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§33-25A-1. Short Title and Purpose - (a) This article may be cited as the "Health Maintenance...
§33-25A-2. Definitions - (1) "Basic health care services" means physician, hospital, out-of-area, podiatric,...
§33-25A-3. Application for Certificate of Authority - (1) Notwithstanding any law of this state to the contrary,...
§33-25A-3a. Conditions Precedent to Issuance or Maintenance of a Certificate of Authority; Renewal of Certificate of Authority; Effect of Bankruptcy Proceedings - (a) As a condition precedent to the issuance or maintenance...
§33-25A-4. Issuance of Certificate of Authority - (1) Upon receipt of an application for a certificate of...
§33-25A-5. Powers of Health Maintenance Organizations - (a) Upon obtaining a certificate of authority as required under...
§33-25A-6. Governing Body - (1) The governing body of any health maintenance organization may...
§33-25A-7. Fiduciary Responsibilities of Officers; Fidelity Bond; Approval of Contracts by Commissioner - (a) Any director, officer or partner of a health maintenance...
§33-25A-7a. Provider Contracts - (1) Whenever a contract exists between a health maintenance organization...
§33-25A-7b. Loss Ratio - If a health maintenance organization considers a loss ratio at...
§33-25A-8. Evidence of Coverage; Charges for Health Care Services; Review of Enrollee Records; Cancellation of Contract by Enrollee - (1) (a) Every enrollee is entitled to evidence of coverage...
§33-25A-8a. Third Party Reimbursement for Mammography, Pap Smear or Human Papilloma Virus Testing - (a) Notwithstanding any provision of any policy, provision, contract, plan...
§33-25A-8b. Third Party Reimbursement for Rehabilitation Services - (a) Notwithstanding any provision of any policy, provision, contract, plan...
§33-25A-8c. Third Party Payment for Child Immunization Services - Notwithstanding any provision of any policy, provision, contract, plan or...
§33-25A-8d. Coverage of Emergency Services - (a) Notwithstanding any provision of any policy, provision, contract, plan...
§33-25A-8e. Third Party Reimbursement for Colorectal Cancer Examination and Laboratory Testing - (a) Notwithstanding any provision of any policy, provision, contract, plan...
§33-25A-8f. Required Coverage for Reconstruction Surgery Following Mastectomies - (a) Any policy of insurance described in this article which...
§33-25A-8g. Required Use of Mail-Order Pharmacy Prohibited - (a) A health maintenance organization issuing coverage in this state...
§33-25A-8h. Third-Party Reimbursement for Kidney Disease Screening - (a) Notwithstanding any provision of any policy, provision, contract, plan...
§33-25A-8i. Third-Party Reimbursement for Dental Anesthesia Services - (a) Notwithstanding any provision of any policy, provision, contract, plan...
§33-25A-8j. Coverage for Diagnosis and Treatment of Autism Spectrum Disorders - (a) Notwithstanding any provision of any policy, provision, contract, plan...
§33-25A-8k. Maternity Coverage - Notwithstanding any provision of any policy, provision, contract, plan or...
§33-25A-8l. Deductibles, Copayments and Coinsurance for Anti-Cancer Medications - (a) Notwithstanding any provision of any policy, contract, plan or...
§33-25A-8m. Eye Drop Prescription Refills - A contract, plan or agreement issued by an insurer pursuant...
§33-25A-8n. Deductibles, Copayments and Coinsurance for Abuse-Deterrent Opioid Analgesic Drugs - (a) As used in this section: (1) “Abuse-deterrent opioid analgesic...
§33-25A-8o. Step Therapy - (a) As used in this article: (1) “Health benefit plan”...
§33-25A-8p. Lyme Disease to Be Covered by All Health Insurance Policies - A health maintenance organization issuing coverage in this state pursuant...
§33-25A-8q. Coverage for Amino Acid-Based Formulas - (a) A policy, plan, or contract that is issued or...
