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

OLR Report 2014-R-0143 briefly describes Connecticut’s mandated health insurance benefits. It updates an earlier report (2012-R-0446) by incorporating laws enacted in 2013 and 2014. (See OLR Report 2008-R-0138 for a list of health care providers and facilities whose services health insurance policies must cover under state law.)

A health insurance benefit mandate is a requirement that an insurance company or health plan cover a specified benefit. In Connecticut, private health insurance benefit mandates are contained in Chapter 700c of the General Statutes.

Each benefit mandate statute identifies the specific plans to which the mandate applies. Many of the mandates apply to both individual and group health insurance plans. However, due to the federal Employee Retirement Income Security Act (ERISA), state benefit mandates generally do not apply to self-funded plans.  For more information about ERISA preemption, see OLR Report 2005-R-0753.

In 2013 and 2014, the legislature enacted the following four acts related to health insurance benefit mandates:

1. PA 13-84, An Act Concerning Health Insurance Coverage for Autism Spectrum Disorders (effective upon passage, June 5, 2013).
2. PA 13-131, An Act Concerning Synchronizing Prescription Refills (effective January 1, 2014).
3. PA 13-307, An Act Concerning Copayments for Physical Therapy Services (effective January 1, 2015).
4. PA 14-97, An Act Concerning Copayments for Breast Ultrasound Screenings and Occupational Therapy Services (effective January 1, 2015).

For more information, read the full report.