Connecticut § 38a-511 Copayments re in-network imaging services.

Connecticut Statutes

§ 38a-511 — Copayments re in-network imaging services.

Connecticut·Title 38a Insurance·Ch. 700c Health Insurance

(a)No health insurer, health care center, hospital service corporation, medical service corporation or fraternal benefit society that provides coverage under an individual health insurance policy or contract for magnetic resonance imaging or computed axial tomography may (1) require total copayments in excess of three hundred seventy-five dollars for all such in-network imaging services combined annually, or (2) require a copayment in excess of seventy-five dollars for each in-network magnetic resonance imaging or computed axial tomography, provided the physician ordering the radiological services and the physician rendering such services are not the same person or are not participating in the same group practice.

(b)No health insurer, health care center, hospital service corporation, me

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(a) No health insurer, health care center, hospital service corporation, medical service corporation or fraternal benefit society that provides coverage under an individual health insurance policy or contract for magnetic resonance imaging or computed axial tomography may (1) require total copayments in excess of three hundred seventy-five dollars for all such in-network imaging services combined annually, or (2) require a copayment in excess of seventy-five dollars for each in-network magnetic resonance imaging or computed axial tomography, provided the physician ordering the radiological services and the physician rendering such services are not the same person or are not participating in the same group practice. (b) No health insurer, health care center, hospital service corporation, medical service corporation or fraternal benefit society that provides coverage under an individual health insurance policy or contract for positron emission tomography may (1) require total copayments in excess of four hundred dollars for all such in-network imaging services combined annually, or (2) require a copayment in excess of one hundred dollars for each in-network positron emission tomography, provided the physician ordering the radiological service and the physician rendering such service are not the same person or are not participating in the same group practice. (c) The provisions of subsections (a) and (b) of this section shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 and a copayment-only health plan. For purposes of this section, “copayment-only health plan” means a health plan that imposes a specific dollar amount to be paid by the insured for a health care service or prescription drug paid for or reimbursed by such health plan. “Copayment-only health plan” does not include deductibles or coinsurance. See Sec. 38a-550 for similar provisions re group policies.

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Legislative History

(P.A. 06-180, S. 1; 07-54, S. 3; P.A. 10-5, S. 25; P.A. 18-68, S. 14; July Sp. Sess. P.A. 20-4, S. 25; P.A. 24-81, S. 101.) History: P.A. 07-54 made technical changes in Subsecs. (a) and (b), effective May 22, 2007; P.A. 10-5 replaced reference to Sec. 38a-520 with reference to Sec. 38a-493 in Subsec. (c), effective May 5, 2010; P.A. 18-68 made a technical change in Subsec. (c); July Sp. Sess. P.A. 20-4 amended Subsec. (c) by substituting “high deductible health plan” for “high deductible plan”; P.A. 24-81 amended Subsec. (c) by defining copayment-only health plan and providing that copayment-only health plans shall not be subject to the provisions set forth in said section, effective January 1, 2025.