House Bill No. 6266
               House Bill No. 6266

              PUBLIC ACT NO. 97-268


AN ACT CONCERNING  CONTINUATION OF HEALTH BENEFITS
UNDER  GROUP HEALTH  PLANS  AND  REQUIRING  HEALTH
INSURANCE COVERAGE FOR DIABETES TREATMENT.


    Be  it  enacted  by  the  Senate  and House of
Representatives in General Assembly convened:
    Section  1. Section  38a-538  of  the  general
statutes  is  repealed   and   the   following  is
substituted in lieu thereof:
    [(a) Whenever any  individual  who is a member
of  any  group   health   insurance  plan  becomes
ineligible  for continued  participation  in  such
plan for any  reason  including  death or whenever
any individual who is a spouse of a member becomes
ineligible for continued  coverage  as a dependent
under such plan  as  a  result  of  dissolution of
marriage,  all  benefits   of  such  plan,  except
disability   income  coverage,   shall   be   made
available by the  employer  at the same group rate
(1) to the  individual  and the dependents covered
by the group  plan,  upon  the  termination of the
individual's employment other  than as a result of
his death, for  an extension period of one hundred
and four weeks  and (2) to the surviving or former
spouse and the  dependents  covered  by  the group
plan, upon the  death  of  the  individual  or the
dissolution of his marriage to such spouse, for an
extension period of  one  hundred fifty-six weeks,
or  in  either   case,   (3)  until  such  member,
surviving or former  spouse  or  dependent becomes
eligible for benefits  under  another  group plan,
whichever occurs first.  The employer shall inform
the  individual, surviving  or  former  spouse  or
dependent of such spouse, in writing, of his right
to continue coverage  pursuant  to this subsection
within  ten  days   after   the   member   becomes
ineligible to participate  in  the  plan.  If  the
individual,   surviving  or   former   spouse   or
dependent elects to  continue participation in the
group plan, he  shall  so  notify the employer, in
writing,  within  thirty  days  after  the  member
becomes ineligible to participate or the spouse of
a member becomes ineligible for continued coverage
as a dependent.  The  member,  surviving or former
spouse  or  dependent  shall  be  responsible  for
payment   of   premiums   to   the   employer   or
policyholder  throughout  the   extension  period,
provided the amount  of any such payment shall not
exceed one hundred  two per cent of the applicable
premium for such coverage. Upon termination of the
extension period, the  member, surviving or former
spouse or dependent  shall be entitled to exercise
any option which  is provided in the group plan to
elect a converted  policy. After timely receipt of
the  premium  payment   from   the  individual  or
surviving or former  spouse, if the employer fails
to  make  payment  to  the  insurer,  hospital  or
medical service corporation  or health care center
with the result  that  coverage is terminated, the
employer shall be  liable for benefits to the same
extent as the insurer, hospital or medical service
corporation or health  care center would have been
liable if coverage had not been terminated.
    (b)  Any individual  or  surviving  or  former
spouse or dependent  of such individual who elects
to] EACH EMPLOYER SHALL ALLOW INDIVIDUALS TO ELECT
TO continue coverage  under  a group plan pursuant
to federal extension  requirements  established by
the Consolidated Omnibus Budget Reconciliation Act
of 1985 (P.L. 99-272), as amended. [, shall not be
eligible, at the  termination  of  such  extension
period,  for  an   additional  coverage  extension
period under the provisions of this section.
    (c) The provisions of this section shall apply
to  group  health   insurance  policies  providing
coverage of the  type  specified  in  subdivisions
(1), (2), (4),  (6),  (11)  and  (12)  of  section
38a-469.]
    Sec.  2.  Section   38a-554   of  the  general
statutes  is  repealed   and   the   following  is
substituted in lieu thereof:
    A group comprehensive  health  care plan shall
contain the minimum  standard  benefits prescribed
in section 38a-553  [, including the choice of the
low  option,  middle   option   or   high   option
deductible,] and shall  also  conform in substance
to the requirements of this section.
    (a) The plan  shall  be  one  under  which the
individuals eligible to  be  covered  include: (1)
Each eligible employee;  (2)  the  spouse  of each
eligible  employee,  WHO  SHALL  BE  CONSIDERED  A
DEPENDENT FOR THE  PURPOSES  OF  THIS SECTION; and
(3) dependent unmarried  children,  who  are under
the age of  nineteen  or  are  full-time  students
under the age  of  twenty-three  at  an accredited
institution of higher learning.
