§ 27-20-66. Discretionary clauses.
(a) No new or existing policy or certificate may contain any provision:
(1) Purporting to reserve sole discretion to the insurer or healthcare entity to determine eligibility for benefits or interpret the terms of a policy or certificate; or
(2) Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.
(b) Any such clause or language included in a contract, policy, or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.
(c) Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility; receipt of benefits and claims; or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.
History of Section.
P.L. 2013, ch. 85, § 4; P.L. 2013, ch. 94, § 4.