Sec.38a-472f-3. Minimum Standards for Network Adequacy

(a) Each health carrier that delivers, issues for delivery, renews, amends or continues any individual or group health insurance policy or certificate in this state that uses a provider network shall:

(1) Establish and monitor the provider network to ensure that a person covered under the policy or certificate has access to health care services within the maximum time and distance standards.

(2) Ensure that the provider network has at least one primary care physician per two thousand (2,000) covered persons.

(3) Ensure that the percentage of providers participating in the network that accept new patients is at least seventy percent (70%).

(4) Establish reasonable wait times for access to primary care, urgent care, specialist care, mental health, ancillary services and any other categories of service, and monitor provider compliance with the requirements established pursuant to this subdivision.

(5) Demonstrate a good faith effort to contract with centers of excellence, mobile clinics, walk-in clinics, urgent care facilities and providers of technological or specialty care services, to the extent available.

(6) Have an adequate process in place to provide in-network levels of coverage from nonparticipating providers, without unreasonable travel or delay or unreasonable wait time for an appointment, when a participating provider is not available.

(7) Demonstrate a good faith effort to contract with hospital-based providers.

(8) Ensure that covered persons:

(A) Have access to emergency services, as defined in section 38a-477aa of the Connecticut General Statutes, twenty-four (24) hours a day, seven (7) days a week.

(B) Have reasonable access to participating providers within normal business hours.

(9) Ensure that participating providers shall have admitting rights to at least one participating hospital, where appropriate.

(b) No individual or group health insurance policy or certificate that uses a provider network shall be delivered, issued for delivery, renewed, amended or continued in this state if the provider network does not meet the required minimum standards for network adequacy set forth in subsection (a) of this section.

(Effective July 2, 2018)