HB 5374 — AN ACT CONCERNING HEALTH COVERAGE MANDATES FOR CERTAIN HEALTH CONDITIONS.

General Assembly Substitute House Bill No.

5374 FebruaryPublic Session,Act 2026No. AN ACT CONCERNING HEALTH COVERAGE MANDATES FOR CERTAIN HEALTH CONDITIONS.

26-33 AN ACT CONCERNING HEALTH COVERAGE MANDATES FOR CERTAIN HEALTH CONDITIONS.

Termsused inthistitle andsections2to 5,inclusive, ofthisact,unlessofthisact, unless it appears from the context to the contrary, shall have a scope and meaning as set forth in this section.

This definition does not apply to payments made under a policy of life insurance.Substitute House Bill No.

LCO5374 1insurance. of 10 Substitute Bill No.

5374 (4) "Commissioner" means the Insurance Commissioner.

For purposes of this subdivision "liabilities" shall include but not be limited to reserves required by statute or by regulations adopted by the commissioner in accordance with the provisions of chapter 54 or specific requirements imposed by the commissioner upon a subject companyPublic atAct theNo. time of admission or subsequent thereto.

(11)26-33 "Insurance" means any agreement to pay a sum of money, provide services or any other thing of value on the happening of a LCO 2 of 10 Substitute House Bill No.

5374 particularcompany eventat orthe contingencytime orof toadmission provideor indemnitysubsequent forthereto. loss in respect to a specified subject by specified perils in return for a consideration.

(11) "Insurance" means any agreement to pay a sum of money, provide services or any other thing of value on the happening of a particular event or contingency or to provide indemnity for loss in respect to a specified subject by specified perils in return for a consideration.

(15) "Mutual insurer" means any insurer without capital stock, the managingPublic directorsAct orNo. officers of which are elected by its members.

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5374 managing directors or officers of which are elected by its members.

(17) "Policy" means any document, including attached endorsements LCOand 3riders, purporting to be an enforceable contract, which memorializes in writing some or all of 10the Substituteterms Billof No.an insurance contract.

5374 and riders, purporting to be an enforceable contract, which memorializes in writing some or all of the terms of an insurance contract.

Sec.Public Act No.

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5374 Sec.

LCOSec. 4 of 10 Substitute Bill No.

5374 Sec.

(c) Any individual health insurance policy may require prior authorization for scalp cooling systems, provided such prior authorizationPublic isAct requiredNo. in the same manner and to the same extent as is required for other covered benefits under such policy.

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5374 authorization is required in the same manner and to the same extent as is required for other covered benefits under such policy.

(b) (1) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11), (12) and (13) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2027, that provides coverage for chemotherapy shall provide coverage for scalp LCOcooling 5systems ofused 10in Substituteconnection Billwith No.such chemotherapy that is at least equivalent to such coverage provided under Medicare.

5374 cooling systems used in connection with such chemotherapy that is at least equivalent to such coverage provided under Medicare.

(a) As used in this section, "prosthetic device" means an artificial limb devicePublic toAct replace,No. in whole or in part, an arm or a leg, including a device that contains a microprocessor if such microprocessor-equipped device is determined by the insured's or enrollee's health care provider to be medically necessary.

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5374 device to replace, in whole or in part, an arm or a leg, including a device that contains a microprocessor if such microprocessor-equipped device is determined by the insured's or enrollee's health care provider to be medically necessary.

["Prosthetic device" does not include a device that LCOis 6designed ofexclusively 10for Substituteathletic Billpurposes.] No.Sec.

5374 is designed exclusively for athletic purposes.] Sec.

