Sec. 38a-504c. Evidence and information re eligibility for cancer clinical trial. No coverage required for otherwise reimbursable costs.
Sec. 38a-504c. Evidence and information re eligibility for cancer clinical trial.
No coverage required for otherwise reimbursable costs. In order to be eligible for
coverage of routine patient care costs, as defined in section 38a-504d, the insurer, health
care center or plan administrator may require that the person or entity seeking coverage
for the cancer clinical trial provide: (1) Evidence satisfactory to the insurer, health care
center or plan administrator that the insured person receiving coverage meets all of the
patient selection criteria for the cancer clinical trial, including credible evidence in the
form of clinical or preclinical data showing that the cancer clinical trial is likely to have
a benefit for the insured person that is commensurate with the risks of participation in the
cancer clinical trial to treat the person's condition; and (2) evidence that the appropriate
informed consent has been received from the insured person; and (3) copies of any
medical records, protocols, test results or other clinical information used by the physician
or institution seeking to enroll the insured person in the cancer clinical trial; and (4) a
summary of the anticipated routine patient care costs in excess of the costs for standard
treatment; and (5) information from the physician or institution seeking to enroll the
insured person in the clinical trial regarding those items, including any routine patient
care costs, that are eligible for reimbursement by an entity other than the insurer or
health care center, including the entity sponsoring the clinical trial; and (6) any additional
information that may be reasonably required for the review of a request for coverage
of the cancer clinical trial. The health plan or insurer shall request any additional information about a cancer clinical trial within five business days of receiving a request for
coverage from an insured person or a physician seeking to enroll an insured person in
a cancer clinical trial. Nothing in sections 38a-504a to 38a-504g, inclusive, shall be
construed to require the insurer or health care center to provide coverage for routine
patient care costs that are eligible for reimbursement by an entity other than the insurer,
including the entity sponsoring the cancer clinical trial.
(P.A. 01-171, S. 10, 25.)
History: P.A. 01-171 effective January 1, 2002.
See Sec. 38a-542c for similar provisions re group policies.