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Connecticut Public Acts 1996

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Substitute Senate Bill No. 330

PUBLIC ACT NO. 96-177

AN ACT CONCERNING MINIMUM STAY FOR POST MATERNITY CARE AND INSURANCE COVERAGE FOR BREAST CANCER SURVIVORS.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (a) As used in this section, "carrier" means each insurer, health care center, hospital and medical service corporation, or other entity delivering, issuing for delivery, renewing or amending any individual health insurance policy in this state on or after October 1, 1996, providing coverage of the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 38a-469 of the general statutes.

(b) Each individual health insurance carrier that offers maternity benefits shall provide coverage of a minimum of forty-eight hours of inpatient care for a mother and her newborn infant following a vaginal delivery and a minimum of ninety-six hours of inpatient care for a mother and her newborn infant following a caesarean delivery. The time periods shall commence at the time of delivery.

(c) Any decision to shorten the length of inpatient stay to less than that provided under subsection (b) of this section shall be made by the attending health care providers after conferring with the mother.

(d) If a mother and newborn are discharged pursuant to subsection (c) of this section, prior to the inpatient length of stay provided under subsection (b) of this section, coverage shall be provided for a follow-up visit within forty-eight hours of discharge and an additional follow-up visit within seven days of discharge. Such follow-up services shall include, but not be limited to, physical assessment of the newborn, parent education, assistance and training in breast or bottle feeding, assessment of the home support system and the performance of any medically necessary and appropriate clinical tests. Such services shall be consistent with protocols and guidelines developed by attending providers or by national pediatric, obstetric and nursing professional organizations for these services and shall be provided by qualified health care personnel trained in postpartum maternal and newborn pediatric care.

(e) Each individual health insurance carrier shall provide notice to policyholders regarding the coverage required under this section. The notice shall be in writing and shall be transmitted at the earliest of either the next mailing to the policyholder, the yearly summary of benefits sent to the policyholder or January 1, 1997.

Sec. 2. (NEW) (a) As used in this section, "carrier" means each insurer, health care center, hospital and medical service corporation, or other entity delivering, issuing for delivery, renewing or amending any group health insurance policy in this state on or after October 1, 1996, providing coverage of the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 38a-469 of the general statutes.

(b) Each group insurance carrier that offers maternity benefits shall provide coverage of a minimum of forty-eight hours of inpatient care for a mother and her newborn infant following a vaginal delivery and a minimum of ninety-six hours of inpatient care for a mother and her newborn infant following a caesarean delivery. The time periods shall commence at the time of delivery.

(c) Any decision to shorten the length of inpatient stay to less than that provided under subsection (b) of this section shall be made by the attending health care providers after conferring with the mother.

(d) If a mother and newborn are discharged pursuant to subsection (c) of this section, prior to the inpatient length of stay provided under subsection (b) of this section, coverage shall be provided for a follow-up visit within forty-eight hours of discharge and an additional follow-up visit within seven days of discharge. Such follow-up services shall include, but not be limited to, physical assessment of the newborn, parent education, assistance and training in breast or bottle feeding, assessment of the home support system and the performance of any medically necessary and appropriate clinical tests. Such services shall be consistent with protocols and guidelines developed by attending providers or by national pediatric, obstetric and nursing professional organizations for these services and shall be provided by qualified health care personnel trained in postpartum maternal and newborn pediatric care.

(e) Each group insurance carrier shall provide notice to policyholders regarding the coverage required under this section. The notice shall be in writing and shall be transmitted at the earliest of either the next mailing to the policyholder, the yearly summary of benefits sent to the policyholder or January 1, 1997.

Sec. 3. (NEW) (a) No group health insurance plan, as defined in subdivision (1) of subsection (a) of section 38a-476 of the general statutes, or insurance arrangement, as defined in subdivision (2) of subsection (a) of section 38a-476 of the general statutes, may refuse to cover a group health insurance applicant due to breast cancer if such applicant has remained free from breast cancer for at least five years prior to the applicant's request for group health insurance coverage. The group health insurance carrier may require that the applicant submit to a physical examination.

(b) The provisions of this section shall apply to every health insurance plan or insurance arrangement issued, renewed or continued in this state on or after October 1, 1996. For purposes of this section, the date a plan or arrangement is continued shall be the anniversary date of the issuance of the plan or arrangement.

Sec. 4. (NEW) (a) No individual health insurance plan, as defined in subdivision (1) of subsection (a) of section 38a-476 of the general statutes, or insurance arrangement, as defined in subdivision (2) of subsection (a) of section 38a-476 of the general statutes, may refuse to cover an individual health insurance applicant due to breast cancer if such applicant has remained free from breast cancer for at least five years prior to the applicant's request for individual health insurance coverage. The individual health insurance carrier may require that the applicant submit to a physical examination.

(b) The provisions of this section shall apply to every health insurance plan or insurance arrangement issued, renewed or continued in this state on or after October 1, 1996. For purposes of this section, the date a plan or arrangement is continued shall be the anniversary date of the issuance of the plan or arrangement.

Sec. 5. Subdivision (3) of subsection (a) of section 38a-476 of the general statutes is repealed and the following is substituted in lieu thereof:

(3) "Preexisting conditions provision" means a policy provision which excludes coverage for charges or expenses incurred during a specified period following the insured's effective date of coverage as to a condition which, during a specified period immediately preceding the effective date of coverage, had manifested itself in such a manner as would cause an ordinary prudent person to seek diagnosis, care or treatment or for which medical advice, diagnosis, care or treatment was recommended or received as to that condition or as to a pregnancy existing on the effective date of coverage. ROUTINE FOLLOW-UP CARE TO DETERMINE WHETHER A BREAST CANCER HAS REOCCURRED IN A PERSON WHO HAS BEEN PREVIOUSLY DETERMINED TO BE BREAST CANCER FREE SHALL NOT BE CONSIDERED AS MEDICAL ADVICE, DIAGNOSIS, CARE OR TREATMENT FOR PURPOSES OF THIS SECTION UNLESS EVIDENCE OF BREAST CANCER IS FOUND DURING OR AS A RESULT OF SUCH FOLLOW-UP.

Sec. 6. This act shall take effect from its passage, except that sections 3 to 5, inclusive, shall take effect October 1, 1996.

Approved May 24, 1996. Effective as provided in section 6.

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