§ 20-848 – Prescriptions; cost sharing; refills; dispensing fees; definition
20-848. Prescriptions; cost sharing; refills; dispensing fees; definition A. A subscription contract that is issued or renewed on or after January 1, 2017 and that provides coverage for prescription drugs: 1. May not deny coverage and shall prorate the cost sharing rate for a prescription drug covered by the contract that is dispensed by a […]
§ 20-849 – Contracts; optometrists; covered services; definition
20-849. Contracts; optometrists; covered services; definition A. Except as provided in subsection C of this section, a contract, entered into or renewed on or after January 1, 2022, between an optometric service corporation and an optometrist who is licensed to practice in this state shall not: 1. Require the optometrist to provide a service to […]
§ 20-843 – Eligibility; prohibiting cancellation because of eligibility for certain benefits
20-843. Eligibility; prohibiting cancellation because of eligibility for certain benefits A. Except as specifically provided in sections 20-1379 and 20-1380, with respect to the determination of whether a person is an eligible individual, a hospital and medical service corporation shall not consider the availability of or a person’s eligibility for medical assistance pursuant to title […]
§ 20-844 – Right to open enrollment period; subscribers; definition
20-844. Right to open enrollment period; subscribers; definition A. With respect to subscribers who are members of a group with more than one carrier, if there is an insolvency of a hospital service corporation, medical service corporation, dental service corporation, optometric service corporation or hospital, medical, dental and optometric service corporation, all other carriers that […]
§ 20-845 – Suspension or revocation of certificate of authority; civil penalties
20-845. Suspension or revocation of certificate of authority; civil penalties A. The director may suspend or revoke a certificate of authority issued to a corporation pursuant to this article if the director finds that any of the following conditions exist: 1. The corporation is operating significantly in contravention of its basic organizational documents or in […]
§ 20-846 – Individual health insurance policies; mandatory coverage exemption; definitions
20-846. Individual health insurance policies; mandatory coverage exemption; definitions A. A hospital service corporation, medical service corporation or hospital and medical service corporation may issue a subscription contract to an uninsured individual that is not subject to the requirements of any of the following: 1. Section 20-461, subsection A, paragraph 17 and subsection B. 2. […]
§ 20-847 – Contracts; dentists; covered services; definition
20-847. Contracts; dentists; covered services; definition A. A contract, entered into or renewed on or after January 1, 2011, between a dental service corporation and a dentist who is licensed to practice in this state shall not require the dentist to provide services to an individual covered under a subscription contract based on a fee […]
§ 20-841.04 – Standing referrals to network health care professionals; definition
20-841.04. Standing referrals to network health care professionals; definition A. Any corporation that offers a health benefits plan shall establish a procedure by which a subscriber may apply for a standing referral to a network health care professional. The corporation shall provide a subscriber with a standing referral if all of the following conditions are […]
§ 20-841.05 – Prescription drug formulary; definitions
20-841.05. Prescription drug formulary; definitions A. A corporation with a prescription drug benefit that uses a drug formulary as a component of the subscription contract shall provide to its subscribers notice in the contract and any disclosure form regarding the applicable drug formulary. The corporation shall write the notice so that the language and format […]
§ 20-841.06 – Continuity of care; definition
20-841.06. Continuity of care; definition A. Any corporation that offers a health benefits plan shall allow any new subscriber whose health care provider is not a member of the provider network, on written request of the subscriber to the corporation, to continue an active course of treatment with that health care provider during a transitional […]