§ 20-3604 – Rules
20-3604. Rules A. The director may adopt rules pursuant to title 41, chapter 6 to carry out this article. B. The rules may include regulation of reinsurance arrangements relating to any of the following: 1. Life insurance policies with guaranteed nonlevel gross premiums or guaranteed nonlevel benefits. 2. Universal life insurance policies with provisions resulting […]
§ 20-3605 – Reinsurance agreements affected
20-3605. Reinsurance agreements affected This article applies to all cessions after September 29, 2021 under reinsurance agreements that have an inception, anniversary or renewal date not less than six months after September 29, 2021.
§ 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 […]
§ 20-3406 – Uniform prior authorization request forms; definition
20-3406. Uniform prior authorization request forms; definition A. Notwithstanding any other law, on or before January 1, 2022, the department shall approve a uniform prior authorization request form for prescription drugs, devices or durable medical equipment and a uniform prior authorization request form for all other health care procedures, treatments and services. On or before […]
§ 20-3451 – Definitions
20-3451. Definitions In this chapter, unless the context otherwise requires: 1. " Applicant" means a provider that submits a credentialing application to a health insurer to become a participating provider in the health insurer’s network. 2. " Application" means an applicant’s initial application to be credentialed as a participating provider. 3. " Credentialing" means to […]
§ 20-3452 – Requirements for electronic application submission
20-3452. Requirements for electronic application submission A. A health insurer shall establish a process for the electronic submission of a credentialing application. On or before December 31, 2019, the health insurers shall adopt and implement a standard application. B. On or before December 31, 2019, to the greatest extent possible, a health insurer shall establish […]