Sec. 38a-498. (Formerly Sec. 38-174t). Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider.
Sec. 38a-498. (Formerly Sec. 38-174t). Mandatory coverage for medically necessary ambulance services. Direct payment to ambulance provider. (a) Each individual health insurance policy providing coverage of the type specified in subdivisions
(1), (2), (4), (6), (10), (11) and (12) of section 38a-469 delivered, issued for delivery,
renewed or amended in this state on or after October 1, 2002, shall provide coverage
for medically necessary ambulance services for persons covered by the policy. The
hospital policy shall be primary if a person is covered under more than one policy.
The policy shall, as a minimum requirement, cover such services whenever any person
covered by the contract is transported when medically necessary by ambulance to a
hospital. Such benefits shall be subject to any policy provision which applies to other
services covered by such policies. Notwithstanding any other provision of this section,
such policies shall not be required to provide benefits in excess of the maximum allowable rate established by the Department of Public Health in accordance with section
19a-177.
(b) (1) Each such individual health insurance policy shall provide that any payment
by such company, corporation or center for emergency ambulance services under coverage required by this section shall be paid directly to the ambulance provider rendering
such service if such provider has complied with the provisions of this subsection and
has not received payment for such service from any other source.
(2) Any ambulance provider submitting a bill for direct payment pursuant to this
section shall stamp the following statement on the face of each bill: "NOTICE: This
bill subject to mandatory assignment pursuant to Connecticut general statutes".
(3) This subsection shall not apply to any transaction between an ambulance provider and an insurance company, hospital or medical service corporation, health care
center or other entity if the parties have entered into a contract providing for direct
payment.
(P.A. 83-325; P.A. 84-375, S. 2, 4; P.A. 90-243, S. 88; P.A. 94-239, S. 1; P.A. 02-124, S. 1.)
History: P.A. 84-375 amended Subsec. (a) to provide that on and after March 1, 1984, each hospital or medical expense
insurance policy or hospital or medical service plan contract shall provide such coverage for ambulance services, that with
more than one policy or contract, the hospital policy or contract shall be primary, that the benefits shall be subject to
applicable policy or contract provisions, and $500 shall be the maximum mandatory benefit and added Subsec. (b), mandating direct payment to ambulance providers who meet certain requirements; P.A. 90-243 substituted reference to health
insurance policies for reference to hospital and medical expense policies and contracts, deleted former Subsec. (b)(1) re
group policies and designated former Subdivs. (2) and (3) as (1) and (2); Sec. 38-174t transferred to Sec. 38a-498 in 1991;
P.A. 94-239 substituted "medically necessary" for "emergency" ambulance services and deleted the provision that the
patient be admitted to the hospital; P.A. 02-124 amended Subsec. (a) to substitute "each" for "every", rewrite provisions
re policies renewed or amended in this state, substitute "October 1, 2002" for "March 1, 1984", and substitute the maximum
allowable rate established by the Department of Public Health for $500 re the maximum required coverage, inserted new
Subsec. (b)(1) re direct payment for provider who complies with subsection, renumbered Subsecs. (b)(1) and (b)(2) as
Subsecs. (b)(2) and (b)(3), respectively, and amended Subsec. (b)(3) to add "health care center or other entity".