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Section 38-71-10. Coverages which may be written by licensed accident and health insurers. - All licensed accident and health insurers are entitled to: (a)...
Section 38-71-20. Insurers may act as administering agency for government-sponsored health, hospital, and medical service programs. - Insurers licensed to do business in this State have the...
Section 38-71-30. Whole contract, including application, must appear in policy; oral applications. - Every insurer doing accident or health insurance business in the...
Section 38-71-40. Effect of false statement in application. - The falsity of any statement in the application for any...
Section 38-71-46. Diabetes Mellitus coverage in health insurance policies; diabetes education. - (A) On or after January 1, 2000, every health maintenance...
Section 38-71-50. Alteration of application. - No alteration of any written application for insurance by erasure,...
Section 38-71-60. Certain acts do not constitute a waiver by insurer. - The acknowledgment of any insurer of the receipt of notice...
Section 38-71-70. Certain policies may conform to laws of other states. - Any foreign insurer authorized to do business in this State...
Section 38-71-80. Construction of policy issued in violation of chapter. - A policy issued in violation of this chapter is held...
Section 38-71-90. Penalty for violation of chapter. - An insurer, health maintenance organization, or its officer or agent...
Section 38-71-100. Policies exempt from chapter. - Nothing in this chapter applies to or affects: (1) any...
Section 38-71-110. Notice of failure of employer to remit deducted premium required before forfeiture. - No insurer doing business in this State and issuing health...
Section 38-71-125. Mastectomies; hospitalization requirements; early release provisions. - All individual and group health insurance policies and health maintenance...
Section 38-71-130. Breast reconstruction and prosthetic devices; coverage following mastectomy surgery. - All individual and group health insurance policies and health maintenance...
Section 38-71-135. Minimum postpartum hospitalization and attendant services for mothers and newborns. - All individual and group health insurance and health maintenance organization...
Section 38-71-140. Coverage of newborn children. - (A) All individual and group health insurance policies providing coverage...
Section 38-71-143. Health plans must provide same coverage for children placed for adoption. - (A) If an individual or group health plan provides coverage...
Section 38-71-144. Expedited external reviews of certain health benefit plan cancer diagnostic service denials. - (A) For purposes of this section: (1) "Health benefit plan"...
Section 38-71-145. Required coverage for mammograms, pap smears, and prostate cancer examinations; limitations. - (A) All individual and group health insurance and health maintenance...
Section 38-71-147. Freedom of selection and participation in individual or group accident and health or health insurance policy or health maintenance organization plan. - An individual or group accident and health or health insurance...
Section 38-71-150. Required provision in policies as to examination and surrender of policy for return of premium. - Every individual or family accident and health or hospitalization policy,...
Section 38-71-160. When policy sold on direct response basis considered to be returned. - For purposes of Section 38-71-150, the insured is considered to...
Section 38-71-170. Required provision in policies for conversion privileges for former spouses. - No policy or certificate of accident, health, or accident and...
Section 38-71-190. Subrogation of insurer to insured's rights against third party. - Any policy or contract of accident and health insurance issued...
Section 38-71-200. Discrimination forbidden; benefits for services of podiatrist, oral surgeon, or optometrist. - Discrimination between individuals of the same class in the amount...
Section 38-71-210. Health insurance policies to include chiropractic services. - If an insurer offers a policy containing a provision for...
Section 38-71-215. Dermatology referrals. - (A) If a primary care physician makes a referral to...
Section 38-71-220. Misrepresentations to induce termination or conversion of disability insurance policies. - No insurer, or its employee or agent, may make any...
Section 38-71-230. Written notice of health insurance claim policies and procedures; adoption of standardized claim forms; addition of logo to form. - (A) All licensed health care providers are required to provide...
Section 38-71-238. Abortion coverage prohibitions; exceptions. - (A) Abortion coverage may not be provided by a qualified...
Section 38-71-240. Coverage required for cleft lip and palate; certain policies exempt. - (A) As used in this section: (1) "Cleft lip and...
Section 38-71-241. Percentage copayment and deductible must be applied to negotiated rate or lesser charge of that provider. - An insurer that negotiates rates with providers for covered health...
