General Assembly Raised Bill No. 7039 introduces important reforms to health insurance policies in Connecticut, set to take effect on January 1, 2026. The bill prohibits insurers from retroactively denying or recouping payments for mental health and substance use disorder claims after two years from the service date, unless they provide written notice within one year. Additionally, it mandates coverage for medical foods for individuals diagnosed with phenylketonuria and for motorized wheelchairs, including their repairs and replacement batteries. Insurers are also prohibited from recovering lobbying costs through premiums charged to policyholders.

The legislation further requires the Insurance Commissioner to conduct studies on telehealth coverage for out-of-state students, dental provider reimbursement practices, and compensation for healthcare services provided by pharmacists, with reports due by February 1, 2026. A significant revision in the bill is the definition of "clinical peer" in utilization review, which now specifies that a clinical peer must hold a nonrestricted license in a U.S. state and have the same specialty as the treating physician or substantial experience in managing the relevant medical condition. These changes aim to enhance healthcare access and affordability while ensuring that insurance practices are aligned with the needs of Connecticut residents.