§ 23-86-512. Health insurance purchasing group health carrier market
No health insurance purchasing group health carrier shall be required to offer health insurance purchasing group health benefits plans or health benefits plans not subject to state-mandated health benefits to nonhealth insurance purchasing group organizations, associations, or employer groups, including, but not limited to, the small employer health insurance group marketplace in this state.
§ 23-86-402. Legislative finding
The General Assembly finds that: (1) Citizens covered by health benefit plans should have the opportunity to obtain healthcare services at an affordable price; (2) The cost of health benefit plans can vary depending upon the kind of arrangement the health benefit plan has with providers of healthcare services; (3) In order to provide affordable […]
§ 23-86-403. Definitions
As used in this subchapter: (1) “Benefit level” means an obligation of the health maintenance organization or insurance company under its health benefit plan. The benefit level is actuarially determined considering the copayments, deductibles, and dollar limits of the health benefit plan; (2) “Covered healthcare services” means services rendered or products sold by a healthcare […]
§ 23-86-404. Optional health benefit plans
(a) A health maintenance organization may offer and issue health benefit plans that reimburse or arrange for covered healthcare services to covered persons through a limited network plan if: (1) The health maintenance organization provides itself, or arranges through an insurance company, for an annual option for covered persons to choose a health benefit plan […]
§ 23-86-405. Effect of subchapter on pricing
Nothing in this subchapter shall be construed to prohibit a health maintenance organization from pricing any health benefit plan according to sound actuarial principles.
§ 23-86-406. Effect of subchapter on coverage of specific services
Nothing in this subchapter shall be construed to require a health maintenance organization to cover any specific healthcare service.
§ 23-86-501. Title
This subchapter shall be known and cited as the “Small Employer Health Insurance Purchasing Group Act of 2001”.
§ 23-86-502. Definitions
As used in this subchapter: (1) “Commissioner” means the Insurance Commissioner; (2) “Eligible employee” means an employee or individual who is a full-time employee of an eligible employer and is qualified to enroll in a health benefit plan offered through a health insurance purchasing group; (3) “Eligible employer” means an employer employing no more than […]
§ 23-86-503. Health insurance purchasing group organization requirements
(a) Each health insurance purchasing group shall be a nonprofit corporation operated under the direction of a board of directors that is composed of five (5) representatives of eligible employers. (b) (1) (A) Each health insurance purchasing group shall be composed of at least five hundred (500) eligible employees from one (1) or more eligible […]
§ 23-86-504. Health insurance purchasing group health benefits coverage requirements
(a) (1) In conjunction with a health insurance purchasing group health carrier, each health insurance purchasing group that offers health benefit plans to small employers as defined by § 23-86-303 shall guarantee the availability of coverage to small employers as required by § 23-86-312(a). (2) All health benefit plans provided through a health insurance purchasing […]