§ 38a-503f — Mandatory coverage for certain health benefits and services for women, infants, children and adolescents and certain evidence-based items or services for individuals.

(a)(1) Except as provided in subdivision (2) of this subsection, each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for the following benefits and services: (A) Domestic and interpersonal violence screening and counseling for any woman; (B) Tobacco use intervention and cessation counseling for any woman who consumes tobacco; (C) Well-woman visits for any woman who is younger than sixty-five years of age; (D) Breast cancer chemoprevention counseling for any woman who is at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by such woman's physician or advanced practice registered nurse; (E) Breast cancer risk assessment, genetic testing and counseling; (F) Chlamydia infection screening for any sexually-active woman; (G) Cervical and vaginal cancer screening for any sexually-active woman; (H) Gonorrhea screening for any sexually-active woman; (I) Human immunodeficiency virus screening for any sexually-active woman; (J) Human papillomavirus screening for any woman with normal cytology results who is thirty years of age or older; (K) Sexually transmitted infections counseling for any sexually-active woman; (L) Anemia screening for any pregnant woman and any woman who is likely to become pregnant; (M) Folic acid supplements for any pregnant woman and any woman who is likely to become pregnant; (N) Hepatitis B screening for any pregnant woman; (O) Rhesus incompatibility screening for any pregnant woman and follow-up rhesus incompatibility testing for any pregnant woman who is at increased risk for rhesus incompatibility; (P) Syphilis screening for any pregnant woman and any woman who is at increased risk for syphilis; (Q) Urinary tract and other infection screening for any pregnant woman; (R) Breastfeeding support and counseling for any pregnant or breastfeeding woman; (S) Breastfeeding supplies, including, but not limited to, a breast pump for any breastfeeding woman; (T) Gestational diabetes screening for any woman who is twenty-four to twenty-eight weeks pregnant and any woman who is at increased risk for gestational diabetes; (U) Osteoporosis screening for any woman who is sixty years of age or older; (V) Such additional evidence-based items or services not described in subparagraphs (A) to (U), inclusive, of this subdivision that receive a rating of “A” or “B” in any recommendations of the United States Preventive Services Task Force effective after January 1, 2018; and (W) With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the United States Health Resources and Services Administration, as effective on January 1, 2018, and such additional preventive care and screenings provided for in any comprehensive guidelines supported by said administration and effective after January 1, 2018. (2) No policy described in subdivision (1) of this subsection shall be required to provide coverage for any benefit or service described in subparagraphs (A) to (U), inclusive, of said subdivision unless such benefit or service is an evidence-based item or service that had a rating of “A” or “B” in the recommendations of the United States Preventive Services Task Force as such recommendations were in effect on January 1, 2018. (b) No policy described in subsection (a) of this section shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under said subsection. The provisions of this subsection shall apply to a high deductible health plan, as that term is used in subsection (f) of section 38a-493 , to the maximum extent permitted by federal law, except if such plan is used to establish a medical savings account or an Archer MSA pursuant to Section 220 of the Internal Revenue Code of 1986 or any subsequent corresponding internal revenue code of the United States, as amended from time to time, or a health savings account pursuant to Section 223 of said Internal Revenue Code, as amended from time to time, the provisions of this subsection shall apply to such plan to the maximum extent that (1) is permitted by federal law, and (2) does not disqualify such account for the deduction allowed under said Section 220 or 223, as applicable. Nothing in this section shall preclude a policy that provides the coverage required under subsection (a) of this section and uses a provider network from imposing cost-sharing requirements for any benefit or service required under said subsection (a) that is delivered by an out-of-network provider. See Sec. 38a-530f for similar provisions re group policies.

Legislative History

(P.A. 18-10, S. 3; July Sp. Sess. P.A. 20-4, S. 24.) History: P.A. 18-10 effective January 1, 2019; July Sp. Sess. P.A. 20-4 amended Subsec. (b) by substituting “high deductible health plan” for “high deductible plan”, adding reference to medical savings account and Archer MSA, and making technical and conforming changes.