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CHAPTER 58-17

HEALTH INSURANCE POLICIES

58-17-1    Requirements for all health insurance policies delivered in state.

58-17-1.1    Grandfathered plans required to cover low-dose mammography--Extent of coverage.

58-17-1.2    Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations.

58-17-1.3    Diabetes coverage not required of certain plans and policies.

58-17-1.4    Policies required to cover occult breast cancer screening.

58-17-2    Persons covered by policy.

58-17-2.1    Health insurance on a franchise plan.

58-17-2.2    Conversion privileges of insured's spouse upon divorce.

58-17-2.3    Dependent coverage termination--Age--Full-time students.

58-17-3    Time of commencement and termination to be set out in policy.

58-17-4    Consideration for policy to be stated.

58-17-4.1    Filing and approval of individual policy premium rates.

58-17-4.2    Premium rates required to be reasonable--Rules to establish minimum standards promulgated by director.

58-17-4.3    58-17-4.3. Transferred to § 58-17-74.1 by SL 2005, ch 10, § 41.

58-17-5    Identification of forms, riders and endorsements--Form number, location.

58-17-6    Style and arrangement of policy provisions--Printing, size of type.

58-17-7    Documents forming part of policy--Setting forth in full, rates and classifications excepted.

58-17-8    Exceptions and reductions of coverage to be clearly set out.

58-17-9    Renewal of policy at option of insurer--Statement in policy so informing the policyholder.

58-17-10    58-17-10. Repealed by SL 2006, ch 259, § 32.

58-17-10.1    Reduction of benefits because of increase in statutory disability benefits prohibited.

58-17-10.2    Individual policy for insured's spouse required in policies covering spouse--Eligibility--Coverage--Waiting periods.

58-17-11    Return of policy by purchaser--Refund of premium paid--Dissatisfaction with terms after examination.

58-17-11.1    Issuance of policies by insurance company, nonprofit hospital service plan, medical service corporation, or fraternal benefit society--Delivery receipts--Certificates of mailing--Term of retention.

58-17-12    Required provisions--Captions--Substitutes, approval by director.

58-17-13    Omission from policy of inapplicable provision--Approval of director--Modification of inconsistent provision.

58-17-14    Entire contract and change clauses required--Signed acceptance required for endorsements.

58-17-15    Time limit on certain defenses--Application of section.

58-17-16    58-17-16. Repealed by SL 2011, ch 216, § 5.

58-17-17    Grace period on premiums required in policy.

58-17-18    Renewal of policy--Restriction on company's right to refuse.

58-17-19    Reinstatement when premium not paid within grace period.

58-17-20    Omission of provision as to application of premiums accepted in connection with reinstatement--Right of insured to continue policy in force by payment of premiums.

58-17-21    Notice of claim--Provision required in policy.

58-17-22    Notice of claim--Loss of time benefit--Optional provision, insertion by insurer.

58-17-23    Claim forms--Furnishing by insurer.

58-17-24    Proofs of loss--Provision required in policy.

58-17-25    Time of payment of claims--Provision required in policy.

58-17-26    Payment of claims--Persons to whom benefits payable--Provision required in policy.

58-17-27    Payment of claims--Optional provisions, insertion by insurer.

58-17-28    Physical examination of insured--Autopsy in death claims--Provision required in policy.

58-17-29    Action to recover under policy--Time for beginning.

58-17-30    Beneficiary--Changes reserved to insured.

58-17-30.1    Continuation of coverage for child with intellectual or physical disability--Proof of dependency.

58-17-30.2    Family coverage to include newborn or newly adopted children--Payment of claim not to be withheld during bonding period of adopted child.

58-17-30.3    Premature birth and congenital defects covered--Applicability.

58-17-30.4    Notice of birth or adoption required for continued coverage.

58-17-30.5    Coverage for inpatient alcoholism treatment required.

58-17-30.6    Alcoholism benefits provided--Days of care.

58-17-30.7    Policies excluded from alcoholism coverage requirements.

58-17-30.8    Exclusion of benefits for injury while under the influence of alcohol or drugs prohibited--Exception for sickness or injury caused in commission of felony.

