§36-7401. Stop-loss coverage – Minimum aggregate retention.
Any stop-loss insurance coverage issued by an insurer authorized to do business in this state that provides an aggregate retention benefit shall provide an aggregate retention of no less than one hundred ten percent (110%) of the expected claims. The Insurance Commissioner shall develop minimum disclosure standards that can be incorporated into a form that […]
§36-7402. Evaluation of effect of limits on opioid prescriptions and claims and out-of-pocket costs – Report.
The Insurance Department shall evaluate the effect of the limits on prescriptions for opioid drugs established by this act on the claims paid by health insurance carriers and the out-of-pocket costs including copayments, coinsurance and deductibles paid by individual and group health insurance policyholders. On or before January 1, 2021, the Insurance Department shall submit […]
§36-7123. Permit required – Contracts in violation of act.
A. Any organization which shall accept money or anything of value for cemetery merchandise pursuant to a prepaid cemetery merchandise contract shall first obtain a permit from the Insurance Commissioner authorizing the transaction of this type of business before entering into the contract. It shall be unlawful to sell any prepaid cemetery merchandise unless the […]
§36-7204. Payment deadlines.
A. Except as provided in subsection B of this section, the access payments required to be paid by health carriers in Section 3 of this act shall be due and reported to the Insurance Commissioner on claims paid and incurred beginning July 1, 2010. B. The access payments required in Section 3 of this act […]
§36-7124. Administration of act – Appeals – Exemption for prepaid plans.
A. The Cemetery Merchandise Trust Act, Sections 7121 through 7135 of this title, shall be administered by the Insurance Commissioner. The Commissioner is authorized to promulgate reasonable rules concerning the keeping and inspection of records, the filing of contracts and reports, investments of and handling of the trust funds, and all other matters concerning the […]
§36-7301. Dental plan fee regulation – Appeals procedures.
A. No contract between a dental plan of a health benefit plan and a dentist for the provision of services to patients may require that a dentist provide services to its subscribers at a fee set by the health benefit plan unless the services are covered services under the applicable subscriber agreement. B. As used […]
§36-7125. Application for permit – Cancellation of or refusal to issue or renew permit – Appeal.
A. Each organization desiring to accept money or anything of value for prepaid cemetery merchandise shall file an application for a permit with the Insurance Commissioner, and shall at the time of filing the application pay one initial filing fee of Two Hundred Dollars ($200.00). The Commissioner shall issue a permit upon the receipt of […]
§36-7302. Dental insurance plans – Contracting entity requirements
A. As used in this section: 1. “Contracting entity” means any person or entity that is engaged in the act of contracting with providers for the delivery of dental services or the selling or assigning of dental plans to other dental care entities; 2. “Identify” means providing in writing, by email or otherwise, to the […]
§36-7126. Establishment and maintenance of cemetery merchandise trust funds
A. Each organization shall establish and maintain a cemetery merchandise trust fund with a financial institution having trust powers. A cemetery merchandise trust fund shall at all times be in the custody of a financial institution. Any cemetery merchandise trust funds may be invested, reinvested, exchanged, retained, sold and managed as a part of common […]
§36-7303. Prohibition on denial of claim in a prior authorization – Exceptions – Requirements.
A. For the purposes of this section, “prior authorization” means any predetermination, prior authorization, or similar authorization that is verifiable, whether through issuance of letter, facsimile, email, or similar means, indicating that a specific procedure is, or multiple procedures are, covered under the patient’s dental plan and reimbursable at a specific amount, subject to applicable […]