Section 38-71-242. Specified disease insurance policies; payment of claims and benefits. - (A)(1) When used in any individual or group specified disease...
Section 38-71-243. Continuation of care; definitions; applicability; requirements. - (A) As used in this section: (1) "Continuation of care"...
Section 38-71-245. Prohibited grounds for denial of enrollment to child of health plan participant. - No health insurer, including a group health plan, as defined...
Section 38-71-246. Continuation of care; provider contract requirements. - (A) Each provider contract must contain a continuation of care...
Section 38-71-247. Continuation of care; plain language description requirement. - Each health insurance issuer shall include a plain language description...
Section 38-71-250. Duties of insurer as to court-ordered health care coverage for child of eligible parent. - If, pursuant to a court order which meets the specifications...
Section 38-71-255. Health insurer may not impose different requirements on state agency. - A health insurer, including a group health plan as defined...
Section 38-71-260. Duties of health insurer of child to custodial parent. - If a child has health coverage through the health insurer...
Section 38-71-265. Health insurer not to consider State medical assistance; subrogation of state to right to insurance payment for health care. - (A) In enrolling a person or in making any payments...
Section 38-71-275. Insurance coverage for certain drugs not to be excluded from policy definitions. - (A) No insurance policy which provides coverage for drugs shall...
Section 38-71-280. Autism spectrum disorder; coverage; eligibility for benefits. - (A) As used in this section: (1) "Autism spectrum disorder"...
Section 38-71-290. Mental health coverage; definitions; treatment requirements; exceptions - (A) As used in this section: (1) "Health insurance plan"...
Section 38-71-310. Filing of forms and rates; approval or disapproval; withdrawal of approval; exceptions; loss ratio guarantee. - (A) A policy or certificate of accident, health, or accident...
Section 38-71-315. Decrease of premium charges. - Any insurer of individual accident and health insurance may at...
Section 38-71-320. Policies issued for delivery in another state. - If a policy is issued by an insurer domiciled in...
Section 38-71-325. Requirements for approval of new individual major medical expense coverage policies. - On January 1, 1992, in addition to any other requirements...
Section 38-71-330. Form of policies. - No policy of accident and health insurance may be delivered...
Section 38-71-335. Accident and/or health insurance cancellation provision prohibited; optionally renewable policies prohibited; notice of nonrenewal. - (A) No individual or family accident, health, or accident and...
Section 38-71-340. Required provisions. - Except as provided in Section 38-71-410, each accident, health, or...
Section 38-71-350. Required provision for continuation of coverage for handicapped and dependent children of policyholder. - An individual hospital or medical expense insurance policy, hospital service...
Section 38-71-355. Dependent child; medically necessary leave of absence. - (A) As used in this section: (1) "Dependent child" means...
Section 38-71-360. Continuation of coverage for nonhandicapped dependent children. - An individual hospital, medical, or surgical expense incurred insurance policy,...
Section 38-71-370. Optional provisions. - Except as provided in Section 38-71-410, no individual accident, health,...
Section 38-71-380. Medical expense policy; optional intoxicants and narcotics exclusion inapplicable. - (A) For purposes of this section, "medical expense policy" means...
Section 38-71-410. Omission or modification of required or optional provisions. - If any provision of Sections 38-71-340 and 38-71-370 is in...
Section 38-71-420. Placement of required and optional provisions in policy. - The provisions which are the subject of Sections 38-71-340 and...
Section 38-71-430. Additional provisions may not make policy less favorable. - A policy provision which is not subject to Sections 38-71-340...
Section 38-71-440. HMO's and health benefit plans offering medical eye care or vision care benefits; prohibited actions. - (A) As used in this section: (1) "Health benefit plan"...
Section 38-71-510. Declaration of purpose. - The purpose of this subarticle is to provide reasonable standardization...
Section 38-71-520. Definitions. - As used in this subarticle, unless the context clearly indicates...
Section 38-71-530. Regulations establishing specific standards that set forth manner, content, and required disclosure for sale of individual policies. - (a) The department shall promulgate regulations to establish specific standards,...
