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22-21-361
Section 22-21-361 Definitions. The following terms shall have the meanings respectively
ascribed by this section unless the context clearly indicates otherwise: (1) COMMISSIONER.
The commissioner of insurance of this state. (2) DENTAL SERVICE PLAN or PLAN. Any plan or
other arrangement whereby dental services are provided in whole or in part through a dental
service corporation by dentists participating in the plan to provide dental services to those
members of the public who become subscribers to the plan under a contract with such corporation.
The terms "dental service plan" or "plan" do not include an insurer authorized
by the insurance department to transact insurance in this state or to a nonprofit health insurance
plan organized pursuant to Section 10-4-100, or to any policy of insurance or contract
which includes dental benefits issued by such insurer or nonprofit health insurance plan.
(3) DEPARTMENT. The Department of Insurance. (4) LICENSE. The certificate of authority issued...
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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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36-29-23
Section 36-29-23 Authorization to establish flexible employee benefit plan; provisions
of plan. The board, with the approval of the Governor, is authorized to establish a flexible
employee benefit plan for state employees in compliance with Section 125 and any other
applicable sections of the Internal Revenue Code. The flexible employee benefit plan may provide
for payments or salary reductions for qualified benefits in accordance with Section
125 of the Internal Revenue Code, which presently include health insurance premiums, group
life insurance, disability insurance, supplemental health and accident insurance, dependent
care expenses, and such other types of employee benefits permitted under Section 125
and any other applicable sections of the Internal Revenue Code. Futhermore, the board may
establish a long-term care plan for employees. (Acts 1989, No. 89-644, p. 1272, §4; Act 98-639,
p. 1410, §1.)...
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27-56-3
Section 27-56-3 Payment for services. An insurance policy, plan, or contract providing
for third-party payment or prepayment of health or medical expenses shall include a provision
for the payment to a licensed optometrist for each service which falls within the scope of
the optometrist's license, if the policy, plan, or contract pays for the same service when
provided by any other provider for such services. (Act 2001-477, p. 640, §3.)...
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36-29-16
Section 36-29-16 Group insurance for retired judges of probate and legislators; payment
of cost. Any judge of probate who qualifies to retire from active service with a benefit from
the Judicial Retirement Fund or any legislator shall be entitled to participate in the State
Employees' Health Insurance Plan. The entire cost for the group health insurance during retirement
for a judge of probate or for a legislator shall be paid by such retired judge or legislator
under such terms and conditions as the group insurer may, from time to time, prescribe for
such group health insurance. (Acts 1994, No. 94-608, p. 1123, §1.)...
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16-25A-6
Section 16-25A-6 Exclusions. Such health insurance shall not include the following:
(1) Expenses incurred by or on account of an individual prior to the effective date of the
plan as to him; (2) Hearing aids and examinations for the prescription or fitting thereof;
(3) Cosmetic surgery or treatment, except to the extent necessary for correction of damage
caused by accidental injury while covered by the plan or as a direct result of disease covered
by the plan; (4) Services received in a hospital owned or operated by the United States government
for which no charge is made; (5) Services received for injury or sickness due to war or any
act of war, whether declared or undeclared, which war or act of war shall have occurred after
the effective date of this plan; (6) Expenses for which the individual is not required to
make payment; (7) Expenses to the extent of benefits provided under any employer group plan
other than this plan in which the state participates in the cost thereof; (8)...
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27-1-17.1
Section 27-1-17.1 Payment of providers through electronic funds transfer methods. (a)
As used in this section, the following words shall have the following meanings: (1)
ACH ELECTRONIC FUNDS TRANSFER. An electronic funds transfer through the Health Insurance Portability
and Accountability Act (HIPPA) standard Automated Clearing House network. (2) COVERED HEALTH
CARE PROVIDER. A physician as defined in Section 34-24-50.1; a dentist as defined in
Section 34-9-1; a chiropractor as defined in Section 34-24-120; an individual
engaged in the practice of optometry as defined in Section 34-22-1; other licensed
health care professionals as defined in Title 34; a hospital as defined in Section
22-21-20; and a health care facility, or other provider who or that is accredited, licensed,
or certified and who or that is performing within the scope of that accreditation, license,
or certification. (3) HEALTH INSURANCE PLAN. Any hospital and medical expense incurred policy,
health maintenance...
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27-45A-5
Section 27-45A-5 Disclosure of cost share information; discussion and sale of prescription
drug alternatives; prohibited payment practices. (a) A pharmacy or pharmacist may provide
a covered person with information regarding the amount of the covered person's cost share
for a prescription drug. Neither a pharmacy nor a pharmacist shall be proscribed by a pharmacy
benefits manager from discussing any such information or for selling a more affordable alternative
to the covered person if such an alternative is available. (b) A health benefit plan that
covers prescription drugs may not include a provision that requires an enrollee to make a
payment for a prescription drug at the point of sale in an amount that exceeds the lessor
of: (1) the contracted co-payment amount; or (2) the amount an individual would pay for a
prescription if that individual were paying with cash. (c) For purposes of this section,
the following words have the following meanings: (1) COVERED PERSON. Any individual,...
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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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16-25A-7
Section 16-25A-7 Authorization and execution of contracts; evidence of coverage; denial
of claims. (a) The board is hereby authorized to execute a contract or contracts to provide
for the benefits or the administration of the plan determined in accordance with the provisions
of this article. Such contract or contracts may be executed with one or more agencies or corporations
licensed to transact or administer group health insurance business in this state. All of the
benefits to be provided under this article may be included in one or more similar contracts
issued by the same or different companies. The board is further authorized to develop a plan
whereby it may become self-insured upon its finding that such arrangement would be financially
advantageous to the state and plan participants. (b) Before entering into any contract or
contracts authorized by subsection (a), the board shall invite competitive bids from all qualified
entities who may wish to administer or offer plans for the...
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