Sec. 38a-482b. Individual health insurance policy providing limited coverage to include disclosure. Limited coverage defined.
Sec. 38a-482b. Individual health insurance policy providing limited coverage
to include disclosure. Limited coverage defined. (a) Each individual health insurance
policy, subscriber contract or certificate of coverage delivered or issued for delivery in
this state on or after January 1, 2008, that provides limited coverage, and any marketing
material, application for coverage and enrollment material relative to such policy, contract or certificate, shall include the following statement printed in capital letters in not
less than twelve-point bold face type and located in a conspicuous manner on such
document:
"THIS LIMITED HEALTH BENEFITS PLAN DOES NOT PROVIDE COMPREHENSIVE MEDICAL COVERAGE. IT IS A BASIC OR LIMITED BENEFITS POLICY AND IS NOT INTENDED TO COVER ALL MEDICAL EXPENSES. THIS
PLAN IS NOT DESIGNED TO COVER THE COSTS OF SERIOUS OR CHRONIC
ILLNESS. IT CONTAINS SPECIFIC DOLLAR LIMITS THAT WILL BE PAID FOR
MEDICAL SERVICES WHICH MAY NOT BE EXCEEDED. IF THE COST OF SERVICES EXCEEDS THOSE LIMITS, THE BENEFICIARY AND NOT THE INSURER IS RESPONSIBLE FOR PAYMENT OF THE EXCESS AMOUNTS. THE
SPECIFIC DOLLAR LIMITS ARE AS FOLLOWS: (INSURER TO SPECIFY SUCH
AMOUNTS)."
(b) For the purposes of this section, "limited coverage" means an insurance policy
providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of
section 38a-469 that contains an annual maximum benefit of less than one hundred
thousand dollars or fixed dollar benefits of less than twenty thousand dollars on any
core services. For the purpose of this section, "core services" means medical, surgical
and hospital services, including inpatient and outpatient physician, laboratory and imaging services.
(P.A. 07-96, S. 1; P.A. 08-147, S. 11.)
History: P.A. 07-96 effective July 1, 2007; P.A. 08-147 redefined "limited coverage" in Subsec. (b) to specify fixed
dollar benefits of less than $20,000 on any core services.
See Sec. 38a-513d for similar provisions re group policies.