Title 27
Insurance

Chapter 18.6
Large Group Health Insurance Coverage

§ 27-18.6-3.2. Preventive services.

(a) As used in this section, “preventive services” means those services described in 42 U.S.C. § 300gg-13 and implementing regulations and guidance.

(b) If any provision of the federal Patient Protection and Affordable Care Act and implementing regulations relating to preventive services without cost sharing are determined by the commissioner to have been repealed or to have been declared invalid or nullified by the final judgment of a federal court applicable to the state or by executive or administrative action, which shall be deemed to include an action of the executive or judicial branch that nullifies the effectiveness of the obligation to provide coverage without cost sharing for a meaningful range of preventive services substantially similar to those in effect as of January 1, 2023, then the following shall apply:

(1) A health insurance policy, subscriber contract, or health plan offered, issued, renewed, issued for delivery, or issued to cover a resident of this state, by a health insurance company licensed pursuant to this title and/or chapter, shall provide coverage of preventive services from in-network providers without applying any copayments, deductibles, coinsurance, or other cost sharing, as described in 42 U.S.C. § 300gg-13 and related regulations and guidance, including existing exemptions, in effect as of the date immediately prior to their repeal, revocation, or nullification, as set forth above.

(2) To the extent that the U.S. Preventive Services Taskforce revises its recommendations with respect to grade “A” or “B” preventive services or other expert advisory panel described in 42 U.S.C. § 300gg-13, similarly provides new or revised recommendations the office of the health insurance commissioner shall have the authority to issue guidance clarifying the services that shall qualify as preventive services under this section, consistent with said recommendations, and in accordance with the process as had been described by the version of 42 U.S.C. § 300gg-13(b) and related regulations and guidance in effect as of the date immediately prior to their repeal, revocation, or nullification, as set forth above.

(c) If a health insurance policy, subscriber contract, or health plan offered, issued, renewed, issued for delivery, or issued to cover a resident of this state, by a health insurance company licensed pursuant to this title and/or chapter, was not subject to the requirements described in subsection (b) of this section prior to their repeal, revocation, or nullification, then such policy, contract, or plan shall remain so exempt and the provisions of this section shall not apply.