Chapter 19
Nonprofit Hospital Service Corporations

Index of Sections

§ 27-19-1. Definitions.

§ 27-19-2. Organization as charitable corporation — Insurance laws inapplicable.

§ 27-19-2.1. Investments and holdings in certain corporations authorized.

§ 27-19-3. [Repealed.]

§ 27-19-4. Certificate of public convenience and advantage.

§ 27-19-5. Contracts with subscribers, hospitals, and other eligible entities.

§ 27-19-5.1. Cancellation of coverage by employers.

§ 27-19-5.2. Patient responsibility — Administrative requirements.

§ 27-19-5.3. Additional powers.

§ 27-19-6. Rates charged subscribers.

§ 27-19-7. Rates charged by hospitals.

§ 27-19-7.1. Uniform explanation of benefits and coverage.

§ 27-19-7.2. Filing of policy forms.

§ 27-19-8. Annual and quarterly statements.

§ 27-19-9. Examination of affairs of corporations.

§ 27-19-10. Commission plans for solicitors or insurance producers.

§ 27-19-11. Investment standards.

§ 27-19-12. Corporations deemed public charitable institutions.

§ 27-19-13. Services rendered in certain institutions.

§ 27-19-14. Repealed.

§ 27-19-15. Repealed.

§ 27-19-16. Repealed.

§ 27-19-17. Additional benefits.

§ 27-19-18. Coverage for adoptive children.

§ 27-19-19. Changing coverage.

§ 27-19-20. Mammograms and pap smears — Coverage mandated.

§ 27-19-21. Mammograms — Quality assurance standards.

§ 27-19-22. Pap smears — Quality assurance standards.

§ 27-19-23. Coverage for infertility.

§ 27-19-23.1. Insurance coverage for postpartum hospital stays.

§ 27-19-24. Nonprofit hospital service corporations assessment.

§ 27-19-25. Discontinuance of coverage — Chronic disabilities.

§ 27-19-26. Drug coverage.

§ 27-19-26.1. Medication synchronization.

§ 27-19-26.2. Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies.

§ 27-19-26.3. Patient choice in dispensing of clinician-administered drugs. [Effective January 1, 2025.]

§ 27-19-27. Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists.

§ 27-19-28. Rehabilitation, liquidation, or conservation.

§ 27-19-29. Holding company systems.

§ 27-19-29.1. No derogation of attorney general.

§ 27-19-30. Regulations.

§ 27-19-30.1. Health insurance rates.

§ 27-19-31. Certified counselors in mental health and therapists in marriage and family practice.

§ 27-19-32. Repealed.

§ 27-19-32.1. Repealed.

§ 27-19-32.2. Repealed.

§ 27-19-32.3. Repealed.

§ 27-19-33. Repealed.

§ 27-19-34. Mastectomy treatment.

§ 27-19-34.1. Insurance coverage for mastectomy hospital stays.

§ 27-19-35. Diabetes treatment.

§ 27-19-36. Primary and preventive obstetric and gynecological care.

§ 27-19-36.1. Hysterectomy or myomectomy treatment.

§ 27-19-37. Whistleblowers protection.

§ 27-19-38. Penalties and remedies.

§ 27-19-39. Additional relief and damages — Reinstatement.

§ 27-19-40. Third-party reimbursement for services of certain healthcare workers.

§ 27-19-40.1. Third-party reimbursement for services of registered nurse first assistants.

§ 27-19-41. Human leukocyte antigen testing.

§ 27-19-42. Drug coverage.

§ 27-19-42.1. Specialty drugs. [Effective January 1, 2025.]

§ 27-19-43. Restricted annual rate payments prohibited.

§ 27-19-44. Genetic testing.

§ 27-19-44.1. Genetic information.

§ 27-19-45. Repealed.

§ 27-19-46. Magnetic resonance imaging — Quality assurance standards.

§ 27-19-47. Acupuncture services.

§ 27-19-48. FDA approved prescription contraceptive drugs and devices.

§ 27-19-49. Prostate and colorectal examinations — Coverage mandated — The Maryellen Goodwin Colorectal Cancer Screening Act.

§ 27-19-50. Eligibility for children’s benefits.

§ 27-19-51. Hearing aids.

§ 27-19-52. Prompt processing of claims.

§ 27-19-53. Mandatory coverage for certain lyme disease treatments.

§ 27-19-54. Dental insurance assignment of benefits.

§ 27-19-55. Coverage for early intervention services.

§ 27-19-56. Post-payment audits.

§ 27-19-57. Tobacco cessation programs.

§ 27-19-58. Reimbursement for orthotics and prosthetic services.

§ 27-19-59. Mandatory coverage for scalp hair prosthesis.

§ 27-19-60. Licensed ambulance service.

§ 27-19-61. Enteral nutrition products.

§ 27-19-62. Prohibition on rescission of coverage.

§ 27-19-63. Prohibition on annual and lifetime limits.

§ 27-19-64. Coverage for individuals participating in approved clinical trials.

§ 27-19-65. Medical loss ratio reporting and rebates.

§ 27-19-66. Emergency services.

§ 27-19-67. Internal and external appeal of adverse benefit determinations.

§ 27-19-68. Prohibition on preexisting condition exclusions.

§ 27-19-69. Primary care provider designation requirement.

§ 27-19-70. Discretionary clauses.

§ 27-19-71. Orally administered anticancer medication — Cost-sharing requirement.

§ 27-19-72. Consumer notification.

§ 27-19-73. Opioid antagonists.

§ 27-19-74. Healthcare provider credentialing.

§ 27-19-75. Unfair discrimination prohibited.

§ 27-19-76. Health insurance contracts — Full year coverage for contraception.

§ 27-19-77. Prohibition on discrimination in organ transplants.

§ 27-19-78. Health insurance contracts — Copayments exemption for COVID-19 vaccinations.

§ 27-19-79. Perinatal doulas.

§ 27-19-80. Gender rating.

§ 27-19-81. Coverage for biomarker testing.

§ 27-19-82. Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. [Expires December 31, 2025.]

§ 27-19-83. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective until January 1, 2025.]27-19-83. 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, 2025.]

§ 27-19-84. Expedited prior authorization for HIV PrEP or PEP drugs. [Repealed effective January 1, 2025.]27-19-84. Expedited prior authorization. [Repealed effective January 1, 2025.]

§ 27-19-85. Dispensing and administration of HIV PrEP or PEP drugs.

§ 27-19-86. Epinephrine injectors.