20-1057.14. Cancer treatment medications; cost sharing; definition A. An evidence of coverage that is issued, delivered or renewed by a health care services organization on or after January 1, 2016 and that provides coverage both for cancer treatment medications that are injected or intravenously administered by a health care provider and for patient-administered cancer treatment […]
20-1057.15. Prescriptions; cost sharing; refills; dispensing fees; definition A. An evidence of coverage that is issued or renewed on or after January 1, 2017 and that provides coverage for prescription drugs: 1. May not deny coverage and shall prorate the cost sharing rate for a prescription drug covered by the evidence of coverage that is […]
20-1057.16. Prescription eyedrops; refills A. Beginning January 1, 2018, any evidence of coverage that is issued, delivered or renewed by a health care services organization and that provides coverage for prescription eyedrops to treat glaucoma or ocular hypertension may not deny coverage for a refill of a prescription for eyedrops to treat glaucoma or ocular […]
20-1057.17. Coverage of health care services Any evidence of coverage issued, delivered or renewed on or after July 1, 2017 by a health care services organization in this state must provide coverage for lawful health care services that are provided by a health care provider to an enrollee regardless of the familial relationship of the […]
20-1057.18. Contracts; optometrists; covered services; definition A. Except as provided in subsection C of this section, a contract, entered into or renewed on or after January 1, 2022, between a health care services organization and an optometrist who is licensed to practice in this state shall not: 1. Require the optometrist to provide a service […]
20-1057.19. Biomarker testing; coverage; definitions A. A health care services organization that issues, amends, delivers or renews an evidence of coverage on or after January 1, 2023 shall provide coverage for biomarker testing. B. An evidence of coverage shall cover biomarker testing for the purposes of diagnosis, treatment, appropriate management or ongoing monitoring of an […]
20-1058. Examination of health care services organizations A. The director may once in each six months for the first three years after organization and once each year thereafter, or more often if deemed necessary by the director, visit each health care services organization organized under the laws of this state to examine its financial condition, […]
20-1059. Annual report to director A. Every health care services organization annually on or before March 31 shall file with the director a report of its financial condition, transactions and affairs as of the preceding December 31 as prescribed in sections 20-223 and 20-234 and shall pay the annual renewal fee prescribed in section 20-167. […]
20-1059.01. Admitted assets; health care delivery assets A. This section applies to reporting entities that directly provide health care services to enrollees. B. In addition to the assets allowed by section 20-501, the following are admitted assets to the extent the assets conform with the accounting practices and procedures manual adopted by the national association […]
20-1060. Taxes; exemption A. Except as provided in subsection C of this section, on the tax payment dates prescribed in section 20-224, each health care services organization shall pay to the director for deposit, pursuant to sections 35-146 and 35-147, in a form prescribed by the director a tax for transacting a health care plan […]
20-1061. Prohibited practices; definition A. Chapter 2, article 6 of this title relating to unfair trade practices and frauds applies to health care services organizations, except to the extent the director determines that the nature of health care services organizations renders particular provisions inappropriate. B. A contract between the health care services organization and a […]
20-1062. Regulation of agents The director may, after notice and hearing, promulgate such reasonable rules and regulations as are necessary to provide for the licensing of agents which shall include provisions for examination, licensing, annual fees and disciplinary procedures similar to those proposed in chapter 2, article 3 of this title.
20-1063. Powers of insurers and hospital and medical service corporations A. An insurer, or a hospital or medical service corporation, authorized to do business in this state either directly or through a subsidiary or an affiliate may organize and operate a health care services organization under the provisions of this article. Notwithstanding any other law […]
20-1064. Examination A. The director may conduct an examination of the affairs of any health care services organization as often as the director deems it necessary for the protection of the interests of the people of this state and for this purpose shall have the powers set forth in this title with respect to examinations […]
20-1065. Suspension or revocation of certificate of authority; civil penalties A. The director may suspend or revoke any certificate of authority issued to a health care services organization under this article if the director finds that any of the following conditions exists: 1. The health care services organization is operating significantly in contravention of its […]
20-1066. Rehabilitation, liquidation or conservation of health maintenance organization A. Any rehabilitation, liquidation, or conservation of a health care services organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurer and shall be conducted as provided in chapter 3, article 4 of this title. B. Unless preempted under federal law or […]
20-1068. Statutory construction and relationship to other laws A. Except as they relate to an insurer or a hospital or medical service corporation, the provisions of this title are applicable to health care services organizations only as provided in this article, chapter 1 of this title, chapter 2, article 12 of this title, chapter 3, […]
20-1069.01. Right to open enrollment period; enrollees; definitions A. With respect to enrollees who are members of a group with more than one carrier, if there is an insolvency of a health care services organization, each open enrollment carrier shall offer enrollees of the insolvent health care services organization who are members of that group […]
20-1070. Acquisitions and mergers A. No health care services organization may merge with another foreign or domestic health care services organization or may be acquired by a person except on approval by the director and by complying with the provisions of general law governing the merger or consolidation of stock corporations and the other provisions […]
20-1071. Prohibition against excluding coverage because of previous tests for a condition A. An insurance contract offered by a health care services organization shall not exclude coverage of a condition if the insured person has previously had tests for the condition and the condition was not found to exist. There must be evidence that a […]
