CT SB01003

Health insurers, managed care organizations, and pharmacy benefits managers must give credit for third-party payments or discounts toward patient out-of-pocket expenses including copayments, coinsurance, deductibles, and other cost-sharing when calculating patient liability, effective January 1, 2022.

Prohibition applies to all individual and group health insurance policies, managed care plans, and pharmacy benefit contracts delivered, issued, renewed, amended or continued in Connecticut on or after January 1, 2022.

Third-party assistance programs (such as manufacturer copay assistance, charitable programs, or patient assistance programs) cannot be excluded from counting toward a patient's deductible or out-of-pocket maximum accumulation.

Requirements apply to all entities delivering health insurance coverage including insurers, health care centers, hospital service corporations, medical service corporations, managed care organizations, and pharmacy benefits managers.

Applies to covered benefits including medical, surgical, hospital, major medical, disability, dental, vision, and mental health coverage as specified under Connecticut general statutes.