For purposes of this section, "infertility" means [the condition of an individual who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period or such treatmentPublic isAct medically necessary] (1) the inability to establish or carry a pregnancy based on an individual's medical, sexual and reproductive history, age, physical findings, diagnostic testing or any combination of such factors, including, but not limited to, infertility arising from disabilities or from medical treatments or conditions associated with a disability, (2) the need for medical intervention, including, but not limited to, the use of donor gametes, donor embryos or a gestational surrogate, to establish a pregnancy either as an individual or with a partner, (3) an individual's inability to establish a pregnancy or carry a pregnancy to live birth after twelve months of unprotected sexual intercourse when the individual and the individual's partner have the necessary gametes to establish a pregnancy, provided a pregnancy loss shall not restart the twelve-month period, and (4) an individual's inability to establish a pregnancy or to carry a pregnancy to live birth after six months of unprotected sexual intercourse due to the individual's age when the individual and the individual's partner have the necessary gametes to establish a pregnancy, provided a pregnancy LCO 7 of 10 Substitute Bill No.

537426-33 loss7 shallof not10 restartSubstitute theHouse six-monthBill period.No.

5374 treatment is medically necessary] (1) the inability to establish or carry a pregnancy based on an individual's medical, sexual and reproductive history, age, physical findings, diagnostic testing or any combination of such factors, including, but not limited to, infertility arising from disabilities or from medical treatments or conditions associated with a disability, (2) the need for medical intervention, including, but not limited to, the use of donor gametes, donor embryos or a gestational surrogate, to establish a pregnancy either as an individual or with a partner, (3) an individual's inability to establish a pregnancy or carry a pregnancy to live birth after twelve months of unprotected sexual intercourse when the individual and the individual's partner have the necessary gametes to establish a pregnancy, provided a pregnancy loss shall not restart the twelve-month period, and (4) an individual's inability to establish a pregnancy or to carry a pregnancy to live birth after six months of unprotected sexual intercourse due to the individual's age when the individual and the individual's partner have the necessary gametes to establish a pregnancy, provided a pregnancy loss shall not restart the six-month period.

Nothing in this subdivision shall be construed to deny the coverage required by this section to any individual who foregoes a particular infertility treatment or procedure if the individual's physician determines that such treatment or procedurePublic isAct likelyNo. to be unsuccessful;

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5374 procedure is likely to be unsuccessful;

Subsection (a) of section 38a-536 of the general statutes is repealedandthefollowingissubstitutedinlieurepealedandthefollowingissubstitutedinlieuthereof(EffectiveJanuary thereof(EffectiveJanuary 1, 2027):

For purposes of this section, "infertility" means [the condition of an individual who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period or such treatment is medically necessary] (1) the inability to establish or carry a LCOpregnancy 8based on an individual's medical, sexual and reproductive history, age, physical findings, diagnostic testing or any combination of 10such Substitutefactors, Billincluding, but not limited to, infertility arising from disabilities or from medical treatments or conditions associated with a disability, (2) the need for medical intervention, including, but not limited to, the use of donor gametes, donor embryos or a gestational surrogate, to establish a pregnancy either as an individual or with a partner, (3) an individual's inability to establish a pregnancy or carry a pregnancy to live birth after twelve months of unprotected sexual intercourse when the individual and the individual's partner have the necessary gametes to establish a pregnancy, provided a pregnancy loss shall not restart the twelve-month period, and (4) an individual's inability to establish a pregnancy or to carry a pregnancy to live birth Public Act No.

537426-33 pregnancy9 based on an individual's medical, sexual and reproductive history, age, physical findings, diagnostic testing or any combination of such10 factors,Substitute including,House butBill notNo. limited to, infertility arising from disabilities or from medical treatments or conditions associated with a disability, (2) the need for medical intervention, including, but not limited to, the use of donor gametes, donor embryos or a gestational surrogate, to establish a pregnancy either as an individual or with a partner, (3) an individual's inability to establish a pregnancy or carry a pregnancy to live birth after twelve months of unprotected sexual intercourse when the individual and the individual's partner have the necessary gametes to establish a pregnancy, provided a pregnancy loss shall not restart the twelve-month period, and (4) an individual's inability to establish a pregnancy or to carry a pregnancy to live birth after six months of unprotected sexual intercourse due to the individual's age when the individual and the individual's partner have the necessary gametes to establish a pregnancy, provided a pregnancy loss shall not restart the six-month period.