Sec.38a-513-1. Definitions

As used in sections 38a-513-1 to 38a-513-13, inclusive, of the Regulations of Connecticut State Agencies, unless otherwise provided:

(1) "Activities of daily living" means activities such as bathing, dressing, eating, toileting, and transferring.

(2) “Commissioner” means the Insurance Commissioner of the State of Connecticut.

(3) “Department” means the Connecticut Insurance Department.

(4) “Excessive rate” means the rate is unreasonably high for the insurance provided.

(5) “Experience period” means the most recent twelve (12) month period from which the insurer accumulates the data to support a rate filing.

(6) “Form” means a policy or certificate of insurance against loss or expense from sickness, or from bodily injury or death by accident, or application, rider or endorsement used in connection therewith.

(7) "Formulary" means a list of prescription drugs that are covered by a specific health insurance plan.

(8) "Group specified disease policy" means a group health insurance plan or certificate delivered or issued for delivery in this state which pays benefits for the diagnosis or treatment of one or more specifically named diseases, conditions or syndromes in accordance with section 38a-513-4(g)(13) of the Regulations of Connecticut State Agencies.

(9) “Health insurance plan” has the same meaning as provided in Section 38a-564 of the Connecticut General Statutes.

(10) “Inadequate rate” means a rate that is unreasonably low for the insurance provided, and continued use of it would endanger solvency of the insurer.

(11) "Insurer" means a health care center, as defined in Section 38a-175 of the Connecticut General Statutes, or an insurance company licensed by the Commissioner to write accident and health insurance.

(12) “Loss ratio” has the same meaning as provided in Section 38a-481(a) of the Connecticut General Statutes.

(13) "One period of confinement" means consecutive days of in-hospital service received as an in-patient, or successive confinements when discharge from and readmission to the hospital occurs within a period of not more than ninety (90) days or three times the maximum number of days of in-hospital coverage provided by the policy to a maximum of one hundred and eighty (180) days.

(14) "Pharmaceutical and therapeutics committee" or "P&T committee" means a group of members that may include physicians, pharmacists, administrators, quality improvement managers, other health care professionals and staff appointed by an insurer to establish policies regarding the use of drugs, therapies and drug-related products, identifying those that are most medically appropriate and cost effective.

(15) “PPACA” means Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, and regulations adopted thereunder.

(16) "Prescription drug tier" means a subset of the drugs covered in a formulary that are covered and subject to a specified level of cost share.

(17) “SERFF” means the National Association of Insurance Commissioners’ System for Electronic Rate and Form Filing.

(18) “Small employer” has the same meaning as provided in Section 38a-564 of the Connecticut General Statutes.

(19) "Specialty drug” means a unique prescription drug that may require special handling, close monitoring or may only be available from limited pharmacies.

(20) “Unfairly discriminatory” means rating practices that reflect differences based on age, disability, race, ethnicity, gender, sexual orientation or health status that are not actuarially justified or are otherwise prohibited by law.

(21) “Utilization data” means the number of services used by a fixed number of covered persons, as defined in Section 38a-591a of the Connecticut General Statutes, over a fixed length of time.

(Adopted effective November 30, 2009; Amended December 3, 2018)