(a) The director shall adopt regulations to provide standards and criteria for (1) the structure and operation of utilization review and benefit determination processes; (2) the establishment and maintenance of procedures by health care insurers to ensure that a covered individual has the opportunity for appropriate resolution of grievances; and (3) an independent review of […]
(a) A contract between a participating health care provider and a health care insurer must contain a provision that (1) provides for a reasonable mechanism to identify all medical care services to be provided by the health care insurer; (2) clearly states or references an attachment that states the health care provider’s rate of compensation; […]
A health care insurance policy must contain a provision (1) that preauthorization for a covered medical procedure on the basis of medical necessity may not be retroactively denied unless the preauthorization is based on materially incomplete or inaccurate information provided by or on behalf of the provider; (2) for emergency services that meet the requirements […]
(a) If a health care insurer offers a health care insurance policy that provides for coverage of medical care services only if the services are furnished through a network of health care providers that have entered into a contract with the health care insurer, the health care insurer shall also offer a non-network option to […]
This chapter may not be construed to (1) restrict or limit the right of a health care insurer to include services provided by a religious nonmedical provider as medical care services covered by the health care insurance policy; (2) require a health care insurer, when determining coverage for services provided by a religious nonmedical provider, […]
This chapter may not be construed to supersede or change the provisions of 29 U.S.C. 1001 – 1191 (Employee Retirement Income Security Act of 1974) as those provisions apply to self-insured employers.
In this chapter, (1) [Repealed, § 65 ch 41 SLA 2016.] (2) [Repealed, § 65 ch 41 SLA 2016.] (3) “emergency medical condition” means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, that a prudent person who possesses an average knowledge of health and medicine could reasonably expect that […]
