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27-21A-7
Section 27-21A-7 Evidence of coverage and charges for health care services. (a)(1) Every enrollee
residing in this state is entitled to an evidence of coverage. If the enrollee obtains such
coverage through an insurance policy or a contract issued by a health care service plan, the
insurer or the health care service plan shall issue the evidence of coverage. Otherwise, the
health maintenance organization shall issue the evidence of coverage. (2) No evidence of coverage,
or amendment thereto, shall be issued or delivered to any person in this state until a copy
of the basic form of the evidence of coverage, or amendment thereto, has been filed with the
commissioner and the State Health Officer, and approved by the commissioner. (3) An evidence
of coverage shall contain: a. No provisions or statements which encourage misrepresentation,
or which are untrue, misleading, or deceptive as defined in subsection (a) of Section 27-21A-13;
and b. A clear and concise statement, if a contract, or a...
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27-36A-8
Section 27-36A-8 Reserve valuation method - Life insurance and endowment benefits. (a) Except
as otherwise provided in Sections 27-36A-9, 27-36A-12, and 27-36A-14, reserves according to
the commissioners reserve valuation method, for the life insurance and endowment benefits
of policies providing for a uniform amount of insurance and requiring the payment of uniform
premiums, shall be the excess, if any, of the present value, at the date of valuation, of
the future guaranteed benefits provided for by the policies over the then present value of
any future modified net premiums therefor. The modified net premiums for a policy shall be
the uniform percentage of the respective contract premiums for the benefits, excluding extra
premiums on a substandard policy, that the present value, at the date of issue of the policy,
of all modified net premiums shall be equal to the sum of the then present value of the benefits
provided for by the policy and the excess of subdivision (1) over...
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27-1-21
Section 27-1-21 Uniformity of limits applied to fulfillment of certain drug prescriptions.
(a) For the purposes of this section, the following words shall have the following meanings:
(1) ENROLLEE. A person enrolled in a health benefit plan. (2) HEALTH BENEFIT PLAN. Any individual
or group plan, policy, or contract for health care services issued, delivered, issued for
delivery, renewed in this state by a health care insurer, health maintenance organization,
accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation,
nonprofit medical service corporation, health care service plan, or any other person, firm,
corporation, joint venture, or other similar business entity that pays for, purchases, or
furnishes health care services to patients, insureds, or beneficiaries in this state. The
term includes, but is not limited to, entities created pursuant to Article 6 of Chapter 4
of Title 10. The term shall not include any collective bargaining agreement...
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27-2B-2
Section 27-2B-2 Definitions. As used in this chapter, these terms shall have the following
meanings: (1) ADJUSTED RBC REPORT. An RBC report which has been adjusted by the commissioner
in accordance with subsection (e) of Section 27-2B-3. (2) CORRECTIVE ORDER. An order issued
by the commissioner specifying corrective actions which the commissioner has determined are
required. (3) DOMESTIC INSURER. Any insurer domiciled in this state. (4) FOREIGN INSURER.
Any insurer which is licensed to do business in this state but not domiciled in this state.
(5) FRATERNAL BENEFIT SOCIETY. Any insurer licensed under Chapter 34. (6) HEALTH ORGANIZATION.
Any health care service plan, health maintenance organization, limited health service organization,
dental services corporation, or other managed care organization licensed under this title.
This term does not include any life and disability insurer or property and casualty insurer.
(7) INSURER. As defined in Section 27-1-2, including, without...
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27-56-7
Section 27-56-7 Applicability to certain providers. (a) This chapter does not require and shall
not be construed to require any insurance policy, plan, or contract to provide health care
coverage for eye care. The provisions of this chapter are applicable only to those insurance
policies, plans, or contracts which provide coverage for eye care. (b) Insurers or other issuers
of any insurance policy, plan, or contract which provides coverage for eye care shall continue
to be able to establish and apply selection criteria and utilization protocols for health
care providers as well as credentialing criteria used in the selection of providers. (c) This
chapter does not require and shall not be construed to require the coverage of eye care services
by providers who are not designated as covered providers, or who are not selected as participating
providers, by an insurance policy, plan, or contract, or the issuer thereof having a participating
network of service providers. Provided, however,...
