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27-1-19
Section 27-1-19 Reimbursement of health care providers. (a) The insured, or health or dental
plan beneficiary may assign reimbursement for health or dental care services directly to the
provider of services. Health benefits include medical, pharmacy, podiatric, chiropractic,
optometric, durable medical equipment, and home care services. The company or agency, when
authorized by the insured, or health or dental plan beneficiary, shall pay directly to the
health care provider the amount of the claim, under the same criteria and payment schedule
that would have been reimbursed directly to the contract provider, and any applicable interest.
This amount only applies to assigned claims. Any company or agency making a payment to the
insured, or health or dental plan beneficiary, after the rights of reimbursement have been
assigned to the provider of services, shall be liable to the provider for the payment. If
the company or agency fails to reimburse the provider in accordance with the terms...
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27-15-52
Section 27-15-52 Definitions. The following terms shall have the following meanings: (1) COMMERCIALLY
REASONABLE EFFORT. The plans, processes, or procedures necessary to confirm the death of the
insured, contract owner or annuitant, or retained asset account holder against other available
records and information and, as applicable, to locate the beneficiary or beneficiaries or
other person entitled to payment pursuant to the terms of the policy or contract which have
been developed by each insurer and submitted to and approved by the department. (2) CONTRACT.
An annuity contract. The term contract shall not include an annuity used to fund an employment-based
retirement plan or program where the insurer is not committed by terms of the annuity contract
to pay death benefits to the beneficiaries of specific plan participants. (3) DEATH MASTER
FILE. The United States Social Security Administration's Death Master File or any other database
or service that is at least as comprehensive as...
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27-56-10
Section 27-56-10 Vision care providers - Contract requirements; rates; reimbursements; discounts.
(a) As used in this section, the following words shall have the following meanings: (1) CONTRACTUAL
DISCOUNT. A percentage reduction from a provider's usual and customary rate for covered services
and materials required under a participating provider agreement. (2) COVERED MATERIALS. Materials
for which reimbursement from the insurer or vision care plan is provided to a vision care
provider by an enrollee's plan contract, or for which a reimbursement would be available but
for the application of the enrollee's contractual limitations of deductibles, copayments,
or coinsurance. (3) COVERED SERVICES. Services for which reimbursement from the insurer or
vision care plan is provided to a vision care provider by an enrollee's plan contract, or
for which a reimbursement would be available but for the application of the enrollee's contractual
plan limitations of deductibles, copayments, or...
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27-5B-8
Section 27-5B-8 Certified reinsurer. (a) Credit shall be allowed when the reinsurance is ceded
to an assuming insurer that is certified by the commissioner as a reinsurer in this state
and secures its obligations in accordance with the requirements of this section. In order
to be eligible for certification, the assuming insurer shall meet all of the following requirements:
(1) The assuming insurer must be domiciled and licensed to transact insurance or reinsurance
in a qualified jurisdiction, as determined by the commissioner pursuant to subsection (c).
(2) The assuming insurer must maintain minimum capital and surplus, or its equivalent, in
an amount to be determined by the commissioner pursuant to regulation. (3) The assuming insurer
must maintain financial strength ratings from two or more rating agencies deemed acceptable
by the commissioner pursuant to regulation. (4) The assuming insurer must agree to submit
to the jurisdiction of this state, appoint the commissioner as its agent...
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31-5-10
Section 31-5-10 County service commissioners and district service commissioners - Duties. (a)
The county service commissioner and district service commissioner shall perform such duties
as may be prescribed by policies, rules, and regulations and instructions promulgated by the
State Board of Veterans' Affairs and shall be administratively responsible to the State Service
Commissioner. (b) It shall be the duty of the county service commissioner and district service
commissioner to: (1) Cooperate with and assist the volunteer county veterans' service committees
in his district or county in the development of a veterans' assistance program for his district
or county. (2) Furnish information and data to the office of the State Service Commissioner
relative to the various aspects of the problems of veterans and dependents of veterans in
his jurisdiction. (3) Provide in his office an information and referral service to veterans
seeking aid and assistance in connection with matters...
