CT HB05013

Establishes a catastrophic medical expenses pool administered by the Office of the Healthcare Advocate to provide payment or reimbursement for medical expenses incurred by children on or after January 1, 2011, when family medical costs exceed threshold levels based on income.

Eligible children must be covered by qualifying health insurance, be Connecticut residents and U.S. citizens or resident aliens, not be eligible for Medicaid or HUSKY Plan benefits on the date expenses were incurred, and have exhausted other payment sources and insurance remedies.

Sets income-based thresholds ranging from 8% of family income for families at 200% of federal poverty level to 30% for families at 2,500% of federal poverty level; families exceeding 2,500% of poverty level are ineligible.

Excludes coverage for long-term care exceeding six months, infertility treatments, alternative medicine, routine dental and vision services, over-the-counter products, and services available through state developmental or mental health programs.

Creates the Catastrophic Medical Expenses Advisory Commission to advise the Healthcare Advocate and establishes funding through $1 per life collected annually by insurers and health care centers at policy renewal, deposited into a separate account within the Insurance Fund.