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 "mandated health benefit," which now includes any statutory requirement for health insurance coverage of specific treatments or services. It introduces a sunset provision for new health benefits, which will automatically terminate four years after their effective date unless approved by the General Assembly following a review report assessing their quality and cost impacts. The Insurance Commissioner is tasked with engaging independent experts for these reviews and submitting a mandated health benefit review report three years post-implementation. The bill also modifies the requirements for legislative fiscal notes, mandating that any bill affecting health insurance premiums include an enrollee impact statement prepared by the Office of Fiscal Analysis.

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 evidence. It outlines specific requirements for prior authorization processes, including response timelines for non-urgent and urgent requests. The bill also repeals and substitutes existing sections of the general statutes to enhance transparency regarding the financial implications of health-related legislation. Notably, it narrows the definition of "mandated health benefit" by removing provisions related to expanding or repealing existing coverage obligations and eliminates the requirement for the insurance commissioner to contract with the UConn Center for Public Health and Health Policy for mandated health benefit reviews. Overall, the legislation aims to improve oversight, accountability, and efficiency in health insurance processes while ensuring essential health services are covered.

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