House Bill No. 6266
House Bill No. 6266
PUBLIC ACT NO. 97-268
AN ACT CONCERNING CONTINUATION OF HEALTH BENEFITS
UNDER GROUP HEALTH PLANS AND REQUIRING HEALTH
INSURANCE COVERAGE FOR DIABETES TREATMENT.
Be it enacted by the Senate and House of
Representatives in General Assembly convened:
Section 1. Section 38a-538 of the general
statutes is repealed and the following is
substituted in lieu thereof:
[(a) Whenever any individual who is a member
of any group health insurance plan becomes
ineligible for continued participation in such
plan for any reason including death or whenever
any individual who is a spouse of a member becomes
ineligible for continued coverage as a dependent
under such plan as a result of dissolution of
marriage, all benefits of such plan, except
disability income coverage, shall be made
available by the employer at the same group rate
(1) to the individual and the dependents covered
by the group plan, upon the termination of the
individual's employment other than as a result of
his death, for an extension period of one hundred
and four weeks and (2) to the surviving or former
spouse and the dependents covered by the group
plan, upon the death of the individual or the
dissolution of his marriage to such spouse, for an
extension period of one hundred fifty-six weeks,
or in either case, (3) until such member,
surviving or former spouse or dependent becomes
eligible for benefits under another group plan,
whichever occurs first. The employer shall inform
the individual, surviving or former spouse or
dependent of such spouse, in writing, of his right
to continue coverage pursuant to this subsection
within ten days after the member becomes
ineligible to participate in the plan. If the
individual, surviving or former spouse or
dependent elects to continue participation in the
group plan, he shall so notify the employer, in
writing, within thirty days after the member
becomes ineligible to participate or the spouse of
a member becomes ineligible for continued coverage
as a dependent. The member, surviving or former
spouse or dependent shall be responsible for
payment of premiums to the employer or
policyholder throughout the extension period,
provided the amount of any such payment shall not
exceed one hundred two per cent of the applicable
premium for such coverage. Upon termination of the
extension period, the member, surviving or former
spouse or dependent shall be entitled to exercise
any option which is provided in the group plan to
elect a converted policy. After timely receipt of
the premium payment from the individual or
surviving or former spouse, if the employer fails
to make payment to the insurer, hospital or
medical service corporation or health care center
with the result that coverage is terminated, the
employer shall be liable for benefits to the same
extent as the insurer, hospital or medical service
corporation or health care center would have been
liable if coverage had not been terminated.
(b) Any individual or surviving or former
spouse or dependent of such individual who elects
to] EACH EMPLOYER SHALL ALLOW INDIVIDUALS TO ELECT
TO continue coverage under a group plan pursuant
to federal extension requirements established by
the Consolidated Omnibus Budget Reconciliation Act
of 1985 (P.L. 99-272), as amended. [, shall not be
eligible, at the termination of such extension
period, for an additional coverage extension
period under the provisions of this section.
(c) The provisions of this section shall apply
to group health insurance policies providing
coverage of the type specified in subdivisions
(1), (2), (4), (6), (11) and (12) of section
38a-469.]
Sec. 2. Section 38a-554 of the general
statutes is repealed and the following is
substituted in lieu thereof:
A group comprehensive health care plan shall
contain the minimum standard benefits prescribed
in section 38a-553 [, including the choice of the
low option, middle option or high option
deductible,] and shall also conform in substance
to the requirements of this section.
(a) The plan shall be one under which the
individuals eligible to be covered include: (1)
Each eligible employee; (2) the spouse of each
eligible employee, WHO SHALL BE CONSIDERED A
DEPENDENT FOR THE PURPOSES OF THIS SECTION; and
(3) dependent unmarried children, who are under
the age of nineteen or are full-time students
under the age of twenty-three at an accredited
institution of higher learning.
(b) The plan shall provide the option to
continue coverage under each of the following
circumstances until eligible for other group
insurance: (1) [Upon layoff or] NOTWITHSTANDING
ANY CONTRARY PROVISION OF THIS SECTION, UPON
LAYOFF, REDUCTION OF HOURS, leave of absence, or
termination of employment, other than as a result
of death of the employee OR AS A RESULT OF SUCH
EMPLOYEE'S "GROSS MISCONDUCT" AS THAT TERM IS USED
IN 29 USC 1163(2), continuation of coverage for
such employee and his covered dependents [to the
end of the seventy-eighth week following the day
on which the employee lost eligibility to
participate in the group] FOR THE PERIODS SET
FORTH FOR SUCH EVENT UNDER FEDERAL EXTENSION
REQUIREMENTS ESTABLISHED BY THE CONSOLIDATED
OMNIBUS BUDGET RECONCILIATION ACT OF 1985 (P.L.
99-272), AS AMENDED FROM TIME TO TIME, (COBRA);
(2) upon the death of the employee, continuation
of coverage for the covered dependents of such
employee [to the end of the one hundred
fifty-sixth week following the day on which the
employee lost eligibility to participate in the
group] FOR THE PERIODS SET FORTH FOR SUCH EVENT
UNDER FEDERAL EXTENSION REQUIREMENTS ESTABLISHED
BY THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION
ACT OF 1985 (P.L. 99-272), AS AMENDED FROM TIME TO
TIME, (COBRA); (3) during an employee's absence
due to illness or injury, continuation of coverage
for such employee and his covered dependents
during continuance of such illness or injury or
for up to twelve months from the beginning of such
absence; (4) upon termination of the group plan,
coverage for covered individuals who were totally
disabled on the date of termination, shall be
continued without premium payment during the
continuance of such disability for a period of
twelve calendar months following the calendar
month in which the plan was terminated, provided
claim is submitted therefor within one year of the
termination of the plan; (5) the coverage of any
covered individual shall terminate: (A) As to a
child, [at] THE PLAN SHALL PROVIDE THE OPTION FOR
SAID CHILD TO CONTINUE COVERAGE FOR THE LONGER OF
THE FOLLOWING PERIODS: (i) AT the end of the month
following the month in which the child marries,
ceases to be dependent on the employee or attains
the age of nineteen, whichever occurs first,
except that if the child is a full-time student at
an accredited institution, the coverage may be
continued while the child remains unmarried and a
full-time student, but not beyond the month
following the month in which the child attains the
age of twenty-three. If on the date specified for
termination of coverage on a dependent child, the
child is unmarried and incapable of
self-sustaining employment by reason of mental or
physical handicap and chiefly dependent upon the
employee for support and maintenance, the coverage
on such child shall continue while the plan
remains in force and the child remains in such
condition, provided proof of such handicap is
received by the carrier within thirty-one days of
the date on which the child's coverage would have
terminated in the absence of such incapacity. The
carrier may require subsequent proof of the
child's continued incapacity and dependency but
not more often than once a year thereafter OR (ii)
FOR THE PERIODS SET FORTH FOR SUCH CHILD UNDER
FEDERAL EXTENSION REQUIREMENTS ESTABLISHED BY THE
CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT OF
1985 (P.L. 99-272), AS AMENDED FROM TIME TO TIME,
(COBRA); (B) as to the employee's spouse, at the
end of the month following the month in which a
divorce, COURT-ORDERED annulment or legal
separation is obtained, WHICHEVER IS EARLIER,
EXCEPT THAT THE PLAN SHALL PROVIDE THE OPTION FOR
SAID SPOUSE TO CONTINUE COVERAGE FOR THE PERIODS
SET FORTH FOR SUCH EVENTS UNDER FEDERAL EXTENSION
REQUIREMENTS ESTABLISHED BY THE CONSOLIDATED
OMNIBUS BUDGET RECONCILIATION ACT OF 1985 (P.L.
99-272), AS AMENDED FROM TIME TO TIME, (COBRA);
and (C) as to the employee or dependent who is
sixty-five years of age or older, as of midnight
of the day preceding such person's eligibility for
benefits under Title XVIII of the Social Security
Act; (6) AS TO ANY OTHER EVENT LISTED AS A
"QUALIFYING EVENT" IN 29 USC 1163, AS AMENDED FROM
TIME TO TIME, CONTINUATION OF COVERAGE FOR SUCH
PERIODS SET FORTH FOR SUCH EVENT IN 29 USC 1162,
AS AMENDED FROM TIME TO TIME, PROVIDED SUCH PLAN
MAY REQUIRE THE INDIVIDUAL WHOSE COVERAGE IS TO BE
CONTINUED TO PAY UP TO THE PERCENTAGE OF THE
APPLICABLE PREMIUM AS SPECIFIED FOR SUCH EVENT IN
29 USC 1162, AS AMENDED FROM TIME TO TIME; (7) any
continuation of coverage required by this section
except subdivision (4) OR (6) of THIS subsection
[(b)] may be subject to the requirement, on the
part of the individual whose coverage is to be
continued, that such individual contribute that
portion of the premium he would have been required
to contribute had the employee remained an active
covered employee, except that the individual may
be required to pay UP TO ONE HUNDRED TWO PER CENT
OF the entire premium at the group rate if
coverage is continued in accordance with
subdivision (1), (2) OR (5) of THIS subsection,
[(b) above,] provided the employer shall not be
legally obligated by sections 38a-505, 38a-546 and
38a-551 to 38a-559, inclusive, to pay such premium
if not paid timely by the employee.
(c) The commissioner shall promulgate
regulations concerning coordination of benefits
between the plan and other health insurance plans.
(d) The plan shall make available to
Connecticut residents, in addition to any other
conversion privilege available, a conversion
privilege under which coverage shall be available
immediately upon termination of coverage under the
group plan. The terms and benefits offered under
the conversion benefits shall be at least equal to
the terms and benefits of an individual
comprehensive health care plan.
Sec. 3. Subsection (a) of section 38a-546 of
the general statutes is repealed and the following
is substituted in lieu thereof:
(a) In order to assure reasonable continuation
of coverage and extension of benefits to the
citizens of this state, [all] EACH group health
insurance [policies] POLICY, REGARDLESS OF THE
NUMBER OF INSUREDS, PROVIDING COVERAGE OF THE TYPE
SPECIFIED IN SUBDIVISIONS (1), (2), (3), (4), (11)
AND (12) OF SECTION 38a-469, delivered, [or]
issued for delivery, [or renewal] RENEWED OR
CONTINUED in this state on or after [April 1,
1976] OCTOBER 1, 1997, shall, subject to the
provisions of subsection (d), contain those
provisions described in subsections (b) and (d) of
section 38a-554, AS AMENDED BY THIS ACT.
Sec. 4. (NEW) (a) Each individual health
insurance policy providing coverage of the type
specified in subdivisions (1), (2), (4), (11) and
(12) of section 38a-469 of the general statutes
delivered, issued for delivery or renewed in this
state on or after October 1, 1997, shall provide
coverage for laboratory and diagnostic tests for
all types of diabetes.
(b) Notwithstanding the provisions of section
38a-492a of the general statutes, each individual
health insurance policy providing coverage of the
type specified in subdivisions (1), (2), (4), (11)
and (12) of section 38a-469 of the general
statutes delivered, issued for delivery or renewed
in this state on or after October 1, 1997, shall
provide medically necessary coverage for the
treatment of insulin-dependent diabetes,
insulin-using diabetes, gestational diabetes and
non-insulin-using diabetes. Such coverage shall
include medically necessary equipment, in
accordance with the insured person's treatment
plan, drugs and supplies prescribed by a
prescribing practitioner, as defined in section
20-571 of the general statutes.
Sec. 5. (NEW) (a) Each group health insurance
policy providing coverage of the type specified in
subdivisions (1), (2), (4), (11) and (12) of
section 38a-469 of the general statutes delivered,
issued for delivery or renewed in this state on or
after October 1, 1997, shall provide coverage for
laboratory and diagnostic tests for all types of
diabetes.
(b) Notwithstanding the provisions of section
38a-518a of the general statutes, each group
health insurance policy providing coverage of the
type specified in subdivisions (1), (2), (4), (11)
and (12) of section 38a-469 of the general
statutes delivered, issued for delivery or renewed
in this state on or after October 1, 1997, shall
provide medically necessary coverage for the
treatment of insulin-dependent diabetes,
insulin-using diabetes, gestational diabetes and
non-insulin-using diabetes. Such coverage shall
include medically necessary equipment, in
accordance with the insured person's treatment
plan, drugs and supplies prescribed by a
prescribing practitioner, as defined in section
20-571 of the general statutes.
Approved June 26, 1997