Substitute House Bill No. 6895 aims to enhance the oversight of mandated health benefits in Connecticut by establishing a health benefit review program within the Insurance Department. The bill repeals Section 38a-21 and introduces new definitions for terms such as "Exchange," "Health carrier," and "Qualified health plan," while modifying the definition of "Mandated health benefit" to include any statutory obligation for health insurance coverage. A significant provision of the bill is that any mandated health benefit enacted after January 1, 2026, will automatically terminate four years later unless reapproved by a majority vote of both legislative houses following a review report from the commissioner. This report will assess the quality and cost impacts of the mandated benefits, including evaluations of utilization and existing insurance coverage.

Additionally, the bill mandates coverage for biomarker testing in health insurance policies issued or renewed after January 1, 2026, provided that such testing is supported by clinical utility evidence. It establishes specific timelines for health care providers to respond to prior authorization requests and requires health carriers to create processes for handling coverage exceptions and appeals. The bill also introduces new fiscal note requirements for any legislation affecting health benefit premiums, ensuring that detailed assessments of financial impacts are included. Overall, sHB6895 seeks to improve transparency, accountability, and the quality of health insurance coverage in Connecticut while addressing the financial implications of mandated health benefits.

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