58-17-30.9    Notice that dependent is no longer eligible for coverage--Premium adjustment.

58-17-31    Optional policy provisions.

58-17-32    Occupational change--Policy provision for adjustment of premium or benefits.

58-17-33    Misstatement of age--Policy provision for adjustment of benefits.

58-17-34    Earnings of insured--Policy provision for adjustment of benefits.

58-17-35    Earnings adjustment clause to be coupled with insured's right to continue policy in force.

58-17-36    Option of insurer to define "valid loss of time coverage".

58-17-37    Unpaid premiums--Deduction from benefits.

58-17-38    Conformity with state statutes of insured.

58-17-39    Illegal occupation of insured.

58-17-40    Renewal of policy at option of insurer.

58-17-41    Order of policy provisions.

58-17-42    Age limit in policy--Effect of acceptance of premiums or misstatement of age.

58-17-43    Third parties taking policy covering insured.

58-17-44    Foreign or alien insurer--Policy provision required by home state.

58-17-45    Policy of domestic insurer delivered in other state--Compliance with laws of other state.

58-17-46    Policy provisions not subject to chapter--Conforming to statute required.

58-17-47    Nonconforming and conflicting provisions construed in conformity with statute.

58-17-48    Liability and workers' compensation insurance--Inapplicability of health insurance provisions.

58-17-49    Health insurance provisions inapplicable to group or blanket policy.

58-17-50    Life insurance, endowment or annuity contracts not subject to health insurance provisions.

58-17-51    Health insurance provisions inapplicable to reinsurance.

58-17-52    Prior contracts or policies excepted.

58-17-53    Optometric services--Reimbursement, exceptions.

58-17-54    Reimbursement provisions applicable to all healing arts licensees--Self-insurance plans for public employees--Restrictions on policy limitations.

58-17-54.1    Copayment or coinsurance amounts for chiropractic, physical therapy, or occupational therapy services.

58-17-55    Reimbursement provisions applicable to licensed hospitals.

58-17-56    Reimbursement for service rendered or supervised by qualified mental health professional.

58-17-57    "Abuse of health insurance" defined--Violation as misdemeanor.

58-17-58    Waiver of required deductible or co-payment for charitable purposes permitted.

58-17-59    When waiver presumed.

58-17-60    Certain payments exempt.

58-17-61    Assignment of health insurance proceeds to certain hospitals authorized.

58-17-62    Coverage for phenylketonuria.

58-17-63    "Health benefit plan" defined.

58-17-64    Minimum loss ratio for individual health benefit plans.

58-17-65    Individual health insurance plan used in conjunction with managed care plan or utilization review organization.

58-17-66    Definitions for 58-17-66 through 58-17-87.

58-17-67    "Professional association" defined.

58-17-68    "Professional association plan" defined.

58-17-69    "Creditable coverage" defined.

58-17-70    Application of 58-17-66 to 58-17-87, inclusive.

58-17-71    Separate classes of individual business--Reasons--Number.

58-17-72    Transitional period when additional class of business acquired.

58-17-73    Director approval required to establish additional classes of business--Rates or rating methodologies.

58-17-74    Provisions for premium rates for individual health benefit plans.

58-17-74.1    Premium rate limitations.

58-17-75    Promulgation of rules for rates charged for individual health benefit plans.

58-17-76    Transfer into or out of class of business.

58-17-77    Temporary suspension of premium rates for individual health insurance--Reasons.

58-17-78    Required disclosure when offering individual health benefit plan.

58-17-79    Documentation of rating methods and practices.

58-17-80    58-17-80. Repealed by SL 2009, ch 262, § 1.

58-17-81    Availability of information on rating methods and practices of carriers offering individual health benefit plans.

58-17-82    Renewal of individual health benefit plans--Exceptions.

58-17-83    Election not to renew individual health benefit plan--Future business restricted.

58-17-84    Provisions for carriers providing individual coverage other than excepted benefits.

58-17-84.1    (Text of section effective until the first plan year, policy year, or renewal date on or after January 1, 2019) Anesthesia and hospitalization for dental care to be provided certain covered persons.

