January 10, 2012

Hot Report: OLR Backgrounder: State-Mandated Health Insurance Benefits

OLR Report 2011-R-0504 explains what private health insurance benefits must be provided.

Here's a list from the report of the new mandates added in 2011 that became effective January 1, 2012.

In 2011, the legislature enacted numerous revisions to Connecticut's health insurance mandates. Effective January 1, 2012, health insurance policies must:
  1. cover newborns for 61 days, up from 31 days (PA 11-171);
  2. not impose out-of-pocket expenses for medically necessary early intervention services, unless the policy is a high-deductible health plan (PA 11-44);
  3. if a group policy, provide children with autism spectrum disorder coverage for medically necessary early intervention services of at least $50,000 per child annually, up to $150,000 per child over three years (PA 11-44);
  4. cover medically necessary prostate cancer treatment in accordance with guidelines established by the National Comprehensive Cancer Network, American Cancer Society, or American Society of Clinical Oncology (PA 11-225);
  5. not require an insured person to use an alternative brand name prescription or over-the-counter drug before using a brand name prescription drug prescribed by a licensed physician for pain management (PA 11-169);
  6. cover at least $2,500 (up from $1,000) per year for medically necessary ostomy-related appliances and supplies, if the policy covers ostomy surgery (PA 11-204);
  7. not impose out-of-pocket expenses for an additional colonoscopy a physician orders for an insured person in a policy year, unless the policy is a high deductible health plan (PA 11-83);
  8. cover magnetic resonance imaging (MRI) of a woman's breasts if a mammogram shows she has dense breast tissue or she is at increased breast cancer risk (PA 11-67);
  9. cover MRIs in accordance with guidelines established by the American Cancer Society or American College of Radiology (PA 11-171);
  10. cover routine patient costs related to disabling or life-threatening chronic diseases (PA 11-172); and
  11. cover bone marrow testing for people who join the National Marrow Donor Program (PA 11-88).
For the entire list of mandated benefits, see the full report.