R.C.S.A. § 38a-192-2
Method of providing access to health care
Cite as Conn. Agencies Regs. § 38a-192-2
(a) In addition to the methods set forth in section 38a-177 of the Connecticut General
Statutes and subject to section 38a-183 of the Connecticut General Statutes, a health
care center may provide access to health care through the use of a high deductible
plan.
(b) Only expenses for health care services that are generally covered by the nondeductible
portion of the contract may be applied against the deductible. This restriction includes
limitations on particular providers, including in-network and out-of-network providers,
if any, as set forth in the contract.
(c) Deductibles shall not be limited to single benefit services only.
(d) The expense for health care services applied against the deductible shall be the actual
amount paid to the provider by the member, enrollee or their designee on behalf of
the member or enrollee, excluding any amounts in excess of the negotiated allowable
expense and any copay amounts paid by the member, enrollee or their designee on behalf
of the member or enrollee.
(e) If a high deductible health plan is intended to be federally tax qualified, there
shall be disclosure on the face page of the policy in quarter inch type or contrasting
color that states: "This policy is intended to be federally tax qualified. Approval
by the Insurance Department does not guarantee tax qualification and members and enrollees
are encouraged to seek the counsel of a tax advisor".