(a) For the purposes of this section:

(1) “Employee” has the same meaning as specified in section 38a-564.

(2) “Essential health benefits” means health care services and benefits that fall within the following categories:

(A) Ambulatory patient services;

(B) Emergency services;

(C) Hospitalization;

(D) Maternity and newborn health care;

(E) Mental health and substance use disorder services, including, but not limited to, behavioral health treatment;

(F) Prescription drugs;

(G) Rehabilitative and habilitative services and devices;

(H) Laboratory services;

(I) Preventive and wellness services and chronic disease management; and

(J) Pediatric services, including, but not limited to, oral and vision care.

(3) (A) “Small employer” means an employer that employed an average of at least one but not more than fifty employees on business days during the preceding calendar year and employs at least one employee on the first day of the group health insurance policy year. “Small employer” does not include a sole proprietorship that employs only the sole proprietor or the spouse of such sole proprietor.

(B) (i) For the purposes of subparagraph (A) of this subdivision, the number of employees shall be determined by adding (I) the number of full-time employees for each month who work a normal work week of thirty hours or more, and (II) the number of full-time equivalent employees, calculated for each month by dividing by one hundred twenty the aggregate number of hours worked for such month by employees who work a normal work week of less than thirty hours, and averaging such total for the calendar year.

(ii) If an employer was not in existence throughout the preceding calendar year, the number of employees shall be based on the average number of employees that such employer reasonably expects to employ in the current calendar year.

(b) Each group health insurance policy providing, through a small employer, coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state on or after January 1, 2019, shall provide coverage for essential health benefits.

(c) No provision of the general statutes concerning a requirement of the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, shall be construed to supersede any provision of this section that provides greater protection to an insured, except to the extent this section prevents the application of a requirement of the Affordable Care Act.

(d) The Insurance Commissioner may adopt regulations, in accordance with chapter 54, to carry out the purposes of this section, including, but not limited to, regulations specifying the health care services and benefits that fall within each category set forth in subdivision (2) of subsection (a) of this section.

(P.A. 18-10, S. 2.)

History: P.A. 18-10 effective January 1, 2019.

See Sec. 38a-492q for similar provisions re individual policies.