House bill mandating infertility insurance be offered

Notwithstanding any other provision of this section, any insurance company, hospital service corporation, medical service corporation or health care center that is owned, operated or substantially controlled by a religious organization that has religious or moral tenets that conflict with the requirements of this section may provide for the coverage of prescription contraceptive methods as required under this section through another such entity offering a limited benefit plan.

The cost, terms and availability of such coverage shall not differ from the cost, terms and availability of other prescription coverage offered to the insured.(a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state [that provides coverage for outpatient prescription drugs approved by the federal Food and Drug Administration shall not exclude coverage for prescription contraceptive methods approved by the federal Food and Drug Administration.(2) If a contraceptive method described in subdivision (1) of this subsection is prescribed by a licensed physician, physician assistant or advanced practice registered nurse, a twelve-month supply of such contraceptive method dispensed at one time or at multiple times, provided an insured shall not be entitled to receive a twelve-month supply of such contraceptive method more than once during any plan year;(4) Counseling in (A) contraceptive methods approved by the federal Food and Drug Administration, and (B) the proper use of contraceptive methods approved by the federal Food and Drug Administration; and(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the methods and services required under subsection (a) of this section, except that any such policy that uses a provider network may require cost-sharing when such methods and services are rendered by an out-of-network provider.

Because of the federal Employee Retirement Income Security Act (ERISA), state insurance benefit mandates do not apply to self-insured benefit plans.

To the extent an existing state insurance law requires coverage of a health service or benefit that conflicts with the scope of an essential health benefit, the bill requires a policy to cover the service or benefit that provides greater coverage to the insured person, as determined by the insurance commissioner.

Act 34 provides that the documentation submitted to the Council by supporters and opponents of a proposed mandated benefit should address eight specific areas.

In reviewing these eight points, Council staff performs a preliminary review to determine whether the information received is sufficient to warrant the formal Mandated Benefits Review process outlined in the Act.

It generally requires policies to cover these services in full with no cost sharing (such as coinsurance, copayments, or deductibles), except for high deductible plans designed to be compatible with federally qualified health savings accounts.

Policies may impose cost sharing on contraceptive methods and services rendered by an out-of-network provider.

The cost, terms and availability of such coverage shall not differ from the cost, terms and availability of other prescription coverage offered to the insured.

(b) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, amended, renewed or continued in this state on or after January 1, 2019, shall provide coverage for essential health benefits.(c) If a policy described in subsection (b) of this section is required to provide coverage for any health care service or benefit pursuant to chapter 700c of the general statutes, and the scope of such health care service or benefit conflicts with the scope of an essential health benefit that such policy is required to cover pursuant to subsection (b) of this section, such policy shall provide coverage for the health care service or benefit that, in the opinion of the Insurance Commissioner, provides greater coverage to the insured.(d) No provision of the general statutes concerning a requirement of the Patient Protection and Affordable Care Act, P. 111-148, as amended from time to time, shall be construed to supersede any provision of this section that provides greater protection to an insured, except to the extent this section prevents the application of a requirement of the Affordable Care Act.(e) The Insurance Commissioner may adopt regulations, in accordance with chapter 54 of the general statutes, to carry out the purposes of this section, including, but not limited to, regulations specifying the health care services and benefits that fall within each category set forth in subsection (a) of this section.(b) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, amended, renewed or continued in this state on or after January 1, 2019, shall provide coverage for essential health benefits.(c) If a policy described in subsection (b) of this section is required to provide coverage for any health care service or benefit pursuant to chapter 700c of the general statutes, and the scope of such health care service or benefit conflicts with the scope of an essential health benefit that such policy is required to cover pursuant to subsection (b) of this section, such policy shall provide coverage for the health care service or benefit that, in the opinion of the Insurance Commissioner, provides greater coverage to the insured.(d) No provision of the general statutes concerning a requirement of the Patient Protection and Affordable Care Act, P. 111-148, as amended from time to time, shall be construed to supersede any provision of this section that provides greater protection to an insured, except to the extent this section prevents the application of a requirement of the Affordable Care Act.(e) The Insurance Commissioner may adopt regulations, in accordance with chapter 54 of the general statutes, to carry out the purposes of this section, including, but not limited to, regulations specifying the health care services and benefits that fall within each category set forth in subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible plan as that term is used in subsection (f) of section 38a-493 of the general statutes. The provisions of this subsection shall not apply to a high deductible plan as that term is used in subsection (f) of section 38a-493 of the general statutes. The provisions of this subsection shall not apply to a high deductible plan as that term is used in subsection (f) of section 38a-493 of the general statutes. The provisions of this subsection shall not apply to a high deductible plan as that term is used in subsection (f) of section 38a-493 of the general statutes. The provisions of this subsection shall not apply to a high deductible plan as that term is used in subsection (f) of section 38a-493 of the general statutes. The provisions of this subsection shall not apply to a high deductible plan as that term is used in subsection (f) of section 38a-493 of the general statutes.(a) No individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state shall include a lifetime limit on the dollar value of benefits for a covered individual, for covered benefits that are essential health benefits, as defined in (a) No group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state shall include a lifetime limit on the dollar value of benefits for a covered individual, for covered benefits that are essential health benefits, as defined in (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state [that provides coverage for outpatient prescription drugs approved by the federal Food and Drug Administration shall not exclude coverage for prescription contraceptive methods approved by the federal Food and Drug Administration.(2) If a contraceptive method described in subdivision (1) of this subsection is prescribed by a licensed physician, physician assistant or advanced practice registered nurse, a twelve-month supply of such contraceptive method dispensed at one time or at multiple times, provided an insured shall not be entitled to receive a twelve-month supply of such contraceptive method more than once during any plan year;(4) Counseling in (A) contraceptive methods approved by the federal Food and Drug Administration, and (B) the proper use of contraceptive methods approved by the federal Food and Drug Administration; and(b) No policy described in subsection (a) of this section shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the methods and services required under subsection (a) of this section, except that any such policy that uses a provider network may require cost-sharing when such methods and services are rendered by an out-of-network provider.

(NEW) (Effective January 1, 2019) (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for:(4) Breast cancer chemoprevention counseling for any woman who is at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by such woman's physician or advanced practice registered nurse;(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. (NEW) (Effective January 1, 2019) (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for:(4) Breast cancer chemoprevention counseling for any woman who is at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by such woman's physician or advanced practice registered nurse;(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. (NEW) (Effective January 1, 2019) (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for prescription drugs shall provide coverage for immunizations recommended by the American Academy of Pediatrics, American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. (NEW) (Effective January 1, 2019) (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for prescription drugs shall provide coverage for immunizations recommended by the American Academy of Pediatrics, American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. (NEW) (Effective January 1, 2019) (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for preventive care and screenings for individuals twenty-one years of age or younger in accordance with the most recent edition of the American Academy of Pediatrics' "Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents".(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. (NEW) (Effective January 1, 2019) (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for preventive care and screenings for individuals twenty-one years of age or younger in accordance with the most recent edition of the American Academy of Pediatrics' "Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents".(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section.

These include, for example, immunizations for influenza, meningitis, tetanus, HPV, hepatitis A and B, measles, mumps, rubella, and varicella.

The bill requires health insurance policies to cover preventive services for people age 21 or younger in accordance with the most recent edition of the American Academy of Pediatrics' Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.

Leave a Reply