§ 38a-505 — (Formerly Sec. 38-378). Insurance Commissioner's powers concerning comprehensive health care plans. Disclosures.

In order to provide reasonable simplification of terms and coverages of individual health insurance policies, to facilitate public understanding and comparison, to eliminate provisions that may be misleading or unreasonably confusing in connection with either the purchase of such coverage or with the settlement of claims and to provide for full disclosure in the sale of such coverages: (1) The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to establish specific standards for policy provisions used in individual health insurance policies, that shall be in addition to and in accordance with sections 38a-80 , 38a-321 to 38a-324 , inclusive, 38a-326 , 38a-329 , 38a-334 to 38a-336a , inclusive, 38a-338 to 38a-358 , inclusive, 38a-470 to 38a-472 , inclusive, 38a-475 , 38a-480 to 38a-503 , inclusive, 38a-507 , 38a-514 , 38a-519 , 38a-523 , 38a-531 , 38a-577 to 38a-590 , inclusive, and 38a-802 to 38a-810 , inclusive, and other applicable laws of this state that may cover the terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, termination of insurance, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacements, recurrent conditions, preexisting conditions, and the definition of the terms hospital, accident, sickness, injury, physician, accidental means, total disability, permanent disability, partial disability, nervous disorders, guaranteed renewable and noncancellable. (2) The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, that specify prohibited policy provisions not otherwise specifically authorized by statute that in the opinion of the commissioner are unjust, unfair or unfairly discriminatory to the policyholder, any person insured under the policy or any beneficiary. (3) The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to establish minimum standards for benefits under each of the following categories of coverage in individual policies: Basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income protection coverage, accident only coverage, specified accident coverage and specified disease coverage. (4) Nothing in this section shall preclude the issuance of any policy that combines two or more of the categories of coverage enumerated in subdivision (3) of this section, except that specified accident coverage shall not be combined with any other category of coverage. The commissioner shall prescribe the method of identification of policies based upon coverage provided. (5) No policy shall be delivered or issued for delivery in this state that does not meet the prescribed minimum standards for the categories of coverage listed in subdivision (3) of this section, provided nothing in this section shall preclude the delivery or issuance of any policy that does not meet such prescribed minimum standards of coverage so long as such policy is clearly identified as not meeting such prescribed standards. (6) No such policy shall be delivered in this state unless: (A) An outline of coverage described herein accompanies the policy or (B) the outline of coverage described in this section is delivered to the applicant at the time application is made and acknowledgment of receipt of certificate of delivery of such outline is provided the carrier with the application. In the event the policy is issued on a basis other than that applied for, the outline of coverage properly describing the policy shall accompany the policy when it is delivered. The outline of coverage shall include: (i) A statement identifying the applicable category or categories of coverage provided by the policy in accordance with this section; (ii) a description of the principal benefits and coverage provided in the policy; (iii) a statement of the exceptions, reductions and limitations contained in the policy or contract; (iv) a statement of the renewal provisions including any reservation by the carrier of a right to change premiums; and (v) a statement that the outline is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions. (7) Regulations promulgated pursuant to this section shall specify an effective date applicable to policy and benefit riders delivered or issued for delivery in this state on and after such effective date that shall not be less than one hundred eighty days after the date of adoption or promulgation.

Legislative History

(P.A. 75-616, S. 8, 12; P.A. 76-399, S. 4, 5; P.A. 90-200, S. 2; 90-243, S. 155; P.A. 93-297, S. 22, 23, 29; P.A. 08-181, S. 5; P.A. 15-247, S. 10; P.A. 17-15, S. 58.) History: P.A. 76-399 clarified prohibition of specific disease policies in Subsec. (c) to specify “riders and benefits” and “whether issued on a group or individual basis”; P.A. 90-200 amended Subsec. (c) to allow the issuance of specified disease policies for accelerated benefits of life insurance policies provided the commissioner adopts regulations re minimum standards for issuance; P.A. 90-243 substituted “health insurance policies” for “accident and sickness contracts” and deleted the reference to “contracts”; Sec. 38-378 transferred to Sec. 38a-505 in 1991; P.A. 93-297 added references to Sec. 38a-336a in Subsecs. (a) and (g), effective January 1, 1994, and applicable to acts or omissions occurring on or after said date; P.A. 08-181 amended Subsec. (c) by deleting prohibition on sale of specified disease policies, riders and benefits and adding specified disease coverage to list of individual policies for which commissioner is directed to adopt regulations, effective June 12, 2008; P.A. 15-247 redesignated existing Subsecs. (a) to (f) and (h) as Subdivs. (1) to (7), respectively, amended redesignated Subdiv. (1) by adding reference to Ch. 54 and deleting reference to group conversion policies, amended redesignated Subdiv. (3) by deleting reference to conversion policies, deleted former Subsec. (g) re use of simplified application form, and made technical and conforming changes, effective July 10, 2015; P.A. 17-15 made technical changes in Subdivs. (2), (3) and (5).