Section 38-71-540. Regulations establishing minimum standards for benefits. - (a) The department shall promulgate regulations to establish minimum standards...
Section 38-71-550. Outline of coverage required. - (a) In order to provide for full and fair disclosure...
Section 38-71-560. Effect of use of simplified application form. - Notwithstanding the provisions of item (2) of Section 38-71-340 or...
Section 38-71-610. Notice of premiums due required. - (1) All insurers issuing accident or health policies, or combinations...
Section 38-71-620. Advance notice required for increase in premium. - If an accident and health insurance policy contains provisions which...
Section 38-71-630. Acceptance of premium for period beyond expiration date of policy. - If any accident, health, or accident and health policy contains...
Section 38-71-640. Person with insurable interest may take out policy on insured. - The term "insured" as used in this article may not...
Section 38-71-650. Right to transfer to policy of equal or lesser benefits with same insurer. - Any person purchasing an individual accident, health, or accident and...
Section 38-71-670. Definitions. - As used in this subarticle: (1) "Bona fide association" means,...
Section 38-71-675. Renewal or continuance of coverage at option of insurer; conditions for nonrenewal or discontinuance; modification of coverage. - (A) Except as provided in this section, a health insurance...
Section 38-71-680. Application of Section 38-71-850(D). - Section 38-71-850(D) applies to health insurance coverage offered by a...
Section 38-71-710. Definitions. - (1) "Employees" as used in this article includes, for the...
Section 38-71-720. Approval of forms required; refusal or withdrawal of approval; optional life insurance riders. - (A) A policy or contract of group accident, group health,...
Section 38-71-730. Requirements for group accident, group health, and group accident and health policies. - No policy of group health, group accident, or group accident...
Section 38-71-735. Required provisions. - No policy of group accident, group health, or group accident...
Section 38-71-737. Requirement of coverage for psychiatric conditions in group health insurance policies; "psychiatric conditions" defined. - (A) An offer to sell a group health insurance policy...
Section 38-71-740. Restrictions on mass-marketed insurance. - No mass-marketed accident, health, or accident and health insurance may...
Section 38-71-750. Requirements of group policies extended to group policies issued outside State to residents; approval required for mass-marketed policies and certificates. - (1) No group accident, group health, or group accident and...
Section 38-71-760. Standards for group accident and health insurance coverage, discontinuance, and replacement. - (a) This section applies to a group accident, group health,...
Section 38-71-770. Mandatory continuation privileges. - A group policy issued for delivery or renewed in this...
Section 38-71-780. Required provision for continuation of coverage for handicapped and dependent children. - A group hospital or medical expense insurance policy, hospital service...
Section 38-71-785. Dependent child; medically necessary leave of absence. - (A) As used in this section: (1) "Dependent child" means...
Section 38-71-790. Payment of benefits. - The benefits payable under any policy or contract of group...
Section 38-71-800. Hospital and medical expenses. - Any policy or contract of group accident, group health, or...
Section 38-71-810. Readjustment of rates or refunds or dividends. - Any policy or contract of group accident, group health, or...
Section 38-71-840. Definitions. - (A) As used in this subarticle: (1) "Affiliation period" means...
Section 38-71-850. Preexisting condition exclusion; limitations; creditable coverage; certification; enrollment for coverage. - (A) Subject to subsection (C), a health insurance issuer offering...
Section 38-71-860. Health status-related factors in relation to individual enrollees and their dependents; restrictions on eligibility rules and premium charges. - (A)(1) Subject to item (2), a health insurance issuer offering...
Section 38-71-870. Coverage in small or large group market in connection with group health plan; nonrenewal or discontinuance; restrictions; modification of coverage; plan sponsor. - (A) Except as provided in this section, if a health...
Section 38-71-880. Medical and surgical benefits and mental health or substance use disorder benefits; aggregate lifetime limits. - (A)(1) In the case of health insurance coverage offered in...
Section 38-71-910. Legislative intent. - The intent of this subarticle is to promote the availability...
Section 38-71-920. Definitions. - As used in this subarticle: (1) "Small employer" means, in...
Section 38-71-930. Application of this subarticle. - (A) Except as provided in subsection (B), the provisions of...
