CT HB05529

Redefines "medically necessary" or "medical necessity" for individual and group health insurance policies to explicitly include mental illness and its effects as conditions requiring evaluation, diagnosis, or treatment.

Adds a requirement that medical necessity determinations be based on an assessment of the patient and his or her medical condition.

Changes the standard for "generally accepted standards of medical practice" from requiring credible scientific evidence published in peer-reviewed medical literature to standards generally recognized by the relevant medical community or consistent with policy issues involving clinical judgment.

Applies to health insurance policies issued by insurers, health care centers, hospital service corporations, medical service corporations, and similar entities providing specified types of coverage.

Effective October 1, 2014, with an exemption for entities under national settlement agreements until those agreements expire.