CurrentConnecticut Insurance DepartmentPolicy N/A

Individual Accident and Sickness Insurance Policies

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This bulletin governs how insurers licensed to write accident and health insurance must categorize, label, disclose, and structure individual accident and sickness insurance policies in Connecticut, including combination, limited-benefit, and accident-only coverage.

Policy Summary

PayerConnecticut Insurance Department

PolicyIndividual Accident and Sickness Insurance Policies

Policy CodePolicy N/A

Change TypeRevised bulletin

Effective DateN/A

Next Review DateN/A

Key ActionClassify each individual health policy within an authorized Connecticut health insurance category and ensure that minimum standards are met for each applicable category.

SourceLink

POLICY UPDATE CHANGES

The revised bulletin updates the discussion of individual accident and sickness insurance previously found in Bulletins HC-25 and HC-33.

9Health insurance categories

2Permitted exceptions

$30/dayExample minimum benefit

$10/dayLimited-benefit example

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CurrentConnecticut Insurance DepartmentPolicy N/A

Individual Accident and Sickness Insurance Policies

Customize your policy alerts

Sign up for all Connecticut Insurance Department policy alerts

Know when Connecticut Insurance Department releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerConnecticut Insurance Department

PolicyIndividual Accident and Sickness Insurance Policies

Policy CodePolicy N/A

Change TypeRevised bulletin

Effective DateN/A

Next Review DateN/A

Key ActionClassify each individual health policy within an authorized Connecticut health insurance category and ensure that minimum standards are met for each applicable category.

SourceLink

POLICY UPDATE CHANGES

The revised bulletin updates the discussion of individual accident and sickness insurance previously found in Bulletins HC-25 and HC-33.

9Health insurance categories

2Permitted exceptions

$30/dayExample minimum benefit

$10/dayLimited-benefit example

4Accident-only categories

Policy Categories and Minimum Standards

Policy Category and Combination Requirements

All individual health insurance policies must fall within a health insurance category listed in Connecticut General Statutes §38a-469 or a coverage category established in the Individual Accident and Sickness Insurance Minimum Standards, beginning at §38a-505-1 of the Regulations of Connecticut State Agencies.

Policy category and combination requirements

Permitted categories
- Basic Hospital Expense Coverage
- Basic Medical-Surgical Expense Coverage
- Hospital Indemnity Coverage
- Major Medical Expense Coverage
- Disability Income Protection Coverage
- Accident Only Coverage
- Specified Accident Coverage
- Limited Benefit Health Insurance Coverage
- Specified Disease Policies
A policy combining two or more categories is permitted only when it meets the minimum standards for each category.
Permitted exceptions to the combination/minimum-standard rule
- Additional benefits exception
  - A policy meeting the minimum standards for a given category may add certain benefits that are not related to that category.
  - The policy must be labeled according to its main category.
  - The policy must include the required disclosure language in quarter-inch type or in a contrasting color: "THIS POLICY MEETS CONNECTICUT'S MINIMUM STANDARDS FOR (INSERT NAME OF CATEGORY). IT ALSO CONTAINS ADDITIONAL BENEFITS. PLEASE READ THE ATTACHED OUTLINE OF COVERAGE WHICH EXPLAINS THE BENEFITS IN DETAIL."
  - Example: a hospital indemnity policy may include nursing home benefits, but it must remain labeled as a hospital indemnity policy.
- Lower-than-minimum benefit exception

The applicable minimum standards are those established for the policy's category under the Individual Accident and Sickness Insurance Minimum Standards Regulation.

Accident-Only and Limited-Benefit Requirements

Accident-only policies are permitted under §38a-505-9(G) and must fit within one or more of the specified accident-only categories. Accident-only benefits exclude sickness benefits.

Accident-only coverage requirements

Permitted accident-only categories, singly or in combination
- Death
- Disability
- Dismemberment
- Hospital and Medical
Applicable standards

Required Policy Classification and Disclosure Actions

Documentation Required

Categorize each individual health policy

Classify every individual accident and sickness insurance policy within one of Connecticut’s authorized health insurance categories and meet the applicable minimum standards. Combinations of two or more categories are permitted only when the minimum standards are met for each category.

Basic Hospital Expense Coverage
Basic Medical-Surgical Expense Coverage
Hospital Indemnity Coverage
Major Medical Expense Coverage
Disability Income Protection Coverage
Accident Only Coverage
Specified Accident Coverage
Limited Benefit Health Insurance Coverage
Specified Disease Policies

Documentation Required

Disclose additional unrelated benefits

Key Policy Terms

Combination Policy

DefinitionAn individual health policy that combines two or more permitted health insurance categories.

Minimum-standard requirementThe minimum standards must be met for each category included in the combination.

Permitted categoriesPermitted categories include basic hospital expense, basic medical-surgical expense, hospital indemnity, major medical expense, disability income protection, accident only, specified accident, limited benefit health insurance, and specified disease policies.

Limited Benefit Health Insurance Policy

DefinitionA policy that contains all benefits required for a category but provides coverage below the applicable minimum standard.

Required policy labelThe policy must be labeled only as a Limited Benefit Health Insurance Policy, with no other policy description.

Policy Summary

PayerConnecticut Insurance Department

PolicyIndividual Accident and Sickness Insurance Policies

Policy CodePolicy N/A

Change TypeRevised bulletin

Effective DateN/A

Next Review DateN/A

Key ActionClassify each individual health policy within an authorized Connecticut health insurance category and ensure that minimum standards are met for each applicable category.

SourceLink

On This Page

An individual health policy may contain all benefits required by a category while providing those benefits at a level below the applicable minimum standard.

The policy must be labeled only as a Limited Benefit Health Insurance Policy, with no other policy description.

The policy must include the required disclosure language in quarter-inch type or in a contrasting color: "THIS POLICY CONTAINS BENEFITS WHICH DO NOT MEET CONNECTICUT MINIMUM STANDARDS. PLEASE READ THE ATTACHED OUTLINE OF COVERAGE WHICH EXPLAINS THE BENEFITS IN DETAIL."

Example: a hospital indemnity policy required to provide $30.00 per day for at least 31 days is a Limited Benefit Health Policy if it provides only $10.00 per day.

Policies providing disability benefits must comply with the regulation for Disability Income Coverage, except that they must not include sickness benefits.

Policies providing hospital and medical benefits must comply with the conditions applicable to Basic Hospital Expense Coverage and Basic Medical-Surgical Expense Coverage, except that they must not include sickness benefits.

When a policy includes benefits unrelated to its primary category, label it according to its main category and include the required disclosure overprint and attached outline of coverage. The overprint must state: “THIS POLICY MEETS CONNECTICUT'S MINIMUM STANDARDS FOR (INSERT NAME OF CATEGORY). IT ALSO CONTAINS ADDITIONAL BENEFITS. PLEASE READ THE ATTACHED OUTLINE OF COVERAGE WHICH EXPLAINS THE BENEFITS IN DETAIL.”

Use quarter-inch type or a contrasting color for the overprint.
Example: a hospital indemnity policy with nursing home benefits must be labeled as a hospital indemnity policy.

Denial Risk

Label below-minimum coverage

If a policy contains all benefits required for a category but provides coverage below the applicable minimum standard, label it only as a Limited Benefit Health Insurance Policy. Include the required disclosure overprint and attached outline of coverage.

The overprint must state: “THIS POLICY CONTAINS BENEFITS WHICH DO NOT MEET CONNECTICUT MINIMUM STANDARDS. PLEASE READ THE ATTACHED OUTLINE OF COVERAGE WHICH EXPLAINS THE BENEFITS IN DETAIL.”
Use quarter-inch type or a contrasting color for the overprint.
Example: hospital indemnity coverage of $10.00 per day must be categorized as a Limited Benefit Health Policy; the standard example is $30.00 per day for at least 31 days.

Documentation Required

Structure accident-only coverage

Limit accident-only policies to the permitted coverage categories of death, disability, dismemberment, or hospital and medical benefits, either singly or in combination. Accident-only disability policies must exclude sickness benefits, as must accident-only hospital and medical policies.

Accident-only disability coverage follows the applicable disability income coverage regulation, without sickness benefits.
Accident-only hospital and medical coverage follows the conditions for basic hospital and basic medical-surgical expense coverage, without sickness benefits.

Disclosure requirementThe policy must include an overprint stating that its benefits do not meet Connecticut minimum standards and must direct the reader to the attached outline of coverage.

Accident Only Coverage

DefinitionCoverage offering one or more permitted categories of accident-only benefits, either singly or in combination.

Permitted benefit categoriesDeath, disability, dismemberment, or hospital and medical coverage.

Accident-only disabilitySubject to the regulation for Disability Income Coverage, but without sickness benefits.

Accident-only hospital and medicalSubject to the conditions for Basic Hospital and Basic Medical-Surgical Expense Coverage, but without sickness benefits.