Sec. 38a-513. Approval of group health insurance policies and certificates. Medicare supplement policies and certificates: Age, gender, previous claim or medical history rating prohibited. Exceptions.
Sec. 38a-513. Approval of group health insurance policies and certificates.
Medicare supplement policies and certificates: Age, gender, previous claim or medical history rating prohibited. Exceptions. Optional life insurance riders. Regulations. Group specified disease policies. (a) No group health insurance policy, as defined
by the commissioner, or certificate shall be issued or delivered in this state unless a copy
of the form for such policy or certificate has been submitted to and approved by the
commissioner under the regulations adopted pursuant to this section. The commissioner
shall adopt regulations, in accordance with chapter 54, concerning the provisions, submission and approval of such policies and certificates and establishing a procedure for
reviewing such policies and certificates. If the commissioner issues an order disapproving the use of such form, the provisions of section 38a-19 shall apply to such order.
(b) No insurance company, fraternal benefit society, hospital service corporation,
medical service corporation, health care center or other entity which delivers or issues for
delivery in this state any Medicare supplement policies or certificates shall incorporate in
its rates or determinations to grant coverage for Medicare supplement insurance policies
or certificates any factors or values based on the age, gender, previous claims history
or the medical condition of any person covered by such policy or certificate, except for
plans "H" to "J", inclusive, as provided in section 38a-495b. In plans "H" to "J", inclusive, previous claims history and the medical condition of the applicant may be used in
determinations to grant coverage under Medicare supplement policies and certificates
issued prior to January 1, 2006.
(c) Nothing in this chapter shall preclude the issuance of a group health insurance
policy which includes an optional life insurance rider, provided the optional life insurance rider must be filed with and approved by the Insurance Commissioner pursuant to
section 38a-430. Any company offering such policies for sale in this state shall be licensed to sell life insurance in this state pursuant to the provisions of section 38a-41.
(d) Not later than January 1, 2009, the commissioner shall adopt regulations, in
accordance with chapter 54, to establish minimum standards for benefits in group specified disease policies, certificates, riders, endorsements and benefits.
(P.A. 90-243, S. 97; P.A. 93-390, S. 7, 8; P.A. 96-51, S. 3; P.A. 05-20, S. 6; P.A. 08-181, S. 6.)
History: P.A. 93-390 added Subsec. (b) prohibiting the incorporation of factors for age, gender, previous claim or
medical condition history, into the insurer's rate schedule, effective January 1, 1994; P.A. 96-51 added Subsec. (c) to
permit optional life insurance riders; P.A. 05-20 made technical changes, amended Subsec. (a) re regulations and amended
Subsec. (b) to reference "determinations to grant coverage" and plans "H" to "J", inclusive, "issued prior to January 1,
2006," re use of claim history and medical condition, effective July 1, 2005; P.A. 08-181 added Subsec. (d) directing
commissioner to adopt regulations to establish minimum benefit standards for group specified disease policies, effective
June 12, 2008.
See Sec. 38a-477a re notification by Insurance Commissioner of required benefits and policy forms.