Connecticut health plans will cover childhood disorders and scalp cooling

Individual and group health policies must cover treatment for PANDAS and PANS, including intravenous immunoglobulin therapy. This applies to the listed types of individual and group health policies issued in Connecticut. The requirement applies to policies delivered, issued, renewed, amended, or continued in Connecticut on or after January 1, 2027.

Individual and group plans that cover chemotherapy must cover scalp cooling systems at least as fully as Medicare does. This applies to the listed individual and group health policies that cover chemotherapy. A scalp cooling system is a reusable medical device that cools the scalp to prevent or reduce chemotherapy-related hair loss. A plan cannot impose more restrictive cost sharing than it does for substantially all other benefits. High deductible plans are exempt from the deductible limits. Plans may require prior authorization, but must do so in the same way and to the same extent as for other covered benefits. The requirement applies to policies delivered, issued, renewed, amended, or continued in Connecticut on or after January 1, 2027.

Individual and group policies must cover medically necessary infertility diagnosis and treatment, subject to limits on coverage for IVF and related procedures. These provisions apply to the listed individual policies; parallel provisions apply to the listed group policies. Infertility includes certain medical histories and needs for medical intervention, including using donor eggs or sperm, donor embryos, or a gestational carrier. For people with a partner and the necessary eggs or sperm, infertility also includes being unable to establish or carry a pregnancy after 12 months of unprotected sex, or after six months when age is the reason. A pregnancy loss does not restart either period. Coverage for IVF and related procedures is limited to people who meet the definition and could not establish or carry a pregnancy through less expensive, medically viable covered treatment. A person may skip a treatment if their physician determines it is likely to fail. The definition and coverage provisions take effect January 1, 2027. The referenced policies include those delivered, amended, renewed, or continued in Connecticut on or after January 1, 2018.