Chapter 18
Accident and Sickness Insurance Policies

Index of Sections

§ 27-18-1. “Policy of accident and sickness insurance” construed.

§ 27-18-1.1. Definitions.

§ 27-18-2. Form of policy.

§ 27-18-2.1. Uniform explanation of benefits and coverage.

§ 27-18-3. Required provisions.

§ 27-18-3.1. Alternative coverage by employer.

§ 27-18-3.2. Rules and regulations.

§ 27-18-3.3. Penalties.

§ 27-18-3.4. Judicial review.

§ 27-18-3.5. Non-applicability.

§ 27-18-4. Optional provisions.

§ 27-18-5. Inapplicable or inconsistent provisions.

§ 27-18-6. Sequence of provisions.

§ 27-18-7. Third party ownership.

§ 27-18-8. Filing of accident and sickness insurance policy forms.

§ 27-18-8.1. Waiting period — Effective date of filings.

§ 27-18-8.2. Notice of disapproval.

§ 27-18-8.3. Withdrawal of approval.

§ 27-18-8.4. Rules as to filing.

§ 27-18-9. Policies of foreign insurers.

§ 27-18-10. Compliance by domestic insurer with laws of other states.

§ 27-18-11. Application of provisions to policy issued to nonresident.

§ 27-18-12. Less favorable provisions prohibited.

§ 27-18-13. Effect of policies inconsistent with chapter.

§ 27-18-14. Copies of applications.

§ 27-18-15. Alteration of application.

§ 27-18-16. False statements in application.

§ 27-18-17. Acts not constituting waiver of insurer’s defenses.

§ 27-18-18. Acceptance of premiums after effective period of policy.

§ 27-18-19. Insurance exempt from chapter.

§ 27-18-20. Penalties for violations.

§ 27-18-21. Appeals from commissioner.

§ 27-18-22. Effect on other law.

§ 27-18-23. Severability.

§ 27-18-24. Immunity of benefits from process.

§ 27-18-25. Unfair discrimination prohibited.

§ 27-18-26. Physical examinations by insurance company.

§ 27-18-27. Adoptive children.

§ 27-18-28. [Repealed.]

§ 27-18-29. Changing coverage.

§ 27-18-30. Health insurance contracts — Infertility.

§ 27-18-31. Insurance coverage for services of licensed midwives.

§ 27-18-32. Discontinuance of coverage — Chronic disabilities.

§ 27-18-33. Drug coverage.

§ 27-18-33.1. Insurance coverage for post-partum hospital stays.

§ 27-18-33.2. Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies.

§ 27-18-34. Health insurance contracts — Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists.

§ 27-18-35. Certified counselors in mental health and therapists in marriage and family practice.

§ 27-18-36. Repealed.

§ 27-18-36.1. Repealed.

§ 27-18-36.2. Repealed.

§ 27-18-36.3. Repealed.

§ 27-18-37. Repealed.

§ 27-18-38. Diabetes treatment.

§ 27-18-39. Mastectomy treatment.

§ 27-18-40. Insurance coverage for mastectomy hospital stays.

§ 27-18-41. Mammograms and pap smears — Coverage mandated. [Effective until January 1, 2024.]27-18-41. Mammograms and pap smears — Coverage mandated. [Effective January 1, 2024.]

§ 27-18-42. Mammograms — Quality assurance standards.

§ 27-18-43. Pap smears — Quality assurance standards.

§ 27-18-44. Primary and preventive obstetric and gynecological care.

§ 27-18-44.1. Hysterectomy or myomectomy treatment.

§ 27-18-45. Whistleblowers protection.

§ 27-18-46. Penalties and remedies.

§ 27-18-47. Additional relief and damages — Reinstatement.

§ 27-18-48. Third party reimbursement for services of certain healthcare workers.

§ 27-18-48.1. Third party reimbursement for services of registered nurse first assistants.

§ 27-18-49. Human leukocyte antigen testing.

§ 27-18-50. Drug coverage.

§ 27-18-50.1. Medication synchronization.

§ 27-18-50.2. Specialty drugs. [Effective January 1, 2025.]

§ 27-18-51. Restricted annual rate payments prohibited.

§ 27-18-52. Genetic testing.

§ 27-18-52.1. Genetic information.

§ 27-18-53. Magnetic resonance imaging — Quality assurance standards.

§ 27-18-54. Health insurance rates.

§ 27-18-55. Acupuncture services.

§ 27-18-56. Prohibition against dentists being required to indemnify provider.

§ 27-18-57. F.D.A. approved prescription contraceptive drugs and devices.

§ 27-18-58. Prostate and colorectal examinations — Coverage mandated — The Maryellen Goodwin Colorectal Cancer Screening Act.

§ 27-18-59. Eligibility for children’s benefits. [Effective until January 1, 2024.]27-18-59. Eligibility for children’s benefits. [Effective January 1, 2024.]

§ 27-18-60. Hearing aids.

§ 27-18-61. Prompt processing of claims.

§ 27-18-62. Mandatory coverage for certain lyme disease treatments.

§ 27-18-63. Dental insurance assignment of benefits.

§ 27-18-64. Coverage for early intervention services.

§ 27-18-65. Post-payment audits.

§ 27-18-66. Tobacco cessation programs.

§ 27-18-67. Reimbursement for orthotic and prosthetic services.

§ 27-18-68. Mandatory coverage for scalp hair prosthesis.

§ 27-18-69. Licensed ambulance service.

§ 27-18-70. Enteral nutrition products.

§ 27-18-71. Prohibition on preexisting condition exclusions.

§ 27-18-72. Prohibition on rescission of coverage.

§ 27-18-73. Prohibition on annual and lifetime limits.

§ 27-18-74. Coverage for individuals participating in approved clinical trials.

§ 27-18-75. Medical loss ratio reporting and rebates.

§ 27-18-76. Emergency services.

§ 27-18-77. Internal and external appeal of adverse benefit determinations.

§ 27-18-78. Primary care provider designation requirement.

§ 27-18-79. Discretionary clauses.

§ 27-18-80. Orally administered anticancer medication — Cost-sharing requirement.

§ 27-18-81. Consumer notification.

§ 27-18-82. Opioid antagonists.

§ 27-18-83. Healthcare provider credentialing.

§ 27-18-84. Health insurance contracts — Full year coverage for contraception.

§ 27-18-85. Prohibition on discrimination in organ transplants.

§ 27-18-86. Health insurance contracts — Copayments exemption for COVID-19 vaccinations.

§ 27-18-87. Perinatal doulas.

§ 27-18-88. Gender rating.

§ 27-18-89. Coverage for biomarker testing.

§ 27-18-90. Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. [Expires December 31, 2025.]

§ 27-18-91. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective January 1, 2024.]

§ 27-18-92. Expedited prior authorization. [Effective January 1, 2024.]

§ 27-18-93. Dispensing and administration of HIV PrEP or PEP drugs. [Effective January 1, 2024.]

§ 27-18-94. Epinephrine injectors.