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Substitute House Bill No. 5566

Public Act No. 02-124

AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR AMBULANCE SERVICES.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 38a-498 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2002):

(a) [Every] Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 38a-469 delivered, issued for delivery, [or] renewed [in this state,] or amended [to substantially alter or change benefits or coverages, on or after March 1, 1984,] in this state on or after October 1, 2002, shall provide coverage for medically necessary ambulance services for persons covered by the policy. The hospital policy shall be primary if a person is covered under more than one policy. The policy shall, as a minimum requirement, cover such services whenever any person covered by the contract is transported when medically necessary by ambulance to a hospital. Such benefits shall be subject to any policy provision which applies to other services covered by such policies. Notwithstanding any other provision of this section, such policies shall not be required to provide benefits in excess of [five hundred dollars for any one medically necessary ambulance service] the maximum allowable rate established by the Department of Public Health in accordance with section 19a-177, as amended.

(b) (1) Each such individual health insurance policy shall provide that any payment by such company, corporation or center for emergency ambulance services under coverage required by this section shall be paid directly to the ambulance provider rendering such service if such provider has complied with the provisions of this subsection and has not received payment for such service from any other source.

[(b) (1)] (2) Any ambulance provider submitting a bill for direct payment pursuant to this section shall stamp the following statement on the face of each bill: "NOTICE: This bill subject to mandatory assignment pursuant to Connecticut general statutes".

[(2)] (3) This subsection shall not apply to any transaction between an ambulance provider and an insurance company, [or] hospital or medical service corporation, health care center or other entity if the parties have entered into a contract providing for direct payment.

Sec. 2. Section 38a-525 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2002):

(a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6), (11) and (12) of section 38a-469 delivered, issued for delivery, [or] renewed [in this state,] or amended [to substantially alter or change benefits or coverages, on or after March 1, 1984, by any insurance company, hospital or medical service corporation or health care center] in this state on or after October 1, 2002, shall provide coverage for [emergency] medically necessary ambulance services for persons covered by the policy. The hospital policy shall be primary if a person is covered under more than one policy. The policy shall, as a minimum requirement, cover such services whenever any person covered by the contract is transported when medically necessary by ambulance to a hospital. [and is admitted to such hospital as an inpatient. ] Such benefits shall be subject to any policy provision which applies to other services covered by such policies. Notwithstanding any other provision of this section, such policies shall not be required to provide benefits in excess of [five hundred dollars for any one emergency ambulance service] the maximum allowable rate established by the Department of Public Health in accordance with section 19a-177, as amended.

(b) (1) Each such group health insurance policy [delivered, issued for delivery or renewed in this state, or amended to substantially alter or change benefits or coverages, on or after October 1, 1984, by any insurance company, hospital or medical service corporation or health care center] shall provide that any payment by such company, corporation or center for emergency ambulance services under coverage required by this section shall be paid directly to the ambulance provider rendering such service if such provider has complied with the provisions of this subsection and has not received payment for such service from any other source.

(2) Any ambulance provider submitting a bill for direct payment pursuant to this section shall stamp the following statement on the face of each bill: "NOTICE: This bill subject to mandatory assignment pursuant to Connecticut general statutes".

(3) This subsection shall not apply to any transaction between an ambulance provider and an insurance company, [or] hospital or medical service corporation, health care center or other entity if the parties have entered into a contract providing for direct payment.

Approved May 10, 2002