§33-25A-8r. Substance Use Disorder - (a) As used in this section, the following words have...
§33-25A-8s. Prior Authorization - (a) As used in this section, the following words and...
§33-25A-8t. Fairness in Cost-Sharing Calculation - (a) As used in this section: "Cost sharing" means any...
§33-25A-8u. Mental Health Parity - (a) As used in this section, the following words and...
§33-25A-8v. Incorporation of the Health Benefit Plan Access and Adequacy Act - The provisions of the Health Benefit Plan Network Access and...
§33-25A-8w. Incorporation of the Coverage for 12-Month Refill for Contraceptive Drugs - The provision requiring coverage for 12-month refill for contraceptive drugs...
§33-25A-9. Annual Report - Every health maintenance organization shall comply with and is subject...
§33-25A-10. Information to Enrollees - Every health maintenance organization or its representative shall annually, before...
§33-25A-11. Open Enrollment Period - (1) Once a health maintenance organization has been in operation...
§33-25A-12. Grievance Procedure - (a) A health maintenance organization shall establish and maintain a...
§33-25A-13. Investments - With the exception of investments otherwise made in accordance with...
§33-25A-14. Prohibited Advertising Practices - (a) No health maintenance organization, or representative of a health...
§33-25A-14a. Other Prohibited Practices - (a) No health maintenance organization may cancel or fail to...
§33-25A-15. Agent Licensing and Appointment Required; Regulation of Marketing - (1) Health maintenance organizations are subject to the provisions of...
§33-25A-16. Powers of Insurers and Hospital and Medical Service Corporations - (1) An insurance company licensed in this state or a...
§33-25A-17. Examinations - (a) The Commissioner may make an examination of the affairs...
§33-25A-17a. Quality Assurance - (a) Each health maintenance organization shall have in writing a...
§33-25A-18. Suspension or Revocation of Certificate of Authority - (1) The commissioner may suspend or revoke any certificate of...
§33-25A-19. Rehabilitation, Liquidation or Conservation of Health Maintenance Organization - Any rehabilitation, liquidation or conservation of a health maintenance organization...
§33-25A-20. Regulations - The commissioner may after notice and hearing promulgate reasonable rules...
§33-25A-21. Administrative Procedures - (1) When the commissioner has cause to believe that grounds...
§33-25A-22. Fees - Every health maintenance organization subject to this article shall pay...
§33-25A-23. Penalties and Enforcement - (1) The Commissioner may, in lieu of suspension or revocation...
§33-25A-23a. Civil Penalty Imposed by Commissioner - No provider shall collect or attempt to collect from a...
§33-25A-24. Scope of Provisions; Applicability of Other Laws - (a) Except as otherwise provided in this article, provisions of...
§33-25A-25. Filings and Reports as Public Documents - All applications, filings and reports required under this article shall...
§33-25A-26. Confidentiality of Medical Information - Any data or information pertaining to the diagnosis, treatment or...
§33-25A-27. Authority to Contract With Health Maintenance Organizations Under Medicaid - The department of welfare is hereby authorized to enter into...
§33-25A-28. Required Health Maintenance Organization Option - (1) Each employer shall offer no less than once every...
§33-25A-31. Policies Discriminating Among Health Care Providers - Notwithstanding any other provisions of law, when any health insurance...
§33-25A-32. Authority of Commissioner to Promulgate Rules and Regulations Regarding Affiliate and Subsidiary Operating Results - The commissioner may as he deems necessary after notice and...
§33-25A-33. Guaranty Fund - On or before January 15, 1996, the commissioner shall submit...
§33-25A-34. Ambulance Services - The Legislature finds that ambulance services in this state are...
§33-25A-35. Rural Health Maintenance Organizations - [Repealed.]
§33-25A-36. Assignment of Certain Benefits in Dental Care Insurance Coverage - (a) Any entity regulated under this article that provides dental...