Section 38-71-940. Premium rates for health insurance plans; rating factors; involuntary business class transfer prohibited. - (A) Premium rates for health insurance plans subject to this...
Section 38-71-960. Required disclosure in solicitation and sales materials; proprietary or trade secret information. - In connection with offering any health insurance plans to small...
Section 38-71-970. Insurer rating and renewal records; filing of certification; confidentiality. - (A) A small employer insurer shall maintain at its principal...
Section 38-71-980. Suspension of premium rate restrictions upon request of certain insurers. - The director or his designee may suspend all or any...
Section 38-71-990. Effective date of this subarticle. - The provisions of this subarticle apply to each health insurance...
Section 38-71-1010. "Blanket accident and health insurance" defined. - "Blanket accident and health insurance" is defined to be that...
Section 38-71-1020. Requirements as to policies. - All blanket accident and health insurance policies are subject to...
Section 38-71-1030. Individual applications and certificates not required. - An individual application is not required from an individual covered...
Section 38-71-1040. Payment of benefits. - All benefits under any blanket accident and health policy are...
Section 38-71-1050. Legal liability of policyholders not affected. - Nothing contained in this article affects the legal liability of...
Section 38-71-1110. "Franchise accident and health insurance" defined. - "Accident and health insurance on a franchise plan" is that...
Section 38-71-1310. Short title. - This article shall be known and may be cited as...
Section 38-71-1320. Purpose and intent. - The purpose and intent of this article is to promote...
Section 38-71-1330. Definitions. - As used in this article: (1) "Basic health insurance plan"...
Section 38-71-1340. Application of article; group size for health group cooperative. - (A) Except as provided in subsection (B), the provisions of...
Section 38-71-1345. Formation of health group cooperative; requirements; registration; organization as nonprofit corporation. - (A) A health group cooperative of small employers may be...
Section 38-71-1350. Premium rates; requirements. - (A) Except as provided in Section 38-71-1345(A)(7)(b), premium rates for...
Section 38-71-1355. Health group cooperative; powers and duties. - (1) shall arrange for group health insurance plan coverage for...
Section 38-71-1360. Insurers required to offer all plans actively marketed to small employers; availability to all eligible employees; network plans; denial of coverage. - (A)(1) Every small employer insurer shall, as a condition of...
Section 38-71-1365. Small employer insurer requirements; compliance with federal laws applicable to cooperatives. - (A) A health group cooperative shall contract only with a...
Section 38-71-1370. Applicability of certain code sections; late enrollees. - (A) Except to the extent inconsistent with specific provisions of...
Section 38-71-1380. Notification of intent to operate; certain reinsuring insurers not permitted to continue to reinsure health insurance plan. - (A)(1) Within sixty days after the plan of operation is...
Section 38-71-1390. Application to become risk-assuming insurer; approval or denial; factors to consider. - (A) Any small employer insurer may elect to become a...
Section 38-71-1400. Election to become reinsuring insurer. - (A) A small employer insurer may elect to become a...
Section 38-71-1410. South Carolina Small Employer Insurer Reinsurance Program. - (A) There is hereby created a nonprofit entity to be...
Section 38-71-1420. Advisory committee. - (A) The Governor shall appoint an advisory committee to the...
Section 38-71-1430. Annual public report. - The board, in consultation with members of the committee, shall...
Section 38-71-1440. Requirements upon small employer insurers. - (A) Each small employer insurer shall fairly market health insurance...
Section 38-71-1445. Report on effectiveness of health group cooperatives. - The South Carolina Department of Insurance and Revenue and Fiscal...
Section 38-71-1450. Promulgation of regulations. - The Director of Insurance may promulgate regulations as may be...
Section 38-71-1510. Short title. - This article may be cited as the "Access to Emergency...
Section 38-71-1520. Definitions. - As used in this article: (1) "Emergency medical care" means...
Section 38-71-1530. Screening; initial intervention; role of managed care organization; payments to providers. - (A) A patient who presents to an emergency department, by...
Section 38-71-1540. Practice of discouraging use of 911 telephone system prohibited. - No managed care organization may engage in any practice to...
