§ 20-842 – Prohibition against excluding coverage because of previous tests for a condition
20-842. Prohibition against excluding coverage because of previous tests for a condition An insurance contract offered by a hospital, medical, dental or optometric service corporation shall not exclude coverage of a condition if the insured person has previously had tests for the condition and the condition was not found to exist. There must be evidence […]
§ 20-840 – Continuation of existing certificates, licenses and rights
20-840. Continuation of existing certificates, licenses and rights This article shall not be construed in any manner to abrogate, amend or annul any certificate, license or right acquired prior to January 1, 1955 by any corporation, insurer, hospital, physician, dentist, optometrist, individual or subscriber under or pursuant to Laws 1945, 1st special session, chapter 13, […]
§ 20-841 – Prohibiting denial of certain contract benefits
20-841. Prohibiting denial of certain contract benefits A. Notwithstanding any provision of any subscription contract of a hospital and medical service corporation, benefits shall not be denied under the contract for any medical or surgical service performed by a holder of a license issued pursuant to title 32, chapter 7 or 11, if the service […]
§ 20-841.01 – Prohibiting denial of chiropractic contract benefits; direct reimbursement
20-841.01. Prohibiting denial of chiropractic contract benefits; direct reimbursement If a subscription contract of a hospital and medical service corporation provides for or offers reimbursement for any service which is within the lawful scope of the practice of a chiropractor holding a certificate or license issued by the state in which the services are rendered, […]
§ 20-841.02 – Prohibiting denial of psychologist contract benefits
20-841.02. Prohibiting denial of psychologist contract benefits If a subscription contract of a hospital and medical service corporation provides for or offers reimbursement for any service which is within the lawful scope of the practice of a psychologist holding a certificate or license issued by the state in which the services are rendered, a subscriber […]
§ 20-841.03 – Prohibiting denial of contract benefits; nurses; reimbursement
20-841.03. Prohibiting denial of contract benefits; nurses; reimbursement If a subscription contract of a hospital and medical service corporation provides or offers reimbursement for any service which is within the scope of the practice of a registered nurse practitioner or a certified registered nurse qualified under the rules adopted by the state board of nursing […]
§ 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 […]
§ 20-841.07 – Medical supplies
20-841.07. Medical supplies Any corporation that provides coverage for medical supplies shall provide coverage for those medical supplies through one or more participating vendors who are reasonably accessible to subscribers as determined by the department in terms of hours of service and areas of coverage within the geographic service area of the health care plan.