OLR Bill Analysis

SB 459

AN ACT PROHIBITING COPAYMENTS FOR PREVENTIVE CARE.

SUMMARY:

This bill prohibits certain health insurance policies from imposing a copayment, deductible, or other out-of-pocket expense (e. g. , coinsurance) for preventive care. It specifies that “preventive care services” excludes any services or benefits intended to treat an existing illness, injury, or condition, but includes:

1. periodic health evaluations and annual physicals, including tests and diagnostic procedures ordered in connection with them;

2. routine prenatal and well-child care;

3. child and adult immunizations;

4. tobacco cessation programs; and

5. obesity weight-loss programs.

EFFECTIVE DATE: October 1, 2009

APPLICABILITY

The bill applies to individual and group health insurance policies delivered, issued, renewed, amended, or continued in Connecticut on or after January 1, 2012 that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; and (4) hospital or medical services, including coverage under an HMO plan.

Due to federal law (ERISA), state insurance benefit mandates do not apply to self-insured benefit plans.

COMMITTEE ACTION

Insurance and Real Estate Committee

Joint Favorable

Yea

11

Nay

8

(02/19/2009)