    (b)  The plan  shall  provide  the  option  to
continue  coverage under  each  of  the  following
circumstances  until  eligible   for  other  group
insurance: (1) [Upon  layoff  or]  NOTWITHSTANDING
ANY  CONTRARY  PROVISION  OF  THIS  SECTION,  UPON
LAYOFF, REDUCTION OF  HOURS,  leave of absence, or
termination of employment,  other than as a result
of death of  the  employee  OR AS A RESULT OF SUCH
EMPLOYEE'S "GROSS MISCONDUCT" AS THAT TERM IS USED
IN 29 USC  1163(2),  continuation  of coverage for
such employee and  his  covered dependents [to the
end of the  seventy-eighth  week following the day
on  which  the   employee   lost   eligibility  to
participate in the  group]  FOR  THE  PERIODS  SET
FORTH  FOR  SUCH  EVENT  UNDER  FEDERAL  EXTENSION
REQUIREMENTS  ESTABLISHED  BY   THE   CONSOLIDATED
OMNIBUS BUDGET RECONCILIATION  ACT  OF  1985 (P.L.
99-272), AS AMENDED  FROM  TIME  TO TIME, (COBRA);
(2) upon the  death  of the employee, continuation
of coverage for  the  covered  dependents  of such
employee  [to  the   end   of   the   one  hundred
fifty-sixth week following  the  day  on which the
employee lost eligibility  to  participate  in the
group] FOR THE  PERIODS  SET  FORTH FOR SUCH EVENT
UNDER FEDERAL EXTENSION  REQUIREMENTS  ESTABLISHED
BY THE CONSOLIDATED  OMNIBUS BUDGET RECONCILIATION
ACT OF 1985 (P.L. 99-272), AS AMENDED FROM TIME TO
TIME, (COBRA); (3)  during  an  employee's absence
due to illness or injury, continuation of coverage
for  such  employee  and  his  covered  dependents
during continuance of  such  illness  or injury or
for up to twelve months from the beginning of such
absence; (4) upon  termination  of the group plan,
coverage for covered  individuals who were totally
disabled on the  date  of  termination,  shall  be
continued  without  premium   payment  during  the
continuance of such  disability  for  a  period of
twelve  calendar  months  following  the  calendar
month in which  the  plan was terminated, provided
claim is submitted therefor within one year of the
termination of the  plan;  (5) the coverage of any
covered individual shall  terminate:  (A)  As to a
child, [at] THE  PLAN SHALL PROVIDE THE OPTION FOR
SAID CHILD TO  CONTINUE COVERAGE FOR THE LONGER OF
THE FOLLOWING PERIODS: (i) AT the end of the month
following the month  in  which  the child marries,
ceases to be  dependent on the employee or attains
the  age  of  nineteen,  whichever  occurs  first,
except that if the child is a full-time student at
an accredited institution,  the  coverage  may  be
continued while the  child remains unmarried and a
full-time  student,  but   not  beyond  the  month
following the month in which the child attains the
age of twenty-three.  If on the date specified for
termination of coverage  on a dependent child, the
child    is    unmarried    and    incapable    of
self-sustaining employment by  reason of mental or
physical handicap and  chiefly  dependent upon the
employee for support and maintenance, the coverage
on  such  child  shall  continue  while  the  plan
remains in force  and  the  child  remains in such
condition,  provided proof  of  such  handicap  is
received by the  carrier within thirty-one days of
the date on  which the child's coverage would have
terminated in the  absence of such incapacity. The
carrier  may  require   subsequent  proof  of  the
child's continued incapacity  and  dependency  but
not more often than once a year thereafter OR (ii)
FOR THE PERIODS  SET  FORTH  FOR  SUCH CHILD UNDER
FEDERAL EXTENSION REQUIREMENTS  ESTABLISHED BY THE
CONSOLIDATED OMNIBUS BUDGET  RECONCILIATION ACT OF
1985 (P.L. 99-272),  AS AMENDED FROM TIME TO TIME,
(COBRA); (B) as  to  the employee's spouse, at the
end of the  month  following  the month in which a
divorce,   COURT-ORDERED   annulment    or   legal
separation  is  obtained,  WHICHEVER  IS  EARLIER,
EXCEPT THAT THE  PLAN SHALL PROVIDE THE OPTION FOR
SAID SPOUSE TO  CONTINUE  COVERAGE FOR THE PERIODS
SET FORTH FOR  SUCH EVENTS UNDER FEDERAL EXTENSION
REQUIREMENTS  ESTABLISHED  BY   THE   CONSOLIDATED
OMNIBUS BUDGET RECONCILIATION  ACT  OF  1985 (P.L.
