CT SB00383

Requires health carriers to establish a process allowing covered persons to receive covered benefits from nonparticipating providers at in-network cost-sharing levels when participating providers are unavailable, insufficient in number or type, or require unreasonable travel or delay.

Mandates health carriers disclose the nonparticipating provider request process to covered persons diagnosed with conditions requiring specialty care when no appropriate participating provider is available.

Prohibits health carriers from denying requests for nonparticipating providers unless they provide written notice confirming a participating provider's availability with specific contact information and certification of timely access without unreasonable travel or delay.

Requires health carriers to include in adverse determination notices a description of alternative treatments satisfying medical necessity criteria and a list of in-network providers available to deliver those alternatives without unreasonable travel or delay at in-network cost-sharing levels.

Effective January 1, 2019; amends sections 38a-472f(d) and 38a-591d(e) of the general statutes.