§33-55-1. Definitions

For purposes of this article: “Authorized representative” means: (A) A person to whom a covered person has given express written consent to represent the covered person;

§33-55-10. Penalties

A violation of this article shall be penalized in accordance with 33-4-11 of this code.

§33-55-2. Applicability and Scope

(a) Except as provided in subsection (b) of this section, this article applies to all health carriers that offer network plans. (b) The following provisions of this article do not apply to health carriers that offer network plans that consist solely of limited scope dental plans or limited scope vision plans: (1) 33-55-3(a)(2) of this […]

§33-55-3. Network Adequacy

(a)(1) A health carrier providing a network plan shall maintain a network that is sufficient in numbers and appropriate types of providers, including those that serve predominantly low-income, medically underserved individuals, to assure that all covered services to covered persons, including children and adults, will be accessible without unreasonable travel or delay. (2) Covered persons […]

§33-55-4. Provider Directories

(a)(1)(A) A health carrier shall post electronically a current and accurate provider directory for each of its network plans with the information and search functions, as described in subsection (b) of this section. (B) In making the directory available electronically, the carrier shall ensure that the general public is able to view all of the […]

§33-55-5. Intermediaries

A contract between a health carrier and an intermediary shall satisfy all the requirements contained in this section. (a) A health carriers statutory responsibility to monitor the offering of covered benefits to covered persons may not be delegated or assigned to the intermediary. (b) A health carrier has the right to approve or disapprove participation […]

§33-55-6. Filing Requirements and State Administration

(a) At the time a health carrier files its access plan, the health carrier shall file for approval with the commissioner sample contract forms proposed for use with its participating providers and intermediaries. (b) A health carrier shall submit material changes to a contract that would affect a provision required under this article or implementing […]

§33-55-7. Contracting

(a) The execution of a contract by a health carrier does not relieve the health carrier of its liability to any person with whom it has contracted for the provision of services, nor of its responsibility for compliance with the law or applicable regulations. (b) All contracts shall be in writing and subject to review. […]

§33-55-8. Enforcement

(a) If the commissioner determines that a health carrier has not contracted with a sufficient number of participating providers to assure that covered persons have accessible health care services in a geographic area, or that a health carriers network access plan does not assure reasonable access to covered benefits, or that a health carrier has […]

§33-55-9. Rulemaking

The commissioner shall propose a rule for legislative approval in accordance with the provisions of 29A-3-1 et seq. of this code to implement the provisions of this article.