (12) of section 38a-469 of the general statutes delivered, 1027
1220	1220	issued for delivery, renewed, amended or continued in this state on or 1028
1221	1221	after January 1, 2024, shall provide coverage for prenatal care, 1029
1222	1222	postpartum care and costs associated with neonatal intensive care unit 1030
1223	1223	stays. 1031
1224	1224	Sec. 43. (NEW) (Effective January 1, 2024) Each individual health 1032
1225	1225	insurance policy providing coverage of the type specified in 1033
1226	1226	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 1034
1227	1227	statutes delivered, issued for delivery, renewed, amended or continued 1035
1228	1228	in this state on or after January 1, 2024, shall provide coverage for 1036
1229	1229	gambling disorder treatment. For the purposes of this section, 1037
1230	1230	"gambling disorder" has the same meaning as provided in the most 1038
1231	1231	recent edition of the American Psychiatric Association's "Diagnostic and 1039
1232	1232	Statistical Manual of Mental Disorders". 1040
1233	1233	Sec. 44. (NEW) (Effective January 1, 2024) Each group health insurance 1041
1234	1234	policy providing coverage of the type specified in subdivisions (1), (2), 1042
1235	1235	(4), (11) and (12) of section 38a-469 of the general statutes delivered, 1043
1236	1236	issued for delivery, renewed, amended or continued in this state on or 1044
1237	1237	after January 1, 2024, shall provide coverage for gambling disorder 1045
1238	1238	treatment. For the purposes of this section, "gambling disorder" has the 1046
1239	1239	same meaning as provided in the most recent edition of the American 1047
1240	1240	Psychiatric Association's "Diagnostic and Statistical Manual of Mental 1048
1241	1241	Disorders". 1049
1242	1242	Sec. 45. (NEW) (Effective January 1, 2024) (a) As used in this section: 1050
1243	1243	(1) "Biomarker" means a characteristic, including, but not limited to, 1051
1244	1244	a gene mutation or protein expression that can be objectively measured 1052
1245	1245	and evaluated as an indicator of normal biological processes, pathogenic 1053
1246	1246	processes or pharmacologic responses to a specific therapeutic 1054
1247	1247	intervention for a disease or condition. 1055
1248	1248	(2) "Biomarker testing" means the analysis of a patient's tissue, blood 1056
1249	1249	or other biospecimen for the presence of a biomarker, including, but not 1057
1250	1250	limited to, tests for a single substance, tests for multiple substances, 1058 Raised Bill No. 976
1251	1251
1252	1252
1253	1253
1254	1254	LCO No. 3606 36 of 38
1255	1255
1256	1256	diseases or conditions and whole genome sequencing. 1059
1257	1257	(b) Each individual health insurance policy providing coverage of the 1060
1258	1258	type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 1061
1259	1259	of the general statutes delivered, issued for delivery, renewed, amended 1062
1260	1260	or continued in this state on or after January 1, 2024, shall provide 1063
1261	1261	coverage for biomarker testing for the purpose of diagnosis, treatment, 1064
1262	1262	appropriate management or ongoing monitoring of an insured's disease 1065
1263	1263	or condition. 1066
1264	1264	Sec. 46. (NEW) (Effective January 1, 2024) (a) As used in this section: 1067
1265	1265	(1) "Biomarker" means a characteristic, including, but not limited to, 1068
1266	1266	a gene mutation or protein expression that can be objectively measured 1069
1267	1267	and evaluated as an indicator of normal biological processes, pathogenic 1070
1268	1268	processes or pharmacologic responses to a specific therapeutic 1071
