Conn. Agencies Regs. § 38a-481-1

Current through September 27, 2024

Section 38a-481-1 - Definitions

As used in Sections 38a-481-1 to 38a-481-13, inclusive, of the Regulations of Connecticut State Agencies, unless the context otherwise requires:

(1) "Commissioner" means the Insurance Commissioner of the State of Connecticut.

(2) "Department" means the Connecticut Insurance Department.

(3) "Excessive rate" means the rate is unreasonably high for the "insurance provided.

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

(5) "Form" means a policy 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.

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

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

(8) "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.

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

(10) "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.

(11) "PPACA" means Patient Protection and Affordable Care Act, PL. 111-148, as amended from time to time, and regulations adopted thereunder.

(12) "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.

(13) "SERFF" means the National Association of Insurance Commissioners' System for Electronic Rate and Form Filing.

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

(15) "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 otherwise prohibited by law

(16) "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.

Conn. Agencies Regs. § 38a-481-1

Effective September 25, 1992; Amended April 23, 2015; Amended August 2, 2016; Amended 12/3/2018