1999 Legislation Affecting Health Insurance

CT state seal STATE OF CONNECTICUT INSURANCE DEPARTMENT Bulletin HC-55 October 22, 1999 TO: ALL INSURERS LICENSED TO WRITE ACCIDENT AND HEALTH INSURANCE AND ALL HEALTH CARE CENTERS RE: 1999 LEGISLATION AFFECTING HEALTH INSURANCE This year's session of the Connecticut General Assembly resulted in several important measures affecting health insurance, particularly managed care products. This bulletin is intended to call your attention to some of the issues raised by these laws. Treatment of Lyme Disease Carriers should be aware that the provisions of sections 47 and 48 of Public Act 99-284 regarding Lyme disease were amended by sections 2 and 3 of Public Act 99-2 of the June Special Session. As amended, the new laws make it clear that policies must cover basic levels of antibiotic therapy for the treatment of Lyme disease. Technically, the statutes apply to individual and group policies delivered, issued for delivery, renewed or continued on or after January 1, 2000. It is clear, however, that the intent of this legislation is to provide an immediate means of resolving disputes in the best interests of insureds and companies. Consequently, it is my hope that you will honor the spirit and intent of this legislation by acting responsibly to implement its provisions with respect to all existing contracts and new contracts on or before January 1. Any coverage for the treatment of Lyme disease may be subject to contract provisions such as network limitations. Further antibiotic treatment as contemplated by sections 2 and 3 of Public Act 99-2 of the June Special Session, must be covered if recommended by a board certified rheumatologist. infectious disease specialist or neurologist who is licensed in Connecticut or another jurisdiction with similar or higher requirements for practice. Therefore, the fact that the recommendation as outlined in sections 2 and 3 of Public Act 99-2 of the June Special Session was made by a non-participating provider shall not be a basis for denial of coverage. Policy Form Filings In addition to the mandated coverage for Lyme disease, Public Acts 99-284 and 99-79 require additional mandates that affect both individual and group health insurance contracts. Public Act 99-79, An Act Requiring Health Insurers to Cover Prescription Birth Control took effect October 1, 1999. The mandates added by Public Act 99-284, An Act Concerning Managed Care Accountability, take effect as early as January 1, 2000 for both new business sales as well as renewals. In order to facilitate the review of forms by the Insurance Department, insurers are requested to file amendments to existing approved forms as soon as possible. This will ensure that carriers have forms approved for use so there will be no disruption in the marketplace. The filing should identify the policy form(s) that are being amended. George Re~J; ~:r Insurance Commissioner P. 0. Box 816 Hartford, CT 06142-0816 An Equal Opportunity Employer