Connecticut Insurance Commissioner to study health coverage and utilization review standards

The Connecticut State Legislature has introduced House Bill 7040, a significant proposal aimed at enhancing health insurance coverage for life-saving medical treatments. Introduced on March 31, 2025, the bill mandates a comprehensive study by the Insurance Commissioner to evaluate current health carrier coverage guidelines, utilization review processes, and the overall transparency of health insurance practices in the state.

The primary focus of House Bill 7040 is threefold: first, it seeks to compare Connecticut's health carrier coverage guidelines with the latest evidence-based standards from other states; second, it aims to assess the transparency of utilization review measures employed by health carriers; and third, it addresses the necessity for mandated coverage of life-saving medical treatments, stipulating that such coverage should only be denied based on substantial medical evidence.

The bill has sparked discussions among lawmakers and stakeholders, particularly regarding the implications of utilization review time limits for both urgent and non-urgent care requests. Proponents argue that the bill could lead to improved access to essential medical services, potentially saving lives and reducing long-term healthcare costs. However, some critics express concerns about the feasibility of implementing the proposed changes and the potential impact on insurance premiums.

The Insurance Commissioner is required to report findings by February 1, 2026, which will provide critical insights into the effectiveness of current health insurance practices and inform future legislative actions. The outcomes of this study could have far-reaching implications for healthcare accessibility and insurance policy in Connecticut, making House Bill 7040 a pivotal piece of legislation in the ongoing conversation about healthcare reform in the state.