Sec. 38a-976. (Formerly Sec. 38-501). Definitions.
Sec. 38a-976. (Formerly Sec. 38-501). Definitions. As used in sections 38a-975
to 38a-998, inclusive:
(a) "Adverse underwriting decisions" means: (1) Any of the following actions with
respect to insurance transactions involving insurance coverage which is individually
underwritten: (A) A declination or termination of insurance coverage, (B) failure of an
agent to apply for insurance coverage with a specific insurance institution which the
agent represents and which is requested by an applicant, (C) in the case of a property
or casualty insurance coverage, (i) placement by an insurance institution or agent of a
risk with a residual market mechanism, an unauthorized insurer or an insurance institution which specializes in substandard risks, (ii) the charging of a higher rate on the basis
of information which differs from that which the applicant or policyholder furnished or
(iii) changing a risk from a preferred rate program to a standard rate program or from
a standard rate program to a nonstandard rate program within the same company or
between two companies in the same group and (D) in the case of a life, health or disability
insurance coverage, an offer to insure at higher than standard rates. (2) Notwithstanding
the provisions of subdivision (1) of this subsection, the following actions shall not be
considered adverse underwriting decisions: (A) The termination of an individual policy
form on a class or state-wide basis, (B) a declination of insurance coverage solely because such coverage is not available on a class or state-wide basis, or (C) the rescission
of a policy.
(b) "Affiliate" or "affiliated" has the meaning assigned to it in section 38a-1.
(c) "Agent" shall have the same meaning as "insurance producer", as defined in
section 38a-702a.
(d) "Applicant" means any person who seeks to contract for insurance coverage
other than a person seeking group insurance that is not individually underwritten.
(e) "Commissioner" means the Insurance Commissioner.
(f) "Consumer report" means any written, oral or other communication of information bearing on an individual's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living which is used or expected to be used in connection with an insurance transaction.
(g) "Consumer reporting agency" means any person who: (1) Regularly engages,
in whole or in part, in the practice of assembling or preparing consumer reports for a
fee, (2) obtains information primarily from sources other than insurance institutions,
and (3) furnishes consumer reports to other persons.
(h) "Control", including the terms "controlled by" or "under common control with",
has the meaning assigned to it in section 38a-1.
(i) "Declination of insurance coverage" means a denial, in whole or in part, by an
insurance institution or agent, of requested insurance coverage.
(j) "Individual" means any person who: (1) In the case of property or casualty insurance, is a past, present or proposed named insured or certificate holder; (2) in the case
of life, health or disability insurance, is a past, present or proposed principal insured or
certificate holder; (3) is a past, present or proposed policyowner; (4) is a past or present
applicant or claimant; or (5) derived, derives or is proposed to derive insurance coverage
under an insurance policy or certificate subject to sections 38a-975 to 38a-998, inclusive.
(k) "Institutional source" means any person or governmental entity that provides
information about an individual to an agent, insurance institution or insurance-support
organization, other than: (1) An agent, (2) the individual who is the subject of the information, or (3) an individual acting in a personal capacity rather than a business or professional capacity.
(l) "Insurance institution" means any corporation, limited liability company, association, partnership, reciprocal exchange, interinsurer, Lloyd's insurer, fraternal benefit
society or other person engaged in the business of insurance, including health care centers, as defined in section 38a-175, medical service corporations, as defined in section
38a-214, managed care organizations, as defined in section 38a-478 and hospital service
corporations, as defined in section 38a-199. It shall not include agents or insurance-support organizations.
(m) (1) "Insurance-support organization" means any person who regularly engages, in whole or in part, in the practice of assembling or collecting information concerning individuals for the primary purpose of providing the information to an insurance
institution or agent for insurance transactions, including: (A) The furnishing of consumer
reports or investigative consumer reports to an insurance institution or agent for use in
connection with an insurance transaction, (B) the collection of personal information
from insurance institutions, agents or other insurance-support organizations for the purpose of detecting or preventing fraud, material misrepresentation or material nondisclosure in connection with insurance underwriting or insurance claim activity, or (C) collecting medical record information from, disclosing medical record information to, or
collecting medical record information on behalf of an insurance institution or agent in the
ordinary course of business, including, but not limited to, utilization review companies,
benefit management entities, including, but not limited to, pharmaceutical benefit and
disease management entities and information or computer management entities. (2)
Notwithstanding subdivision (1) of this subsection, the following persons shall not be
considered "insurance-support organizations" for purposes of sections 38a-975 to 38a-998, inclusive: Agents, government institutions, insurance institutions, medical care
institutions, medical professionals, pharmacies, universities and schools.
(n) "Insurance transaction" means any transaction involving insurance primarily
for personal, family or household needs rather than business or professional needs which
involves: (1) The determination of an individual's eligibility for an insurance coverage,
benefit or payment, or (2) the servicing of an insurance application, policy, contract or
certificate.
(o) "Investigative consumer report" means a consumer report or portion thereof in
which information about an individual's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with the person's
neighbors, friends, associates, acquaintances or others who may have such knowledge.
