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) […]
Section 27-41-74. – Enteral nutrition products.
§ 27-41-74. Enteral nutrition products. (a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009, shall provide coverage for nonprescription enteral formulas for home use for which […]
Section 27-41-75. – Prohibition on rescission of coverage.
§ 27-41-75. Prohibition on rescission of coverage. (a)(1) Coverage under a health plan subject to the jurisdiction of the commissioner under this chapter with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, shall not be rescinded after the individual is covered under […]
Section 27-41-76. – Prohibition on annual and lifetime limits.
§ 27-41-76. Prohibition on annual and lifetime limits. (a) Annual limits. (1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health maintenance organization subject to the jurisdiction of the commissioner under this chapter may establish an annual limit on the dollar amount of benefits that are essential health […]
Section 27-41-77. – Coverage for individual participating in approved clinical trials.
§ 27-41-77. Coverage for individual participating in approved clinical trials. (a) As used in this section. (1) “Approved clinical trial” means a phase I, phase II, phase III or phase IV clinical trial that is conducted in relation to the prevention, detection or treatment of cancer or a life-threatening disease or condition and is described […]
Section 27-41-78. – Medical loss ratio reporting and rebates.
§ 27-41-78. Medical loss ratio reporting and rebates. (a) A health maintenance organization offering group or individual health insurance coverage of a health benefit plan, including a grandfathered health plan, shall comply with the provisions of Section 2718 of the Public Health Service Act as amended by the federal Affordable Care Act [42 U.S.C. § […]
Section 27-41-79. – Emergency services.
§ 27-41-79. Emergency services. (a) As used in this section: (1) “Emergency medical condition” means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) so that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in […]
Section 27-41-80. – Internal and external appeal of adverse benefit determinations.
§ 27-41-80. Internal and external appeal of adverse benefit determinations. (a) The commissioner shall adopt regulations to implement standards and procedures with respect to internal claims and appeals of adverse benefit determinations, and with respect to external appeals of adverse benefit determinations. (b) The regulations adopted by the commissioner shall apply only to those adverse […]