Chapter 27-41 - HEALTH MAINTENANCE ORGANIZATIONS
- Section 27-41-1 - Short title
- Section 27-41-2 - Definitions
- Section 27-41-3 - Establishment of health maintenance organizations
- Section 27-41-4 - Issuance of license
- Section 27-41-5 - Powers of health maintenance organizations
- Section 27-41-6 - Governing body
- Section 27-41-7 - Fiduciary responsibilities
- Section 27-41-8 - Evidence of coverage and charges for health care services
- Section 27-41-9 - Required reports
- Section 27-41-10 - Information to enrollees
- Section 27-41-11 - Complaint system
- Section 27-41-12 - Investments
- Section 27-41-13 - Protection against insolvency
- Section 27-41-13.1 - Initial net worth and capital requirements
- Section 27-41-13.2 - Ongoing net worth and capital requirements
- Section 27-41-13.3 - Waiver, surplus notes, and risk based capital requirements
- Section 27-41-14 - Prohibited practices
- Section 27-41-14.1 - Prohibition against restraint on provider - Patient communications
- Section 27-41-15 - Powers of insurers and hospital and medical service corporations
- Section 27-41-16 - Examination
- Section 27-41-17 - Suspension or revocation of license
- Section 27-41-18 - Rehabilitation, liquidation, or conservation of health maintenance organization
- Section 27-41-18.1 - Summary orders and supervision
- Section 27-41-19 - Rules and regulations
- Section 27-41-20 - Administrative procedures
- Section 27-41-21 - Penalties and enforcement
- Section 27-41-22 - Statutory construction and relationship to other laws
- Section 27-41-23 - Filings and reports as public documents
- Section 27-41-24 - Director of health's authority to contract
- Section 27-41-25 - Holding company systems
- Section 27-41-26 - Enrollee liability
- Section 27-41-26.1 - Patient responsibility - Administrative requirements
- Section 27-41-27 - Offer of health maintenance organization alternative to employees
- Section 27-41-27.1 - No derogation of attorney general
- Section 27-41-27.2 - Health insurance rates
- Section 27-41-28 - Applicability
- Section 27-41-29 - Severability
- Section 27-41-29.1 - Uniform explanation of benefits and coverage
- Section 27-41-29.2 - Filing of policy forms
- Section 27-41-30 - Mammograms and pap smears - coverage mandated
- Section 27-41-30.1 - Post-partum hospital stays
- Section 27-41-31 - Mammograms - Quality assurance standards
- Section 27-41-32 - Pap smears - Quality assurance standards
- Section 27-41-33 - Coverage for infertility
- Section 27-41-34 - Health maintenance organizations' assessment
- Section 27-41-35 - Enrollment period in the event of insolvency
- Section 27-41-36 - Services of midwives
- Section 27-41-37 - Discontinuance of coverage - Chronic disabilities
- Section 27-41-38 - Drug coverage
- Section 27-41-38.1 - Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies
- Section 27-41-38.2 - Medication synchronization
- Section 27-41-38.3 - [Effective 1/1/2025] Specialty drugs
- Section 27-41-39 - Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists
- Section 27-41-40 - Certified counselors in mental health and therapists in marriage and family practice
- Section 27-41-41 - [Repealed]
- Section 27-41-41.1 - [Repealed]
- Section 27-41-41.2 - [Repealed]
- Section 27-41-41.3 - [Repealed]
- Section 27-41-42 - [Repealed]
- Section 27-41-43 - Mastectomy treatment
- Section 27-41-43.1 - Insurance coverage for mastectomy hospital stays
- Section 27-41-44 - Diabetes treatment
- Section 27-41-45 - Primary and preventive obstetric and gynecological care
- Section 27-41-45.1 - Hysterectomy or myomectomy treatment
- Section 27-41-46 - Whistleblowers protection
- Section 27-41-47 - Penalties and remedies
- Section 27-41-48 - Additional relief and damages - Reinstatement
- Section 27-41-49 - Third party reimbursement for services of certain health care workers
- Section 27-41-49.1 - Third party reimbursement for services of registered nurse first assistants
- Section 27-41-50 - Human leukocyte antigen testing
- Section 27-41-51 - Drug coverage
- Section 27-41-52 - Restricted annual rate payments prohibited
- Section 27-41-53 - Genetic testing
- Section 27-41-53.1 - Genetic information
- Section 27-41-54 - Disassociation prohibited
- Section 27-41-55 - [Repealed]
- Section 27-41-56 - Magnetic resonance imaging - Quality assurance standards
- Section 27-41-57 - Acupuncture services
- Section 27-41-58 - Prohibition against requiring indemnification from dentists
- Section 27-41-59 - FDA approved prescription contraceptive drugs and devices
- Section 27-41-60 - Prostate and colorectal examinations - coverage mandated - the maryellen goodwin colorectal cancer screening act
- Section 27-41-61 - Eligibility for children's benefits
- Section 27-41-62 - Temporary credentials
- Section 27-41-63 - Hearing aids
- Section 27-41-64 - Prompt processing of claims
- Section 27-41-65 - Mandatory coverage for certain lyme disease treatments
- Section 27-41-66 - Dental insurance assignment of benefits
- Section 27-41-67 - Determination of maximum coverage limitation for prescription drug benefits
- Section 27-41-68 - Coverage for early intervention services
- Section 27-41-69 - Post-payment audits
- Section 27-41-70 - Tobacco cessation programs
- Section 27-41-71 - Mandatory coverage for scalp hair prosthesis
- Section 27-41-72 - Reimbursement for orthotic and prosthetic services
- Section 27-41-73 - Licensed ambulance service
- Section 27-41-74 - Enteral nutrition products
- Section 27-41-75 - Prohibition on rescission of coverage
- Section 27-41-76 - Prohibition on annual and lifetime limits
- Section 27-41-77 - Coverage for individual participating in approved clinical trials
- Section 27-41-78 - Medical loss ratio reporting and rebates
- Section 27-41-79 - Emergency services
- Section 27-41-80 - Internal and external appeal of adverse benefit determinations
- Section 27-41-81 - Prohibition on preexisting condition exclusions
- Section 27-41-82 - Primary care provider designation requirement
- Section 27-41-83 - Discretionary clauses
- Section 27-41-84 - Orally administered anticancer medication - Cost-sharing requirement
- Section 27-41-85 - Consumer notification
- Section 27-41-86 - Opioid antagonists
- Section 27-41-87 - Unfair discrimination prohibited
- Section 27-41-88 - Health care provider credentialing
- Section 27-41-89 - Health insurance contracts - full year coverage for contraception
- Section 27-41-90 - Gender rating
- Section 27-41-91 - Prohibition on discrimination in organ transplants
- Section 27-41-92 - Health insurance contracts - copayments exemption for covid-19 vaccinations
- Section 27-41-93 - Perinatal doulas
- Section 27-41-94 - Coverage for biomarker testing
- Section 27-41-95 - Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome
- Section 27-41-96 - Epinephrine injectors
- Section 27-41-97 - Coverage for treatment of pre-exposure prophylaxis (PREP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection
- Section 27-41-98 - Expedited prior authorization
- Section 27-41-99 - Dispensing and administration of HIV PREP or PEP drugs