PA 10-63—sSB 50

Insurance and Real Estate Committee

Appropriations Committee

AN ACT CONCERNING ORAL CHEMOTHERAPY TREATMENTS

SUMMARY: This act requires certain health insurance policies that cover intravenously and orally administered anticancer medications prescribed by a licensed practitioner with prescribing authority to cover the orally administered medication on at least as favorable a basis as the intravenously administered medication. It prohibits insurers, HMOs, medical and hospital service corporations, and fraternal benefit societies from reclassifying anticancer medications or increasing the patient's out-of-pocket costs for the medications as a way to comply.

The act also broadens the applicability of several health insurance benefits required by law, including treatment of tumors and leukemia, reconstructive surgery, nondental prosthesis, chemotherapy, and wigs for chemotherapy patients. It does this by requiring all policies renewed, amended, or continued in Connecticut to include the benefits. Policies delivered or issued here already must include them.

EFFECTIVE DATE: January 1, 2011

EXPANDED APPLICABILITY OF REQUIREMENTS

The act requires health insurance policies renewed, amended, or continued in Connecticut to provide coverage for:

1. the surgical removal of tumors and related outpatient chemotherapy;

2. treatment of leukemia, including outpatient chemotherapy;

3. reconstructive surgery, including on a breast on which a mastectomy was performed and a nondiseased breast for symmetry (such as augmentation or reduction mammoplasty and mastopexy);

4. nondental prosthesis, including any maxillo-facial prosthesis used to replace anatomic structures lost during treatment for head and neck tumors or additional appliances essential for the support of such a prosthesis;

5. an oncologist-prescribed wig for a patient with hair loss resulting from chemotherapy; and

6. if a group health insurance policy, medically necessary removal of breast implants that were implanted before July 2, 1994.

Coverage must be subject to the same terms and conditions applicable to other benefits under the policy. But the policy must provide at least a yearly benefit of: (1) $500 each for the surgical removal of tumors, reconstructive surgery, and outpatient chemotherapy; (2) $350 for a wig; (3) $300 for a nondental prosthesis, unless the prosthesis is due to the surgical removal of breasts because of tumors, in which case the yearly benefit must be at least $300 for each breast; and (4) if a group policy, $1,000 for a breast implant removal. Coverage must be provided for the reasonable cost of reconstructive breast surgery.

By law, policies issued or delivered in Connecticut already must include these benefits.

APPLICABILITY OF THE ACT

The act applies to individual and group health insurance policies delivered, issued, renewed, amended, or continued in Connecticut that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; or (4) hospital or medical services, including coverage under an HMO plan. It also applies to individual health insurance policies that provide limited benefit health coverage.

Due to federal law, state insurance benefit mandates do not apply to self-insured benefit plans.

BACKGROUND

Related Act

PA 10-5 includes the same expanded applicability requirements found in this act.

OLR Tracking: JLK: ND: DF