Insights

On March 2, 2016, the Connecticut Insurance Department published Bulletin HC-111 regarding health insurance coverage for preventative services and the repeal and replacement of Bulletin HC-100 issued on Nov. 3, 2014. The bulletin is directed toward insurers and health care centers operating in Connecticut.

The revised bulletin still addresses health insurance coverage for preventative services. The bulletin clarifies requirements under the federal health care reform law and reconciles these requirements with Connecticut mandates for fully insured non-grandfathered group health plans, effective Jan. 1, 2015. A discussion of the interaction between federal and state mandates follows:

• Clarifying that the term “reasonable medical management” under federal law should be based upon the statutory definition of “medical necessity” found in the Connecticut General Statutes Section 38a-482a.
• Clarifying that “breastfeeding support” as required under federal law should take into account Connecticut mandates found under Connecticut General Statutes Section 38a-530c(d) and 38a-503c(d) which requires two follow up lactation support visits occur when a mother is discharged early from the hospital. The first visit must occur within 48 hours of discharge and the second follow up visit must occur within seven days of discharge.
• Clarifying that contraceptive coverage must include any prescription contraceptive method approved by the Food and Drug Administration (FDA). This means that sterilization procedures for men may not be covered under federal law but may be covered by an insurance company separately, subject to state law.
• Clarifying that maternity coverage, including prenatal care, is covered without cost sharing under federal law. However, services related to maternity that are not preventative may be subject to cost-sharing, although any preventative service with no direct guidance may be subject to medical necessity.

Bulletin HC-111 »