Section 38-71-1545. Exclusion of certain insurance policies. - The provisions of this article do not apply to a...
Section 38-71-1550. Severability. - If any provision of this article or the application of...
Section 38-71-1710. Short title. - This article may be cited as the "South Carolina Patients'...
Section 38-71-1720. Definitions. - As used in this article: (1) "Closed panel health plan"...
Section 38-71-1730. Employers offering closed panel health plans; employee options and payments; use of provider who has discontinued participation in plan; exclusion of certain providers; services of pharmacists and advanced practice nurses; effect... - (A) For purposes of health plans offered pursuant to this...
Section 38-71-1740. Responsibility for errors and omissions by parties to managed care participating provider agreements; limitations on network providers to discuss treatments, risks and legal obligations with an insured or member prohibited; permis... - (A) For purposes of any health insurance plan, health maintenance...
Section 38-71-1750. Disclosures required of network plans. - A network plan must disclose in writing, using the plain...
Section 38-71-1760. Promulgation of regulations. - The Director of the Department of Insurance or his designee...
Section 38-71-1810. Pharmacy audit rights. - (A) For the purposes of this article: (1) "Insurer" means...
Section 38-71-1820. Appeals process; dismissal; copy of audit findings. - (A) Each entity that conducts an audit of a pharmacy...
Section 38-71-1830. Recoupment. - (A) Recoupments of any funds disputed on the basis of...
Section 38-71-1840. Exemptions. - The provisions of this article do not apply to an...
Section 38-71-1910. Short title. - This article may be cited as the "Health Carrier External...
Section 38-71-1920. Definitions. - For purposes of this article: (1) "Adverse determination" means a...
Section 38-71-1930. Application of this article. - (A) Except as provided in subsection (B), this article applies...
Section 38-71-1940. Notice of right to request a review; notice of adverse determination. - (A) A health carrier shall notify the covered person in...
Section 38-71-1950. Requests for external review. - (A) All requests for external review must be made in...
Section 38-71-1960. Exhaustion of internal appeal process. - (A)(1) Except in cases where the covered person's treating physician...
Section 38-71-1970. Requests for external review. - (A)(1) Within sixty days after the date of receipt of...
Section 38-71-1980. Expedited external review. - (A)(1) Within fifteen days after the date of receipt of...
Section 38-71-1990. External review decisions final; exceptions. - (A) An external review decision is binding on the health...
Section 38-71-2000. Approval of independent review organizations. - (A) The director or his designee shall approve independent review...
Section 38-71-2010. Standards for approval of independent review organizations. - (A) To be approved under Section 38-71-2000 to conduct external...
Section 38-71-2020. Liability of independent review organizations and personnel. - No independent review organization, or employee, officer, or director of...
Section 38-71-2030. External review; written records; reports. - (A)(1) An independent review organization assigned pursuant to Section 38-71-1970...
Section 38-71-2040. Health carrier to pay for external review. - The health carrier shall pay for the external review. HISTORY:...
Section 38-71-2050. Health carrier to inform covered persons of rights related to external review. - (A) Each health carrier shall include a description of the...
Section 38-71-2060. Regulations. - The director or his designee may, after notice, promulgate reasonable...
Section 38-71-2110 to 38-71-2150. Repealed. - HISTORY: Former Section 38-71-2110, titled Definitions; application of article, had...
Section 38-71-2200. Definitions. - As used in this article: (1) "Claim" means a request...
Section 38-71-2210. License requirement for pharmacy benefits managers. - (A)(1) A person or organization may not establish or operate...
Section 38-71-2220. No restrictions or penalties against pharmacy for disclosing certain information. - (A) In any participation contracts between pharmacy benefits managers and...
Section 38-71-2230. Pharmacy benefits manager prohibited from taking certain actions. - (A) A pharmacy benefits manager or representative of a pharmacy...
Section 38-71-2240. Placement of drug on Maximum Allowable Cost List. - (A) Before a pharmacy benefits manager places or continues to...
Section 38-71-2250. Enforcement of article; penalties. - (A) The director shall enforce this article. (B)(1) The director...
Section 38-71-2260. Construction and application. - (A) Nothing in this act is intended or may be...