Substitute Bill No. 5374 seeks to amend health insurance mandates in Connecticut, effective January 1, 2027, by introducing new coverage requirements for specific medical conditions and treatments. The bill mandates that health insurance policies must cover Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections and Pediatric Acute-onset Neuropsychiatric Syndrome. Additionally, it requires that policies covering chemotherapy include coverage for scalp cooling systems to prevent hair loss, ensuring that such coverage is at least equivalent to Medicare standards. The bill prohibits insurance policies from imposing more restrictive out-of-pocket expenses for scalp cooling systems compared to other benefits and allows for prior authorization, provided it aligns with other covered benefits.

Moreover, the bill redefines "infertility" to include a broader range of medical conditions and specifies that coverage for infertility treatments, such as in-vitro fertilization, must be provided to individuals meeting the new definition who have not succeeded with less expensive treatments. It also revises the definition of "prosthetic device" to include microprocessor-equipped devices deemed medically necessary, while removing exclusions for devices designed solely for athletic purposes. The legislation repeals Section 38a-1 of the general statutes and replaces it with updated definitions and terms relevant to the new mandates, thereby modernizing the legal framework governing health insurance in the state.

Statutes affected:
Raised Bill:
INS Joint Favorable Substitute:
File No. 242:
APP Joint Favorable: