The national guide covers plan designs (indemnity, HMO, PPO, EPO, POS), cost-sharing, HSAs and FSAs. Connecticut layers its own mandated benefits, prompt-pay rules and an external review process on top, mostly in Conn. Gen. Stat. 38a-476 to 38a-591. This page covers those Connecticut rules.

Connecticut mandated benefits

• Newborns are covered from the moment of birth, including congenital defects (38a-490). The policy may require notice and any added premium within 91 days after birth (38a-490(c) individual, 38a-516(c) group).
• Adopted children are covered once placed for adoption, before it is finalized (38a-508).
• Dependent children stay covered at least until the policy anniversary after they turn 26 (38a-497).
• A disabled dependent stays covered past that age if proof is given within 31 days. After two years, the insurer may ask for proof only once a year (38a-489).
• Mammograms: a baseline between 35 and 39, then annually from 40 (38a-503).
• Chiropractic care is covered to the same extent as physician services for conditions within the chiropractor's license (38a-507).
• Infertility: coverage may be limited to four cycles of ovulation induction, three of intrauterine insemination and two of IVF (38a-509 individual, 38a-536 group).
• Mental health conditions are defined by reference to the current DSM (38a-488a).
• Alcoholism complications such as cirrhosis, GI bleeding, pneumonia and delirium tremens are covered as medical conditions (38a-533).
• No preexisting-condition exclusions in group or individual health plans. Pregnancy is never a preexisting condition (38a-476).

Health care centers (HMOs)

• Connecticut calls HMOs health care centers. Their contracts must state a grace period of at least 10 days (38a-182(b)(16)).

Specified disease and limited policies

• Specified disease policies may impose a waiting period of no more than 30 days. If the disease is diagnosed during the waiting period, the premium is refunded (Reg. 38a-505-13).
• The Medicaid warning appears above the applicant's signature in bold or contrasting type.
• Accident-only policies state that fact on the first page, in contrasting color or boldface (Reg. 38a-505-10).

Claims and appeals

• Prompt pay (38a-816(15)):
  • clean claims paid within 20 days if filed electronically, 60 days on paper
  • late payments carry 15% annual interest
• External review (38a-591g):
  • Request it in writing to the Insurance Commissioner within 120 days of the adverse determination notice.
  • Internal grievances must be used first unless an exception applies or the carrier waives the requirement.
  • The health carrier pays for the independent review.

Underwriting limits

• Individuals of the same class can't be charged different rates or given different benefits (38a-488).
• Health coverage can't be refused, limited or rated because of genetic information or because the person is a victim of domestic violence (38a-816(18), (20)).
• Every insurer, health care center and self-insurer doing business in Connecticut must be a member of the Health Reinsurance Association (38a-556).

Public programs

• HUSKY is Connecticut's Medicaid and children's health brand (17b-290):
  • HUSKY B covers children under 19 in families from just above 196% up to 318% of the federal poverty level.
  • HUSKY C is Medicaid for people 65+, blind or disabled.
  • HUSKY D covers low-income adults aged 18 to 64.

Exam traps

• 91 days to enroll a newborn (not 31). 31 days for disabled-dependent proof.
• Prompt pay is 20 days electronic and 60 days paper, with 15% interest.
• External review: request within 120 days, filed with the Commissioner, paid for by the carrier.
• No preexisting-condition exclusions at all in Connecticut health plans.