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45-31-141.10
Section 45-31-141.10 Powers of district; bylaws. (a) The district shall constitute a public
corporation, which shall have the power to do any and all acts or things necessary and convenient
for carrying out the purposes for which it is created including, but not limited to, all of
the following: (1) To sue or be sued. (2) To have a seal and alter the same at pleasure. (3)
To acquire, hold, and dispose of property, real and personal, tangible and intangible, or
interests therein and to pay therefor in cash or credit, and to secure and procure payment
of all or any part of the purchase price thereof on such terms and conditions as the board
shall determine. (4) To acquire, own, operate, maintain, and improve a system or systems.
(5) To pledge all or any part of its revenues, mortgage, or otherwise encumber, all or any
part of its property for the purpose of securing the payment of the principal of and interest
on any of its obligations. (6) To sell, lease, mortgage, or otherwise encumber...
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45-49A-64.20
Section 45-49A-64.20 Employee protective provisions. (a) The rights, benefits, and other employee
protective conditions and remedies of Section 13(c) of the Urban Mass Transportation Act of
1964, as amended (49 U.S.C. ยง 1609(c)), as determined by the Secretary of Labor, shall apply
to the operation by the authority of any public transportation service and to any contract
or other arrangement for the operation of such service. If the authority acquires an existing
transit system, the authority shall assume and observe all existing labor contracts and pension
obligations. All employees of such system, except executive and administrative officers, shall
be transferred to and appointed as employees of the authority, subject to all rights and benefits
of this section. These employees shall be given seniority credit and sick leave, vacation,
insurance, and pension credits in accordance with the records or labor agreements from the
acquired transit system. The authority shall assume the...
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11-49A-8
Section 11-49A-8 Powers of authority. The authority shall have the following powers, together
with all powers incidental thereto or necessary to the discharge thereof in corporate form:
(1) To have succession by its corporate name for the duration of time (which may be perpetual,
subject to the provisions of Section 11-49A-20) specified in its certificate of incorporation;
(2) To sue and be sued in its own name in civil suits and actions and to defend suits against
it; (3) To adopt and make use of a corporate seal and to alter the same at pleasure; (4) To
adopt and alter bylaws for the regulation and conduct of its affairs and business; (5) To
acquire, receive, and take, by purchase, gift, lease, devise, or otherwise, and to hold property
of every description, real, personal, or mixed, whether located in one or more counties or
municipalities and whether located within or outside the authorizing municipality; (6) To
make, enter into, and execute such contracts, agreements, leases, and...
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11-92C-8
Section 11-92C-8 Powers of authority. (a) The authority shall have the following powers, together
with all powers incidental thereto or necessary to the discharge thereof in corporate form:
(1) To have succession by its corporate name for the duration of time, which may be in perpetuity,
subject to Section 11-92C-20, specified in its certificate of incorporation. (2) To sue and
be sued in its own name and to prosecute and defend civil actions in any court having jurisdiction
of the subject matter and of the parties; provided that the authority shall be deemed to be
a governmental entity as defined in Chapter 93 of this title for the purpose of limiting the
damages for which the authority may be liable. (3) To adopt and make use of a corporate seal
and to alter the seal at its pleasure. (4) To adopt and alter bylaws for the regulation and
conduct of its affairs and business. (5) To acquire, whether by purchase, construction, exchange,
gift, lease, or otherwise, and to refinance existing...
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22-6-153
Section 22-6-153 Contract to provide medical care to Medicaid beneficiaries; enrollment; grievance
procedures; duties of Medicaid Agency. (a) Subject to approval of the federal Centers for
Medicare and Medicaid Services, the Medicaid Agency shall enter into a contract in each Medicaid
region for at least one fully certified regional care organization to provide, pursuant to
a risk contract under which the Medicaid Agency makes a capitated payment, medical care to
Medicaid beneficiaries. However, the Medicaid Agency may enter into a contract pursuant to
this section only if, in the judgment of the Medicaid Agency, care of Medicaid beneficiaries
would be better, more efficient, and less costly than under the then existing care delivery
system. The Medicaid Agency may contract with more than one regional care organization in
a Medicaid region. Pursuant to the contract, the Medicaid Agency shall set capitation payments
for the regional care organization. (b) The Medicaid Agency shall...
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