§ 20-3651 – Definitions
20-3651. Definitions In this article, unless the context otherwise requires: 1. " Clinical practice guidelines" means a systematically developed statement to assist health care providers and patients in making decisions about appropriate health care for specific clinical circumstances and conditions. 2. " Clinical review criteria" means the written screening procedures, decision abstracts, clinical protocols and […]
§ 20-3652 – Applicability
20-3652. Applicability This article applies to: 1. Any health care plan that is subject to state law regulating insurance, that provides prescription drug benefits and that includes coverage for a step therapy protocol regardless of how that coverage is described. 2. A contractor, agent or similar entity that implements coverage for a step therapy protocol […]
§ 20-3653 – Clinical review criteria
20-3653. Clinical review criteria A. Clinical review criteria that are used by a health care insurer, pharmacy benefit manager or utilization review agent to establish a step therapy protocol shall be based on clinical practice guidelines that: 1. Recommend that the prescription drugs be taken in the specific sequence required by the step therapy protocol. […]
§ 20-3551 – Definitions
20-3551. Definitions In this chapter, unless the context otherwise requires: 1. " Aggregator site" means a website that provides access to information regarding insurance products from more than one insurer, including product and insurer information, for use in comparison shopping. 2. " Blanket travel insurance" means a policy of travel insurance that is issued to […]
§ 20-3654 – Exceptions; process
20-3654. Exceptions; process A. Notwithstanding any other law, if coverage of a prescription drug for the treatment of any medical condition is restricted for use by a health care insurer, pharmacy benefit manager or utilization review agent through the use of a step therapy protocol, the patient and prescribing provider shall have access to a […]
§ 20-3552 – Purpose; applicability
20-3552. Purpose; applicability A. The purpose of this chapter is to promote the public welfare by creating a comprehensive legal framework within which travel insurance may be sold in this state. B. The requirements of this chapter apply to travel insurance that covers any resident of this state and that is sold, solicited, negotiated or […]
§ 20-3553 – Limited lines travel insurance producer licensing
20-3553. Limited lines travel insurance producer licensing A. Notwithstanding any other provision of this title, a travel retailer may offer and issue travel insurance under a limited lines travel insurance producer business entity license under the following conditions: 1. The limited lines travel insurance producer or travel retailer provides to purchasers of travel insurance all […]
§ 20-3554 – Premium tax; definitions
20-3554. Premium tax; definitions A. A travel insurer shall pay premium tax as provided in section 20-224 on travel insurance premiums paid by any of the following: 1. An individual primary policyholder who is a resident of this state. 2. A primary certificate holder who is a resident of this state and who elects coverage […]
§ 20-3555 – Travel protection plans
20-3555. Travel protection plans Travel protection plans may be offered for one price for the combined features that the travel protection plan offers in this state if both: 1. The travel protection plan clearly discloses to the consumer, at or before the time of purchase, that it includes travel insurance, travel assistance services and cancellation […]
§ 20-3556 – Sales practices; definition
20-3556. Sales practices; definition A. All persons offering travel insurance to residents of this state are subject to chapter 2, article 6 of this title relating to unfair trade practices and frauds, except as otherwise provided in this section. If a conflict exists between this chapter and another provision of this title regarding the sale […]