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Title: 17 - CORPORATIONS AND INSTITUTIONS FOR FINANCE AND INSURANCE
Chapter: 48A -
Title: 17 - CORPORATIONS AND INSTITUTIONS FOR FINANCE AND INSURANCE
Chapter: 48A - Group contracts; issuance; description; benefits; employees defined.
17:48A-1: Definitions; liability for medical services
17:48A-2: Nonprofit corporation; trustees and physicians; who may operate medical service plan; certificate of authority
17:48A-2.1: Medical service corporation merger procedure
17:48A-3: Issuance of certificate of authority; amendment; counties affected
17:48A-4: Corporate funds required
17:48A-5: Subscription contracts.
17:48A-6: Written contracts required; subscription certificates
17:48A-6.1: Elective surgery; definitions
17:48A-6.2: Second surgical opinion program
17:48A-6.3: Payment for second surgical opinion
17:48A-6.4: Third surgical opinion
17:48A-6.5: Second opinion exclusions
17:48A-6.6: Physicians furnishing opinion and performing surgical procedure; payment
17:48A-6.8: Medical service corporations to offer basic health care contracts
17:48A-6.9: Basic health care contract; provisions
17:48A-6.10: Eligibility for enrollment in medical service corporation
17:48A-6.11: Medical service corporation contract, exclusion, rates, terms based on genetic information prohibited.
17:48A-7: Formal requirements for subscription certificates
17:48A-7a: Treatment of alcoholism; benefits
17:48A-7b: Reconstructive breast surgery; benefits
17:48A-7c: Medical service contracts
17:48A-7d: Medical service corporation insurance benefits for preexisting condition
17:48A-7e: Medical service corporation to pay benefits for treatment of Wilm's tumor
17:48A-7f: Medical service corporation contract, mammogram examination benefits.
17:48A-7g: Medical service corporation, benefits for "off-label" drugs required
17:48A-7h: Medical service corporation, benefits for health promotion
17:48A-7i: Requirements for medical service corporation providing benefits for pharmacy services.
17:48A-7j: Benefits for certain cancer treatments
17:48A-7jj: Medical service corporation contract, coverage for synchronization of prescribed medications.
17:48A-7kk: Medical service corporation to provide benefits for treatment of substance use disorder.
17:48A-7ll: Medical service corporation to provide coverage regardless of gender identity, expression.
17:48A-7mm: Medical service corporation contract to cover digital tomosynthesis of the breast.
17:48A-7k: Coverage for birth and natal care; medical service corporation
17:48A-7l: Coverage for diabetes treatment by individual, group medical service corporation
17:48A-7m: Medical service corporation contract, Pap smear benefits
17:48A-7n: Medical service corporation contract, prostate cancer testing
17:48A-7o: Coverage for minimum inpatient care following mastectomy by individual, group medical service corporation
17:48A-7p: Applicability of Health Care Quality Act
17:48A-7q: Coverage for treatment of inherited metabolic diseases by medical service corporation.
17:48A-7r: Medical service corporation to cover certain audiology, speech-language pathology services.
17:48A-7s: Coverage for treatment of domestic violence injuries by medical service corporation.
17:48A-7t: Coverage for certain dental procedures for the severely disabled or child age five or under by medical service corporation
17:48A-7u: Medical service corporation to provide coverage for biologically-based mental illness.
17:48A-7v: Coverage for hemophilia services by medical services corporation
17:48A-7w: Medical service corporation to provide coverage for treatment of infertility.
17:48A-7x: Medical service corporation to provide coverage for colorectal cancer screening.
17:48A-7y: Medical service corporation prescription drug plans to cover certain infant formulas.
17:48A-7z: Contract issued under C.17:48A-1 et seq. required to cover certain out-of-network services.
17:48A-7aa: Medical service corporation to offer coverage for domestic partner.
17:48A-7bb: Medical service corporation, coverage for prescription female contraceptives.
17:48A-7cc: Medical service corporation to provide benefits for orthotic and prosthetic appliances.
17:48A-7dd: Medical service corporation to provide coverage for hearing aids for certain persons aged 15 or younger.
17:48A-7ee: Individual, group medical service corporation to provide installment payments to obstetrical provider for maternity services.
17:48A-7ff: Medical service corporation to provide benefits for treatment of autism or other developmental disability.
17:48A-7gg: Medical service corporation to provide coverage for oral anticancer medications.
17:48A-7hh: Medical service corporation to provide coverage for sickle cell anemia.
17:48A-7ii: Medical service corporation to provide coverage for prescription eye drops.
17:48A-7.1: Group contracts; issuance; description; benefits; employees defined.
17:48A-7.2: Provisions applicable to group contracts
17:48A-7.3: Group contract form
17:48A-7.4: Participation agreements
17:48A-7.5: Schedule of rates
17:48A-7.6: Combined hospital-medical contract
17:48A-7.7: Review of determinations of commissioner of banking and insurance
17:48A-7.8: Review of practices, rules and procedures of medical service corporations
17:48A-7.9: Adjustment of rates; experience rating formula; approval
17:48A-7.10: Coverage provided by medical service corporation for subscriber's child
17:48A-7.11: Requirements applicable to State Medicaid
17:48A-7.12: Medical service corporation to receive, transmit transactions electronically; standards.
17:48A-7.13: Coverage for certain dependents until age 31 by medical service corporation.
17:48A-8: Participating physicians; payments for medical services
17:48A-9: Filing form of subscription certificate, etc.; disapproval by commissioner
17:48A-9.1: Medical service corporation contract; compliance
17:48A-9.2: Filing of contract or related forms
17:48A-9.3: Contract forms; certification memorandum
17:48A-10: Schedule of rates; filing, disapproval
17:48A-11: Agreements with physicians; approval of payments; corporate records
17:48A-12: Expenditures in soliciting subscribers
17:48A-13: Administrative expenses
17:48A-14: Investments; surplus
17:48A-15: Statement of financial condition; inquiries by commissioner
17:48A-16: Failure to file statement or answer inquiries; penalty
17:48A-17: Examination of assets and affairs; assistants
17:48A-18: Expense of examination; gifts, etc., to departmental employees
17:48A-19: Exhibition of records and accounts; examinations under oath
17:48A-19.2: Increase in amount of capital or surplus required of medical service corporation.
17:48A-19.3: Determination of increase, revision or redetermination; factors.
17:48A-19.4: Suspension, revocation of authority to do business.
17:48A-19.5: Rules, regulations.
17:48A-22: Violations of chapter; penalty and recovery thereof; misdemeanors
17:48A-23: Grants for needy persons
17:48A-24: Corporation as charitable and benevolent institution; tax exemption
17:48A-25: Partial invalidity
17:48A-26: Podiatrist, services performed by.
17:48A-27: Bio-analytical laboratory, services performed by
17:48A-28: Dentists, services performed by
17:48A-28.1: Policies providing for reimbursement of services of dentist; additional applicable provisions
17:48A-28.2: Application of act to contracts with reservation of right to change premium
17:48A-29: Optometrist, services performed by
17:48A-30: Psychologist, services performed by
17:48A-31: Physical therapist, services performed by
17:48A-32: Chiropractors; authorization for payment for diagnostic X-rays; inclusion in act as physician licensed to practice medicine or surgery; liberal constr
17:48A-33: Chiropractors, services performed by
17:48A-34: Nurse-midwives, services performed by
17:48A-35: Services provided by registered professional nurse; benefits