Health Insurance, final third

What this document is

Connecticut General Statutes Chapter 700c - Health Insurance, final third (Secs. 38a-518s through 38a-591o) is a state statute published by Connecticut General Assembly (cga.ct.gov). It is one of the Connecticut documents that insurance license exam questions are written from, including connecticut life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• Conn. Gen. Stat. Chapter 700c § 38a-591g(i)(3) (External Reviews: Carrier Action on Reversal)

  “Upon the receipt of a notice of the independent review organization's decision to reverse or revise an adverse determination or a final adverse determination, the health carrier shall immediately approve the coverage that was the subject of the adverse determination or the final adverse determination.”

• Conn. Gen. Stat. Chapter 700c § 38a-591e(c)(1)(B) (Internal Grievance Process: Clinical Peer Designation)

  “If the adverse determination involves utilization review, the health carrier shall designate an appropriate clinical peer or peers to review such adverse determination. Such clinical peer or peers shall not have been involved in the initial adverse determination.”

• Conn. Gen. Stat. Chapter 700c § 38a-528(b)(2)(B)(iii) (Deemed Election Where Certificate Holder Does Not Respond to Rate Increase Notice)

  “Include a statement in such notice that if a certificate holder fails to elect a reduction in policy benefits or coverage that reflects the minimum set of affordable benefit options developed by the commissioner pursuant to section 38a-475a by the end of the notice period and has not cancelled the...”

• Conn. Gen. Stat. Chapter 700c § 38a-591g(a)(2) (External Reviews: Cost of Independent Review Organization)

  “The health carrier that issued the adverse determination or the final adverse determination that is the subject of the external review request or the expedited external review request shall pay the independent review organization for the cost of conducting the review.”

• Conn. Gen. Stat. Chapter 700c § 38a-528(a)(1) (Group Long-Term Care Policies: Definition and Required Benefits)

  “A long-term care policy shall provide benefits for confinement in a nursing home or confinement in the insured's own home or both. Any additional benefits provided shall be related to long-term treatment of an injury, illness or loss of functional capacity.”

• Conn. Gen. Stat. Chapter 700c § 38a-522(b) (Medicare Supplement Policies: Disclosure of Supplementing or Duplicating Coverage)

  “No such company, society, corporation or center may deliver or issue for delivery any Medicare supplement policy without providing, at the time of solicitation or application for the purchase or sale of such coverage, full and fair disclosure of any coverage supplementing or duplicating Medicare benefits.”

• Conn. Gen. Stat. Chapter 700c § 38a-522(c) (Medicare Supplement Policies: Home Health Aide Services Coverage)

  “Each Medicare supplement policy shall provide coverage for home health aide services for each individual covered under the policy when such services are not paid for by Medicare, provided (1) such services are provided by a certified home health aide employed by a home health care agency licensed...”

• Conn. Gen. Stat. Chapter 700c § 38a-522(e) (Medicare Supplement Policies: Mammographic Examination Benefit)

  “each Medicare supplement policy delivered, issued for delivery, continued or renewed in this state on or after October 1, 1988, shall provide benefits, to any woman covered under the policy, for mammographic examinations every year, or more frequently if recommended by the woman's physician,...”

• Conn. Gen. Stat. Chapter 700c § 38a-528(a)(2)(B) (Claims Submitted or Prepared by a Managed Residential Community)

  “No insurance company, fraternal benefit society, hospital service corporation, medical service corporation or health care center delivering, issuing for delivery, renewing, continuing or amending any long-term care policy in this state may refuse to accept, or refuse to make reimbursement pursuant...”

• Conn. Gen. Stat. Chapter 700c § 38a-534 (Coverage for services performed by chiropractors)

  “Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6) and (11) of section 38a-469 , delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for services rendered by a chiropractor licensed under...”

• Conn. Gen. Stat. Chapter 700c § 38a-549(a) (Coverage for Adopted Children)

  “Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (10), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state shall provide coverage for a child legally placed for adoption with an...”

• Conn. Gen. Stat. Chapter 700c § 38a-537(c) (Wage deductions taken but coverage not procured)

  “Any individual, partnership, corporation or unincorporated association that makes deductions from an employee's wages for group health insurance coverage and fails to procure such coverage shall be liable for benefits to the same extent as the insurer, hospital service corporation, medical service...”

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More Connecticut sources

• Conn. Gen. Stat. Ch. 700c - Health InsuranceState statute
• Conn. Gen. Stat. Ch. 701a - Insurance Producers, Agents and Third-Party AdministratorsState statute
• Conn. Gen. Stat. Chapter 702 - LicensingState statute
• Conn. Gen. Stat. Ch. 704 - Unfair and Prohibited Practices (Unfair Insurance Practices Act)State statute
• Connecticut General Statutes Chapter 698a - Health Care and Related Service Groups (Secs. 38a-175 through 38a-225)State statute
• Connecticut General Statutes Chapter 699 - Insurance Contracts in General (Secs. 38a-283 through 38a-291)State statute
• Connecticut General Statutes Chapter 699a - Readable Language in Insurance Policies (Secs. 38a-295 through 38a-300)State statute
• Connecticut General Statutes Chapter 700b - Life Insurance, Annuities, Burial Contracts and Life Settlements (Secs. 38a-430 through 38a-465q)State statute