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40-26B-70
Section 40-26B-70 Definitions. For purposes of this article, the following terms shall have
the following meanings: (1) ACCESS PAYMENT. A payment by the Medicaid program to an eligible
hospital for inpatient or outpatient hospital care, or both, provided to a Medicaid recipient.
(2) ALL PATIENT REFINED DIAGNOSIS-RELATED GROUP (APR-DRG). A statistical system of classifying
any non-Medicare inpatient stay into groups for the purposes of payment. (3) ALTERNATE CARE
PROVIDER. A contractor, other than a regional care organization, that agrees to provide a
comprehensive package of Medicaid benefits to Medicaid beneficiaries in a defined region of
the state pursuant to a risk contract. (4) CERTIFIED PUBLIC EXPENDITURE (CPE). A certification
in writing of the cost of providing medical care to Medicaid beneficiaries by publicly owned
hospitals and hospitals owned by a state agency or a state university plus the amount of uncompensated
care provided by publicly owned hospitals and hospitals...
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8-32-5
Section 8-32-5 Required provisions, service contracts. (a) Service contracts sold or offered
for sale in this state, in their entirety, shall be written, printed, or typed in eight point
type size, or larger, and shall comply with the requirements set forth in this section, as
applicable. (b) Service contracts insured under a reimbursement insurance policy pursuant
to subdivision (1) of subsection (f) of Section 8-32-3 shall contain a statement in substantially
the following form: "Obligations of the provider under this service contract are guaranteed
under a service contract reimbursement insurance policy." If the provider fails to pay
or to provide service on a claim within 60 days after proof of loss has been filed, the service
contract holder is entitled to make a claim directly against the reimbursement insurance company.
The service contract shall state the name and address of the reimbursement insurance company.
(c) Service contracts not insured under a reimbursement insurance...
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27-20-7
Section 27-20-7 Blanket disability insurance - Payment of benefits. All benefits under any
blanket disability policy shall be payable to the person insured, or to his employer, or to
his designated beneficiary or beneficiaries or to his estate; except, that if the person insured
be a minor or mental incompetent, such benefits may be made payable to his parent, guardian,
or other person actually supporting him, or, if the entire cost of the insurance has been
borne by the employer, such benefits may be made payable to the employer; provided, however,
that the policy may provide that all, or any portion, of any indemnities provided by such
policy on account of hospital, nursing, medical, or surgical services may, at the insurer's
option, be paid directly to the hospital or person rendering such services; but the policy
may not require that the service be rendered by a particular hospital or person. Payment so
made shall discharge the insurer's obligation with respect to the amount of...
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27-53-1
Section 27-53-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) GENETIC CHARACTERISTICS. A scientifically or medically identifiable gene or
chromosome, or alteration thereof, that is known to be a cause of a disease or disorder, or
determined to be associated with a statistically increased risk of development of a disease
or disorder. (2) GENETIC TEST. A pre-symptomatic laboratory test which is generally accepted
in the scientific and medical communities for the determination of the presence or absence
of the genetic characteristics that cause or are associated with risk of a disease or disorder.
(3) HEALTH BENEFIT PLAN. A health insurance policy, including a self-insured health plan,
that covers hospital, medical, or surgical expenses, health maintenance organizations, preferred
provider organizations, medical service organizations, physician-hospital organizations, or
any other person, firm, corporation, joint venture, or other similar...
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8-36-2
Section 8-36-2 Cancellation of residential roofing contract; notice of cancellation; payments.
(a) A person who has entered into a written contract with a residential roofing contractor
to provide goods or services to be paid from the proceeds of a property and casualty insurance
policy may cancel the contract prior to midnight on the fifth business day if the insured
receives written notice from the insurer that all or any part of the claim or contract is
not a covered loss under the insurance policy or that the covered claim will not be sufficient
to cover the amount of the contract. Cancellation shall be evidenced by the insured giving
written notice of cancellation to the residential roofing contractor at the address stated
in the contract. Notice of cancellation, if given by mail, shall be effective upon deposit
into the United States mail, postage prepaid and properly addressed to the residential roofing
contractor and, if given by electronic mail, shall be effective if sent to...
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