Connecticut § 38a-525a Prior authorization prohibited for certain 9-1-1 emergency calls or transporting enrollee to a hospital by ambulance when medically necessary. Denial of payment to ambulance provider responding to 9-1-1 local prehospital emergency medical service system call prohibited on basis that enrollee did not obtain approval prior to calling such system or transporting such enrollee when medically necessary by ambulance to a hospital.

Connecticut Statutes

§ 38a-525a — Prior authorization prohibited for certain 9-1-1 emergency calls or transporting enrollee to a hospital by ambulance when medically necessary. Denial of payment to ambulance provider responding to 9-1-1 local prehospital emergency medical service system call prohibited on basis that enrollee did not obtain approval prior to calling such system or transporting such enrollee when medically necessary by ambulance to a hospital.

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

(a)No group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 38a-469, delivered, issued for delivery or renewed in this state, on or after January 1, 2025, shall direct or require an enrollee to obtain approval from the insurer or health care center prior to (1) calling a 9-1-1 local prehospital emergency medical service system whenever such enrollee is confronted with a life or limb threatening emergency, or (2) transporting such enrollee when medically necessary by ambulance to a hospital. For purposes of this section, a “life or limb threatening emergency” means any event which the enrollee believes threatens such enrollee's life or limb in such a manner that a need for immediate medical care is created

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(a) No group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 38a-469, delivered, issued for delivery or renewed in this state, on or after January 1, 2025, shall direct or require an enrollee to obtain approval from the insurer or health care center prior to (1) calling a 9-1-1 local prehospital emergency medical service system whenever such enrollee is confronted with a life or limb threatening emergency, or (2) transporting such enrollee when medically necessary by ambulance to a hospital. For purposes of this section, a “life or limb threatening emergency” means any event which the enrollee believes threatens such enrollee's life or limb in such a manner that a need for immediate medical care is created to prevent death or serious impairment of health. (b) No insurer or health care center subject to the provisions of subsection (a) of this section shall deny payment to any ambulance provider responding to a 9-1-1 local prehospital emergency medical service system call on the basis that the enrollee did not obtain approval from such insurer or health care center prior to calling such emergency medical service system or prior to transporting such enrollee when medically necessary by ambulance to a hospital. See Sec. 38a-498a for similar provisions re individual policies.

Connecticut § 38a-525a (Prior authorization prohibited for certain 9-1-1 emergency calls or transporting enrollee to a hospital by ambulance when medically necessary. Denial of payment to ambulance provider responding to 9-1-1 local prehospital emergency medical service system call prohibited on basis that enrollee did not obtain approval prior to calling such system or transporting such enrollee when medically necessary by ambulance to a hospital.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Legislative History

(P.A. 96-67, S. 2; P.A. 24-19, S. 35.) History: (Revisor's note: In codifying public act 96-67, an incorrect reference to “of subsection (a)” appearing before the reference to “section 38a-469” was deleted editorially by the Revisors); P.A. 24-19 designated existing provisions as Subsec. (a) and amended same by replacing “October 1, 1996” with “January 1, 2025”, inserting Subdiv. (1) designator and adding Subdiv. (2) prohibiting prior approval for transporting enrollee to hospital by ambulance when medically necessary and added Subsec. (b) prohibiting denial of payment to ambulance provider responding to 9-1-1 local prehospital emergency medical service system call on basis that enrollee did not obtain approval prior to calling such system or transporting such enrollee when medically necessary by ambulance to hospital, effective January 1, 2025.