99-272), AS AMENDED  FROM  TIME  TO TIME, (COBRA);
and (C) as  to  the  employee  or dependent who is
sixty-five years of  age  or older, as of midnight
of the day preceding such person's eligibility for
benefits under Title  XVIII of the Social Security
Act;  (6) AS  TO  ANY  OTHER  EVENT  LISTED  AS  A
"QUALIFYING EVENT" IN 29 USC 1163, AS AMENDED FROM
TIME TO TIME,  CONTINUATION  OF  COVERAGE FOR SUCH
PERIODS SET FORTH  FOR  SUCH EVENT IN 29 USC 1162,
AS AMENDED FROM  TIME  TO TIME, PROVIDED SUCH PLAN
MAY REQUIRE THE INDIVIDUAL WHOSE COVERAGE IS TO BE
CONTINUED TO PAY  UP  TO  THE  PERCENTAGE  OF  THE
APPLICABLE PREMIUM AS  SPECIFIED FOR SUCH EVENT IN
29 USC 1162, AS AMENDED FROM TIME TO TIME; (7) any
continuation of coverage  required by this section
except subdivision (4)  OR  (6) of THIS subsection
[(b)] may be  subject  to  the requirement, on the
part of the  individual  whose  coverage  is to be
continued, that such  individual  contribute  that
portion of the premium he would have been required
to contribute had  the employee remained an active
covered employee, except  that  the individual may
be required to  pay UP TO ONE HUNDRED TWO PER CENT
OF  the  entire  premium  at  the  group  rate  if
coverage   is   continued   in   accordance   with
subdivision (1), (2)  OR  (5)  of THIS subsection,
[(b) above,] provided  the  employer  shall not be
legally obligated by sections 38a-505, 38a-546 and
38a-551 to 38a-559, inclusive, to pay such premium
if not paid timely by the employee.
    (c)   The   commissioner    shall   promulgate
regulations  concerning coordination  of  benefits
between the plan and other health insurance plans.
    (d)  The  plan   shall   make   available   to
Connecticut residents, in  addition  to  any other
conversion  privilege  available,   a   conversion
privilege under which  coverage shall be available
immediately upon termination of coverage under the
group plan. The  terms  and benefits offered under
the conversion benefits shall be at least equal to
the   terms  and   benefits   of   an   individual
comprehensive health care plan.
    Sec. 3. Subsection  (a)  of section 38a-546 of
the general statutes is repealed and the following
is substituted in lieu thereof:
    (a) In order to assure reasonable continuation
of  coverage and  extension  of  benefits  to  the
citizens of this  state,  [all]  EACH group health
insurance  [policies] POLICY,  REGARDLESS  OF  THE
NUMBER OF INSUREDS, PROVIDING COVERAGE OF THE TYPE
SPECIFIED IN SUBDIVISIONS (1), (2), (3), (4), (11)
AND  (12)  OF  SECTION  38a-469,  delivered,  [or]
issued  for  delivery,  [or  renewal]  RENEWED  OR
CONTINUED in this  state  on  or  after  [April 1,
1976]  OCTOBER 1,  1997,  shall,  subject  to  the
provisions  of  subsection   (d),   contain  those
provisions described in subsections (b) and (d) of
section 38a-554, AS AMENDED BY THIS ACT.
    Sec.  4.  (NEW)  (a)  Each  individual  health
insurance policy providing  coverage  of  the type
specified in subdivisions  (1), (2), (4), (11) and
(12) of section  38a-469  of  the general statutes
delivered, issued for  delivery or renewed in this
state on or  after  October 1, 1997, shall provide
coverage for laboratory  and  diagnostic tests for
all types of diabetes.
    (b) Notwithstanding the  provisions of section
38a-492a of the  general statutes, each individual
health insurance policy  providing coverage of the
type specified in subdivisions (1), (2), (4), (11)
and  (12)  of   section  38a-469  of  the  general
statutes delivered, issued for delivery or renewed
in this state  on  or after October 1, 1997, shall
provide  medically  necessary   coverage  for  the
treatment    of    insulin-dependent     diabetes,
insulin-using diabetes, gestational  diabetes  and
non-insulin-using  diabetes. Such  coverage  shall
include   medically   necessary    equipment,   in
accordance  with the  insured  person's  treatment
plan,  drugs  and   supplies   prescribed   by   a
prescribing practitioner, as  defined  in  section
20-571 of the general statutes.
    Sec. 5. (NEW)  (a) Each group health insurance
policy providing coverage of the type specified in
subdivisions  (1), (2),  (4),  (11)  and  (12)  of
section 38a-469 of the general statutes delivered,
issued for delivery or renewed in this state on or
after October 1,  1997, shall provide coverage for
laboratory and diagnostic  tests  for all types of
diabetes.
    (b) Notwithstanding the  provisions of section
38a-518a  of  the  general  statutes,  each  group
health insurance policy  providing coverage of the
type specified in subdivisions (1), (2), (4), (11)
and  (12)  of   section  38a-469  of  the  general
statutes delivered, issued for delivery or renewed
in this state  on  or after October 1, 1997, shall
provide  medically  necessary   coverage  for  the
treatment    of    insulin-dependent     diabetes,
insulin-using diabetes, gestational  diabetes  and
non-insulin-using  diabetes. Such  coverage  shall
include   medically   necessary    equipment,   in
accordance  with the  insured  person's  treatment
plan,  drugs  and   supplies   prescribed   by   a
prescribing practitioner, as  defined  in  section
20-571 of the general statutes.

Approved June 26, 1997