1269	1269	intervention for a disease or condition. 1072
1270	1270	(2) "Biomarker testing" means the analysis of a patient's tissue, blood 1073
1271	1271	or other biospecimen for the presence of a biomarker, including, but not 1074
1272	1272	limited to, tests for a single substance, tests for multiple substances, 1075
1273	1273	diseases or conditions and whole genome sequencing. 1076
1274	1274	(b) Each group health insurance policy providing coverage of the 1077
1275	1275	type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 1078
1276	1276	of the general statutes delivered, issued for delivery, renewed, amended 1079
1277	1277	or continued in this state on or after January 1, 2024, shall provide 1080
1278	1278	coverage for biomarker testing for the purpose of diagnosis, treatment, 1081
1279	1279	appropriate management or ongoing monitoring of an insured's disease 1082
1280	1280	or condition. 1083
1281	1281	This act shall take effect as follows and shall amend the following
1282	1282	sections:
1283	1283
1284	1284	Section 1 January 1, 2024 38a-1
1285	1285	Sec. 2 January 1, 2024 New section
1286	1286	Sec. 3 January 1, 2024 New section
1287	1287	Sec. 4 January 1, 2024 New section Raised Bill No. 976
1288	1288
1289	1289
1290	1290
1291	1291	LCO No. 3606 37 of 38
1292	1292
1293	1293	Sec. 5 January 1, 2024 New section
1294	1294	Sec. 6 January 1, 2024 New section
1295	1295	Sec. 7 January 1, 2024 New section
1296	1296	Sec. 8 January 1, 2024 New section
1297	1297	Sec. 9 January 1, 2024 38a-503e(a)
1298	1298	Sec. 10 January 1, 2024 38a-530e(a)
1299	1299	Sec. 11 January 1, 2024 New section
1300	1300	Sec. 12 January 1, 2024 New section
1301	1301	Sec. 13 January 1, 2024 New section
1302	1302	Sec. 14 January 1, 2024 New section
1303	1303	Sec. 15 January 1, 2024 New section
1304	1304	Sec. 16 January 1, 2024 New section
1305	1305	Sec. 17 January 1, 2024 New section
1306	1306	Sec. 18 January 1, 2024 New section
1307	1307	Sec. 19 January 1, 2024 New section
1308	1308	Sec. 20 January 1, 2024 New section
1309	1309	Sec. 21 January 1, 2024 New section
1310	1310	Sec. 22 January 1, 2024 New section
1311	1311	Sec. 23 January 1, 2024 38a-504
1312	1312	Sec. 24 January 1, 2024 38a-542
1313	1313	Sec. 25 January 1, 2024 38a-492k
1314	1314	Sec. 26 January 1, 2024 38a-518k
1315	1315	Sec. 27 January 1, 2024 New section
1316	1316	Sec. 28 January 1, 2024 New section
1317	1317	Sec. 29 January 1, 2024 New section
1318	1318	Sec. 30 January 1, 2024 New section
1319	1319	Sec. 31 January 1, 2024 New section
1320	1320	Sec. 32 January 1, 2024 New section
1321	1321	Sec. 33 January 1, 2024 New section
1322	1322	Sec. 34 January 1, 2024 New section
1323	1323	Sec. 35 January 1, 2024 New section
1324	1324	Sec. 36 January 1, 2024 New section
1325	1325	Sec. 37 January 1, 2024 38a-479ooo
1326	1326	Sec. 38 January 1, 2024 New section
1327	1327	Sec. 39 January 1, 2024 New section
1328	1328	Sec. 40 January 1, 2024 New section
1329	1329	Sec. 41 January 1, 2024 New section
1330	1330	Sec. 42 January 1, 2024 New section
1331	1331	Sec. 43 January 1, 2024 New section
1332	1332	Sec. 44 January 1, 2024 New section
1333	1333	Sec. 45 January 1, 2024 New section Raised Bill No. 976
1334	1334
1335	1335
1336	1336
1337	1337	LCO No. 3606 38 of 38
1338	1338
1339	1339	Sec. 46 January 1, 2024 New section
1340	1340
1341	1341	Statement of Purpose:
1342	1342	To require certain health insurance coverage for individual and group
1343	1343	health insurance policies in this state.
1344	1344	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
1345	1345	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
1346	1346	underlined.]
1347	1347