Chapter 20
Nonprofit Medical Service Corporations

Index of Sections

§ 27-20-1. Definitions.

§ 27-20-1.1. Applicability.

§ 27-20-2. Organization as charitable corporation — Insurance laws inapplicable.

§ 27-20-3. Qualifications of directors.

§ 27-20-4. Approval of articles of association.

§ 27-20-5. Contracts with subscribers.

§ 27-20-5.1. Cancellation of coverage by employers.

§ 27-20-5.2. Repealed.

§ 27-20-5.3. Patient responsibility — Administrative requirements.

§ 27-20-6. Rates charged subscribers — Hearing by commissioner.

§ 27-20-6.1. Uniform explanation of benefits and coverage.

§ 27-20-6.2. Filing of policy forms.

§ 27-20-7. Relationship of physician and patient — Actions against corporation.

§ 27-20-8. Annual and quarterly statements.

§ 27-20-9. Examination of affairs of corporation.

§ 27-20-10. Commission plans for solicitors or insurance producers.

§ 27-20-11. Investment standards.

§ 27-20-12. Corporation deemed public charitable institution.

§ 27-20-13. Adoption of chapter by hospital service corporation.

§ 27-20-14. Coverage for adoptive children.

§ 27-20-15. Itemized bills for services rendered.

§ 27-20-16. Changing coverage.

§ 27-20-17. Mammograms and pap smears — Coverage mandated.

§ 27-20-17.1. Insurance coverage for postpartum hospital stays.

§ 27-20-18. Mammograms — Quality assurance standards.

§ 27-20-19. Pap smears — Quality assurance standards.

§ 27-20-20. Coverage for infertility.

§ 27-20-21. Nonprofit medical service corporation assessment.

§ 27-20-22. Discontinuance of coverage — Chronic disabilities.

§ 27-20-23. Drug coverage.

§ 27-20-23.1. Medication synchronization.

§ 27-20-23.2. Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies.

§ 27-20-23.3. Patient choice in dispensing of clinician-administered drugs. [Effective January 1, 2025.]

§ 27-20-24. Rehabilitation, liquidation, or conservation.

§ 27-20-25. Holding company systems.

§ 27-20-25.1. No derogation of attorney general.

§ 27-20-25.2. Health insurance rates.

§ 27-20-26. Regulations.

§ 27-20-27. New cancer therapies — Under investigation. [Repealed on effective date of § 27-20-64.]

§ 27-20-27.1. “Reliable evidence” defined. [Repealed on effective date of § 27-20-64.]

§ 27-20-27.2. Conditions of coverage. [Repealed on effective date of § 27-20-64.]

§ 27-20-27.3. Managed care. [Repealed on effective date of § 27-20-64.]

§ 27-20-28. Repealed.

§ 27-20-29. Mastectomy treatment.

§ 27-20-29.1. Insurance coverage for mastectomy hospital stays.

§ 27-20-30. Diabetes treatment.

§ 27-20-31. Primary and preventive obstetric and gynecological care.

§ 27-20-31.1. Hysterectomy or myomectomy treatment.

§ 27-20-32. Whistleblowers protection.

§ 27-20-33. Penalties and remedies.

§ 27-20-34. Additional relief and damages — Reinstatement.

§ 27-20-35. Third-party reimbursement for services of certain healthcare workers.

§ 27-20-35.1. Third-party reimbursement for services of registered nurse first assistants.

§ 27-20-36. Human leukocyte antigen testing.

§ 27-20-37. Drug coverage.

§ 27-20-37.1. Specialty drugs. [Effective January 1, 2025.]

§ 27-20-38. Restricted annual rate payments prohibited.

§ 27-20-39. Genetic testing.

§ 27-20-39.1. Genetic information.

§ 27-20-40. Repealed.

§ 27-20-41. Magnetic resonance imaging — Quality assurance standards.

§ 27-20-42. Acupuncture services.

§ 27-20-43. FDA approved prescription contraceptive drugs and devices.

§ 27-20-44. Prostate and colorectal examinations — Coverage mandated — The Maryellen Goodwin Colorectal Cancer Screening Act.

§ 27-20-45. Eligibility for children’s benefits.

§ 27-20-46. Hearing aids.

§ 27-20-47. Prompt processing of claims.

§ 27-20-48. Mandatory coverage for certain lyme disease treatments.

§ 27-20-49. Dental insurance assignment of benefits.

§ 27-20-50. Coverage for early intervention services.

§ 27-20-51. Post-payment audits.

§ 27-20-52. Reimbursement for orthotics and prosthetic services.

§ 27-20-53. Tobacco cessation programs.

§ 27-20-54. Mandatory coverage for scalp hair prosthesis.

§ 27-20-55. Licensed ambulance service.

§ 27-20-56. Enteral nutrition products.

§ 27-20-57. Prohibition on preexisting condition exclusions.

§ 27-20-58. Prohibition on rescission of coverage.

§ 27-20-59. Annual and lifetime limits.

§ 27-20-60. Coverage for individuals participating in approved clinical trials.

§ 27-20-61. Medical loss ratio reporting and rebates.

§ 27-20-62. Emergency services.

§ 27-20-63. Internal and external appeal of adverse benefit determinations.

§ 27-20-64. [Reserved.]

§ 27-20-65. Primary care provider designation requirement.

§ 27-20-66. Discretionary clauses.

§ 27-20-67. Orally administered anticancer medication — Cost-sharing requirement.

§ 27-20-68. Consumer notification.

§ 27-20-69. Opioid antagonists.

§ 27-20-70. Healthcare provider credentialing.

§ 27-20-71. Unfair discrimination prohibited.

§ 27-20-72. Health insurance contracts — Full year coverage for contraception.

§ 27-20-73. Prohibition on discrimination in organ transplants.

§ 27-20-74. Health insurance contracts — Copayments exemption for COVID-19 vaccinations.

§ 27-20-75. Perinatal doulas.

§ 27-20-76. Gender rating.

§ 27-20-77. Coverage for biomarker testing.

§ 27-20-78. Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. [Expires December 31, 2025.]

§ 27-20-79. 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.]27-20-79. 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.]

§ 27-20-80. Expedited prior authorization for HIV PrEP or PEP drugs. [Repealed effective January 1, 2025.]27-20-80. Expedited prior authorization. [Repealed effective January 1, 2025.]

§ 27-20-81. Dispensing and administration of HIV PrEP or PEP drugs.

§ 27-20-82. Epinephrine injectors.