Chapter 41
Health Maintenance Organizations

Index of Sections

§ 27-41-1. Short title.

§ 27-41-2. Definitions.

§ 27-41-3. Establishment of health maintenance organizations.

§ 27-41-4. Issuance of license.

§ 27-41-5. Powers of health maintenance organizations.

§ 27-41-6. Governing body.

§ 27-41-7. Fiduciary responsibilities.

§ 27-41-8. Evidence of coverage and charges for healthcare services.

§ 27-41-9. Required reports.

§ 27-41-10. Information to enrollees.

§ 27-41-11. Complaint system.

§ 27-41-12. Investments.

§ 27-41-13. Protection against insolvency.

§ 27-41-13.1. Initial net worth and capital requirements.

§ 27-41-13.2. Ongoing net worth and capital requirements.

§ 27-41-13.3. Waiver, surplus notes, and risk-based capital requirements.

§ 27-41-14. Prohibited practices.

§ 27-41-14.1. Prohibition against restraint on provider — Patient communications.

§ 27-41-15. Powers of insurers and hospital and medical service corporations.

§ 27-41-16. Examination.

§ 27-41-17. Suspension or revocation of license.

§ 27-41-18. Rehabilitation, liquidation, or conservation of health maintenance organization.

§ 27-41-18.1. Summary orders and supervision.

§ 27-41-19. Rules and regulations.

§ 27-41-20. Administrative procedures.

§ 27-41-21. Penalties and enforcement.

§ 27-41-22. Statutory construction and relationship to other laws.

§ 27-41-23. Filings and reports as public documents.

§ 27-41-24. Director of health’s authority to contract.

§ 27-41-25. Holding company systems.

§ 27-41-26. Enrollee liability.

§ 27-41-26.1. Patient responsibility — Administrative requirements.

§ 27-41-27. Offer of health maintenance organization alternative to employees.

§ 27-41-27.1. No derogation of attorney general.

§ 27-41-27.2. Health insurance rates.

§ 27-41-28. Applicability.

§ 27-41-29. Severability.

§ 27-41-29.1. Uniform explanation of benefits and coverage.

§ 27-41-29.2. Filing of policy forms.

§ 27-41-30. Mammograms and pap smears — Coverage mandated.

§ 27-41-30.1. Postpartum hospital stays.

§ 27-41-31. Mammograms — Quality assurance standards.

§ 27-41-32. Pap smears — Quality assurance standards.

§ 27-41-33. Coverage for infertility.

§ 27-41-34. Health maintenance organizations’ assessment.

§ 27-41-35. Enrollment period in the event of insolvency.

§ 27-41-36. Services of midwives.

§ 27-41-37. Discontinuance of coverage — Chronic disabilities.

§ 27-41-38. Drug coverage.

§ 27-41-38.1. Medication synchronization.

§ 27-41-38.2. Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies.

§ 27-41-38.3. Specialty drugs. [Effective January 1, 2025.]

§ 27-41-38.4. Patient choice in dispensing of clinician-administered drugs. [Effective January 1, 2025.]

§ 27-41-39. Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists.

§ 27-41-40. Certified counselors in mental health and therapists in marriage and family practice.

§ 27-41-41. Repealed.

§ 27-41-41.1. Repealed.

§ 27-41-41.2. Repealed.

§ 27-41-41.3. Repealed.

§ 27-41-42. Repealed.

§ 27-41-43. Mastectomy treatment.

§ 27-41-43.1. Insurance coverage for mastectomy hospital stays.

§ 27-41-44. Diabetes treatment.

§ 27-41-45. Primary and preventive obstetric and gynecological care.

§ 27-41-45.1. Hysterectomy or myomectomy treatment.

§ 27-41-46. Whistleblowers protection.

§ 27-41-47. Penalties and remedies.

§ 27-41-48. Additional relief and damages — Reinstatement.

§ 27-41-49. Third-party reimbursement for services of certain healthcare workers.

§ 27-41-49.1. Third-party reimbursement for services of registered nurse first assistants.

§ 27-41-50. Human leukocyte antigen testing.

§ 27-41-51. Drug coverage.

§ 27-41-52. Restricted annual rate payments prohibited.

§ 27-41-53. Genetic testing.

§ 27-41-53.1. Genetic information.

§ 27-41-54. Disassociation prohibited.

§ 27-41-55. Repealed.

§ 27-41-56. Magnetic resonance imaging — Quality assurance standards.

§ 27-41-57. Acupuncture services.

§ 27-41-58. Prohibition against requiring indemnification from dentists.

§ 27-41-59. FDA approved prescription contraceptive drugs and devices.

§ 27-41-60. Prostate and colorectal examinations — Coverage mandated — The Maryellen Goodwin Colorectal Cancer Screening Act.

§ 27-41-61. Eligibility for children’s benefits.

§ 27-41-62. Temporary credentials.

§ 27-41-63. Hearing aids.

§ 27-41-64. Prompt processing of claims.

§ 27-41-65. Mandatory coverage for certain lyme disease treatments.

§ 27-41-66. Dental insurance assignment of benefits.

§ 27-41-67. Determination of maximum coverage limitation for prescription drug benefits.

§ 27-41-68. Coverage for early intervention services.

§ 27-41-69. Post-payment audits.

§ 27-41-70. Tobacco cessation programs.

§ 27-41-71. Mandatory coverage for scalp hair prosthesis.

§ 27-41-72. Reimbursement for orthotic and prosthetic services.

§ 27-41-73. Licensed ambulance service.

§ 27-41-74. Enteral nutrition products.

§ 27-41-75. Prohibition on rescission of coverage.

§ 27-41-76. Prohibition on annual and lifetime limits.

§ 27-41-77. Coverage for individual participating in approved clinical trials.

§ 27-41-78. Medical loss ratio reporting and rebates.

§ 27-41-79. Emergency services.

§ 27-41-80. Internal and external appeal of adverse benefit determinations.

§ 27-41-81. Prohibition on preexisting condition exclusions.

§ 27-41-82. Primary care provider designation requirement.

§ 27-41-83. Discretionary clauses.

§ 27-41-84. Orally administered anticancer medication — Cost-sharing requirement.

§ 27-41-85. Consumer notification.

§ 27-41-86. Opioid antagonists.

§ 27-41-87. Healthcare provider credentialing.

§ 27-41-88. Unfair discrimination prohibited.

§ 27-41-89. Health insurance contracts — Full year coverage for contraception.

§ 27-41-90. Prohibition on discrimination in organ transplants.

§ 27-41-91. Health insurance contracts — Copayments exemption for COVID-19 vaccinations.

§ 27-41-92. Perinatal doulas.

§ 27-41-93. Gender rating.

§ 27-41-94. Coverage for biomarker testing.

§ 27-41-95. Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. [Expires December 31, 2025.]

§ 27-41-96. 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.]27-41-96. 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.]

§ 27-41-97. Expedited prior authorization for HIV PrEP or PEP drugs. [Repealed effective January 1, 2025.]27-41-97. Expedited prior authorization. [Repealed effective January 1, 2025.]

§ 27-41-98. Dispensing and administration of HIV PrEP or PEP drugs.

§ 27-41-99. Epinephrine injectors.