OHA: Diabetes

Managed Care Laws


The American Diabetes Association offers the following as a general guideline for the public. People in Connecticut who have diabetes AND Connecticut based insurance are entitled to certain rights under Connecticut laws including PA-97-268 and PA-99-284 and insurance carriers must comply.

If you have diabetes, you have the right to receive supplies, equipment, medication, education and nutrition training as ordered by a physician and you may appeal certain decisions with your insurance plan.

The American Diabetes Association believes that under Connecticut law you are entitled to the following:

  1. MEDICATION necessary to treat people with diabetes; policies without prescription coverage must cover drugs for diabetes.
  2. EQUIPMENT for giving medication such as syringes or pumps. Diabetic medical equipment is not subject to policy yearly limits.
  3. SUPPLIES and equipment to test glucose levels such as meters, strips and lancets.
  4. OUTPATIENT self-management training; including education and medical nutrition therapy training for Type 1, Type 2, or gestational diabetes or when therapy changes are needed.
  5. DIABETES coverage is not subject to internal or calendar year limits named in a policy, except for syringes.
  6. GENERIC or brand co-pays apply and will vary depending on the insurance policy.
  7. MANDATES do not extend to over the counter items such as wipes, cotton, or alcohol.
  8. INTERNAL AND EXTERNAL APPEALS are a right, through the insurance company and the Connecticut Department of Insurance, to resolve disputes.
  9. MEDICARE provisions vary from the entitlements stated above and are not covered by PA-97-268 or PA-99-284.
  10. Connecticut mandates do not apply to: a) Plans that are self-insured, b) Medicare supplemental insurance, c) Federal employee or out of state policies.

If you have any questions about the guidelines or your insurance coverage call:

American Diabetes Association

Connecticut Department of Insurance

State of Connecticut Office of the Healthcare Advocate
(Toll free) 1-866-HMO-4446

These guidelines are subject to some exceptions and further clarifications may be necessary. Other Connecticut General Statutes may apply.

Courtesy of the American Diabetes Association