(p) "Medical-care institution" means any facility or institution that is licensed to
provide health care services to individuals, including but not limited to health care centers, home-health agencies, hospitals, medical clinics, public health agencies, rehabilitation agencies and skilled nursing facilities.
(q) "Medical professional" means any person licensed or certified to provide health
care services to individuals, including but not limited to a chiropractor, clinical dietitian,
clinical psychologist, dentist, nurse, occupational therapist, optometrist, pharmacist,
physical therapist, physician, podiatrist, psychiatric social worker or speech therapist.
(r) "Medical-record information" means personal information which: (1) Relates
to the physical, mental or behavioral health condition, medical history or medical treatment of an individual or a member of the individual's family, and (2) is obtained from
a medical professional or medical-care institution, from a pharmacy or pharmacist, from
the individual, or from the individual's spouse, parent or legal guardian or from the
provision of or payment for health care to or on behalf of an individual or a member of
the individual's family. The term does not include such information from which personal
identifiers that either directly reveal the identity of the patient, or provide a means of
identifying the patient, have been removed or have been encrypted or encoded such that
the identity of the individual is not revealed without the use of an encryption key or code.
(s) "Person" has the meaning assigned to it in section 38a-1.
(t) "Personal information" means any individually identifiable information gathered in connection with an insurance transaction from which judgments can be made
about an individual's character, habits, avocations, finances, occupation, general reputation, credit, health or any other personal characteristics. "Personal information" includes
an individual's name and address and "medical-record information" but does not include
"privileged information".
(u) "Policyholder" means any person who: (1) In the case of individual property or
casualty insurance, is a present named insured; (2) in the case of individual life, health
or disability insurance, is a present policyowner; or (3) in the case of group insurance
which is individually underwritten, is a present group certificate holder.
(v) "Pretext interview" means an interview where a person, in an attempt to obtain
information about an individual, performs one or more of the following acts: (1) Pretends
to be someone he is not, (2) pretends to represent a person he is not in fact representing,
(3) misrepresents the true purpose of the interview, or (4) refuses to identify himself
upon request.
(w) "Privileged information" means any individually identifiable information that:
(1) Relates to a claim for insurance benefits or a civil or criminal proceeding involving
an individual, and (2) is collected in connection with or in reasonable anticipation of a
claim for insurance benefits or a civil or criminal proceeding involving an individual;
provided information otherwise meeting the requirements of this subsection shall nevertheless be considered "personal information" under sections 38a-975 to 38a-998, inclusive, if it is disclosed in violation of section 38a-988.
(x) "Residual market mechanism" means an association, organization or other entity defined or described in sections 38a-328, 38a-329 and 38a-670.
(y) "Termination of insurance coverage" or "termination of an insurance policy"
means either a cancellation or nonrenewal of an insurance policy, in whole or in part,
for any reason other than the failure to pay a premium as required by the policy.
(z) "Unauthorized insurer" has the meaning assigned to it in section 38a-1.
(P.A. 81-368, S. 2, 25; P.A. 83-177, S. 1, 2; P.A. 90-243, S. 165; P.A. 94-160, S. 23, 24; P.A. 95-79, S. 152, 189; P.A.
99-284, S. 17, 60; P.A. 01-113, S. 29, 42.)
History: P.A. 83-177 amended Subsec. (a) by redefining "adverse underwriting decision" to include any change from
a preferred rate program to a standard rate program or from a standard rate program to a nonstandard rate program and
amended Subsec. (x) by including agreements to insure uninsurable applicants as outlined in Sec. 38-201h, within the
definition of a "residual market mechanism"; P.A. 90-243 redefined "affiliate", "affiliated", "control", "person" and "unauthorized insurer"; Sec. 38-501 transferred to Sec. 38a-976 in 1991; P.A. 94-160 substituted "producer" for "insurance
broker" in definition of "agent" to accurately reflect the modernization and nomenclature of the industry, effective June
2, 1994; P.A. 95-79 redefined "insurance institution" to include a limited liability company, effective May 31, 1995;
P.A. 99-284 amended definition of "insurance institution" to include managed care organizations, amended definition of
"insurance-support organization" to add Subpara. (1)(C) re collecting or disclosing medical record information in the
ordinary course of business, and amended Subdiv. (2) to exclude "pharmacies, universities and schools" from the definition
of "insurance-support organization", and amended definition of "medical-record information" to substitute "information
which: (1) Relates to the physical, mental or behavioral health condition, medical history or medical treatment of an
individual or a member of the individual's family" for "information which: (1) Relates to an individual's physical or mental
condition, medical history or medical treatment", amended Subdiv. (2) to include information obtained from a pharmacy
or pharmacist, or from the provision of or payment for health care re an individual or member of the individual's family,
and excluded from definition encrypted or encoded information or other information from which personal identifiers have
been removed, effective July 1, 2000; P.A. 01-113 amended definition of "agent" to delete "insurance agent" from definition, make a technical change and substitute "section 38a-702a" for "section 38a-702", effective September 1, 2002.