January Brings New Laws That Matter to You

It’s a new year and new laws that make a difference to you went into effect on January 1.

Universal worked with partner organizations to advocate for their passage.

We couldn’t have done it without your support for quality, affordable health care for everybody!

Today, we focus on four new state laws and one new federal law that protect the rights and pocketbooks of people when they get the care and prescription drugs they need.

New State Laws

The state laws apply to insurance coverage that can be regulated by the state: fully insured plans for individuals, small employer plans and some large employer plans.

An act concerning diabetes and high deductible health plans.

This law, which passed in July 2020 is finally going into effect now. It caps the maximum monthly out of pocket costs for diabetes medications, including insulin, at $25 and caps the cost of equipment and supplies at $100 a month. In addition, once a year, anyone with diabetes will be eligible for one 30-day emergency supply of insulin from any pharmacy in the state:

An act prohibiting certain health carriers and pharmacy benefits managers from employing copay accumulator programs.

Sometimes patients are able to receive discounts, coupons, or direct assistance to cover the cost of prescription copays and co-insurance so that they can afford their medications. This bill allows that assistance to be counted toward the annual deductible and out of pocket costs so that when discounts disappear, as they often do, patients are already well on their way to meeting their deductible and out-of-pocket maximum limits. Without this protection patients would only be able to count what they had paid out of their own pockets toward the deductible and might not be able to afford their medications:

An act concerning prescription drug formularies and lists of covered drugs.

This law prohibits insurers from dropping a medication from their list of covered drugs (known as a drug formulary). It also stops insurers from moving a covered drug to a higher cost sharing tier:

An act concerning dental and vision insurance coverage for children, stepchildren and other dependent children.

Children up to age 26 can now remain on their parents’ dental and vision coverage until the end of the policy year, rather than being dropped the month they turn 26. This mirrors what is already done with medical insurance:

New Federal Law

The federal law applies to all types of coverage, including self-funded plans, which is the type of insurance most Connecticut workers have.

The No Surprises Act

Passed with bipartisan congressional support, this new federal law went into effect on January 1. Consumers are now better protected from getting unexpected extra bills because they received care from an out-of-network provider they did not or could not choose. When receiving care at an emergency room or urgent care facility, you can only be charged the in-network rate. This is true for air ambulance services, too, although, unfortunately, not for ground ambulances. For elective care in a hospital, the No Surprises Act protects you from getting a surprise bill from other providers such as the radiologist, the anesthesiologist, or assistant surgeon if they happen to be out of network. You still need to make sure the main doctor and hospital you are choosing are in network, but after that, you are not responsible for paying extra for other providers who may care for you. A third part of the bill is focused on the rules for how the providers and your insurance company will settle up. Providers have filed legal challenges against those rules. But the good news is that patients will no longer be caught in the middle while they fight it out in court.

Here is a link to an explainer that gives more detail about this important new law.