(a) On and after January 1, 2017, each health carrier, as defined in section 19a-755b, shall maintain an Internet web site and toll-free telephone number that enables consumers to request and obtain: (1) Information on in-network costs for inpatient admissions, health care procedures and services, including (A) the allowed amount for, at a minimum, admissions and procedures reported to the executive director of the Office of Health Strategy pursuant to section 19a-755b for each health care provider in the state; (B) the estimated out-of-pocket costs that a consumer would be responsible for paying for any such admission or procedure that is medically necessary, including any facility fee, coinsurance, copayment, deductible or other out-of-pocket expense; and (C) data or other information concerning (i) quality measures for the health care provider, (ii) patient satisfaction, to the extent such information is available, (iii) a directory of participating providers, as defined in section 38a-472f, in accordance with the provisions of section 38a-477h; and (2) information on out-of-network costs for inpatient admissions, health care procedures and services.
(b) A health carrier shall advise the consumer when providing the information on out-of-pocket costs that the amounts are estimates and that the consumer's actual cost may vary due to health care provider contractual changes, the need for unforeseen services that arise out of the proposed admission or procedure or other circumstances.
(c) The provisions of this section shall not apply to a health carrier with less than forty thousand covered lives in the state. If in any year, a health carrier exceeds forty thousand covered lives in the state, the provisions of this section shall begin to apply on January first in the following year.
(P.A. 15-146, S. 5; P.A. 16-77, S. 3; 16-205, S. 5; P.A. 17-15, S. 45; June Sp. Sess. P.A. 17-2, S. 123; P.A. 18-91, S. 6.)
History: P.A. 16-77 amended Subsec. (a) by replacing “July 1, 2016” with “January 1, 2017”, and added Subsec. (c) re health carriers to which provisions of section do not apply, effective June 2, 2016; P.A. 16-205 amended Subsec. (a) by adding reference to Sec. 38a-1084a, deleting former Subdiv. (1)(C)(iii) to (1)(C)(v) and adding new Subdiv. (1)(C)(iii) re directory of participating providers, effective January 1, 2017; P.A. 17-15 amended Subsec. (a)(1)(C)(iii) by replacing reference to Sec. 38a-472f with reference to Sec. 38a-477h; June Sp. Sess. P.A. 17-2 amended Subsec. (a) by replacing “38a-1084a” with “19a-755b”, effective October 31, 2017; P.A. 18-91 amended Subsec. (a) by replacing “exchange” with “executive director of the Office of Health Strategy”, effective May 14, 2018.