Starting January 1, 2026, new Connecticut insurance laws expand coverage and limit insurance practices that delay or deny medically necessary care.
These changes are important. Insurance delays are not just frustrating paperwork problems. They can delay diagnoses, interrupt treatment, and cause serious, lasting harm. The new laws are designed to ensure that medical decisions are made by doctors — not insurance companies.
Below is what patients and families should know:
Expanded Coverage for Biomarker Testing
Under the new law, most individual and group health insurance plans in Connecticut must cover biomarker testing when it is medically necessary to: ·
- Diagnose a condition
- Guide treatment decisions
- Monitor disease progression
- Manage ongoing care
Biomarker testing is critical in modern medicine, especially for:
- Cancer treatment
- Neurological conditions
- Autoimmune disorders
- Other complex or life-threatening illnesses
In the past, insurance companies often denied coverage for these tests, even when doctors said they were necessary. Starting in 2026, those denials will be much harder for insurers to justify.
Limits on “Fail First” (Step Therapy) Requirements
The new laws also limit the use of step therapy, often called “fail first” treatment.
Step therapy forces patients to try insurer-preferred medications before receiving the treatment their doctor recommends. For serious conditions, this can cause dangerous delays.
Connecticut law now prohibits step therapy for patients diagnosed with:
- Multiple sclerosis
- Rheumatoid arthritis
- Schizophrenia
- Major depressive disorder
- Bipolar disorder
For neurological and psychiatric conditions, delays can be especially harmful. The law recognizes this risk and puts patient safety first.
Stronger Protections for Anesthesia Coverage
The law also strengthens protections for general anesthesia coverage.
Insurance companies may no longer:
- Impose arbitrary time limits on anesthesia
- Deny coverage because the procedure took longer than expected
Every patient and every surgery is different. Medical care cannot be reduced to a preset time estimate.
Why These Changes Matter
Insurance decisions have real consequences. When insurers override medical judgment or delay care, patients suffer.
These laws are an important step toward accountability — but only if insurance companies follow them. At D’Amico Pettinicchi Injury Lawyers, we have spent decades holding powerful institutions accountable when their decisions cause harm. If you or a loved one has been injured due to delayed treatment or improper insurance practices, we are here to listen — and to fight.
Talk to a Connecticut Insurance Injury Lawyer
If an insurance company delayed, denied, or interfered with necessary medical care and caused harm, you may have legal rights. Contact D’Amico Pettinicchi Injury Lawyers for a confidential consultation. We fight to enforce patient protections and hold insurers accountable when their practices cause real harm.
