Section 27-41-93. – Gender rating. [Effective January 1, 2023.]
§ 27-41-93. Gender rating. [Effective January 1, 2023.] (a) No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state, that provides medical coverage that includes coverage for physician services in a physician’s office, and no policy that provides major medical or similar comprehensive-type coverage, excluding disability […]
Section 27-41-94. – Coverage for biomarker testing.
§ 27-41-94. Coverage for biomarker testing. (a) As used in this section: (1) “Biomarker” means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention. Biomarkers include but are not limited to gene mutations or protein expression. (2) “Biomarker testing” […]
Section 27-41-95. – Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. [Expires December 31, 2025.]
§ 27-41-95. Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. [Expires December 31, 2025.] (a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any […]
Section 27-41-83. – Discretionary clauses.
§ 27-41-83. Discretionary clauses. (a) No new or existing policy or certificate may contain any provision: (1) Purporting to reserve sole discretion to the insurance company to determine eligibility for benefits or interpret the terms of a policy or certificate; or (2) Specifying or affecting a standard of review upon which a court may review […]
Section 27-41-84. – Orally administered anticancer medication — Cost-sharing requirement.
§ 27-41-84. Orally administered anticancer medication — Cost-sharing requirement. (a) Every individual or group hospital or medical expense, insurance policy or individual or group hospital or medical services plan contract, plan or certificate of insurance delivered, issued for delivery, or renewed in this state, on or after January 1, 2014, that offers both medical and […]
Section 27-41-85. – Consumer notification.
§ 27-41-85. Consumer notification. Every health maintenance organization providing dental benefits to subscribers shall include on the identification card provided to its subscribers on the front of the cards the following language when the underlying plan contains a non-duplication of benefits clause: “NO DUPLICATION OF BENEFITS”. History of Section.P.L. 2013, ch. 452, § 5; P.L. […]
Section 27-41-86. – Opioid antagonists.
§ 27-41-86. Opioid antagonists. (a) Every individual or group health insurance contract, plan, or policy that provides prescription coverage that is delivered, issued for delivery, amended, or renewed in this state on or after January 1, 2017, shall provide coverage for at least one generic opioid antagonist and device. Prior authorization may be required for […]
Section 27-41-87. – Healthcare provider credentialing.
§ 27-41-87. Healthcare provider credentialing. (a) For applications received on or after January 1, 2018, a healthcare entity or health plan operating in the state shall be required to issue a decision regarding the credentialing of a healthcare provider as soon as practicable, but no later than forty-five (45) calendar days after the date of […]
Section 27-41-88. – Unfair discrimination prohibited.
§ 27-41-88. Unfair discrimination prohibited. Notwithstanding any provision of any policy of insurance, certificate, or service contract issued in this state, whenever the insurance policy, certificate, or service contract provides for reimbursement for any services that may be legally performed by any person licensed under the provisions of chapters 29, 30, 35 and 37 of […]
Section 27-41-89. – Health insurance contracts — Full year coverage for contraception.
§ 27-41-89. Health insurance contracts — Full year coverage for contraception. Beginning on the first day of each plan year after April 1, 2019, every health insurance issuer offering group or individual health insurance coverage that covers prescription contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three hundred sixty-five (365) […]