Substitute House Bill No. 6895 establishes a health benefit review program within the Insurance Department to evaluate mandated health benefits enacted by the General Assembly starting January 1, 2026. The bill updates key definitions, including "Exchange," "Health carrier," and "Qualified health plan," and modifies the definition of "mandated health benefit" to include any statutory requirement for health insurance coverage of specific treatments or services. A significant provision of the bill is the automatic termination of mandated health benefits four years after their effective date unless reapproved by the General Assembly. The Insurance Commissioner is tasked with submitting a review report within three years of enactment, assessing the quality and cost impacts of each mandated benefit, and the program will be funded by the Insurance Fund.

Additionally, the bill mandates coverage for biomarker testing, requiring health insurance policies issued or renewed after January 1, 2026, to cover such testing if it demonstrates clinical utility based on established medical evidence. It introduces new requirements for prior authorization processes, stipulating response times for insurers, and establishes a clear process for handling coverage exceptions and appeals. The bill also requires legislative fiscal notes for any bills affecting health insurance premiums, including an enrollee impact statement, ensuring that legislators are informed of the financial implications of proposed legislation. The provisions of the bill are set to take effect on January 1, 2026, and aim to enhance the evaluation and transparency of health benefits in Connecticut.

Statutes affected:
Raised Bill:
INS Joint Favorable Substitute: 2-24, 2-24a
File No. 310: 2-24, 2-24a