58-17-85    58-17-85, 58-17-85.1. Repealed by SL 2015, ch 249, §§ 2, 3.

58-17-86    58-17-86. Repealed by SL 2003 (SS) ch 1, § 33

58-17-87    Director to promulgate rules for individual health insurance--Scope of rules.

58-17-88    Minimum inpatient care coverage following delivery.

58-17-89    Shorter hospital stay permitted--Follow-up visit within forty-eight hours required.

58-17-90    Notice to policyholders--Disclosures.

58-17-91    58-17-91 to 58-17-96. Repealed by SL 2000, ch 243, §§ 16 to 21

58-17-97    Provisions covering preexisting conditions.

58-17-98    Health insurance policies to provide coverage for biologically-based mental illnesses.

58-17-99    Application of § 58-17-98--Exemptions.

58-17-100    Definitions.

58-17-101    Insurer may not exclude certain off-label uses of prescription drugs.

58-17-102    Exceptions.

58-17-103    Provisions limited to cancer or life threatening diseases.

58-17-104    Deductibles, copayments, and managed care review not affected.

58-17-105    Drugs used in research trials not covered.

58-17-106    No reduction or limitation of coverage otherwise required by law.

58-17-107    Health insurance policies to provide coverage for prostate cancer screening.

58-17-108    "Disability income insurance" defined.

58-17-109    Exclusion or reduction of benefits.

58-17-110    Commencement of loss.

58-17-111    Minimum standards--Exceptions.

58-17-112    Promulgation of rules regarding disability income policies--Content.

58-17-113    58-17-113, 58-17-114. Repealed by SL 2015, ch 249, § 36, eff. Jan. 1, 2017.

58-17-115    58-17-115. Repealed by SL 2015, ch 249, § 5.

58-17-116    58-17-116. Repealed by SL 2015, ch 249, § 36, eff. Jan. 1, 2017.

58-17-117    58-17-117, 58-17-118. Repealed by SL 2015, ch 249, §§ 6, 7.

58-17-119    58-17-119 to 58-17-124. Repealed by SL 2015, ch 249, § 36, eff. Jan. 1, 2017.

58-17-125    58-17-125. Repealed by SL 2015, ch 249, § 10.

58-17-126    58-17-126. Repealed by SL 2015, ch 249, § 36, eff. Jan. 1, 2017.

58-17-127    58-17-127 to 58-17-137. Repealed by SL 2015, ch 249, §§ 12 to 22.

58-17-138    58-17-138. Repealed by SL 2015, ch 249, § 36, eff. Jan. 1, 2017.

58-17-139    58-17-139 to 58-17-141. Repealed by SL 2015, ch 249, §§ 24 to 26.

58-17-142    Maximum premium rates for plans issued prior to August 1, 2003--Rate provisions of § 58-17-75 to apply upon carrier's discontinuance of active marketing.

58-17-143    58-17-143. Repealed by SL 2015, ch 249, § 36, eff. Jan. 1, 2017.

58-17-144    58-17-144, 58-17-145. Repealed by SL 2015, ch 249, §§ 28, 29.

58-17-145.1    Deadline for submission of health claim under risk pool.

58-17-146    Dental insurers prohibited from setting fees for noncovered service.

58-17-147    Elective abortion coverage prohibited in qualified health plan offered through health insurance exchange.

58-17-148    Qualified health plan sold through exchange to provide for placement through licensed insurance producer--Commissions.

58-17-149    Definitions regarding retrospective payment of clean claims for covered services provided during credentialing period.

58-17-150    Retrospective payment of clean claims for covered services provided by health care professional during credentialing period--Requirements.

58-17-151    Applications to be credentialed.

58-17-152    Application of §§ 58-17-149 to 58-17-151.

58-17-153    Coverage for treatment of hearing impairment for persons under age nineteen.

58-17-154    Definitions for §§ 58-17-155 to 58-17-162.

58-17-155    Exceptions to application of §§ 58-17-154 to 58-17-162.

58-17-156    Policies, contracts, certificates, and plans subject to §§ 58-17-154 to 58-17-162.

58-17-157    Coverage for applied behavior analysis for treatment of autism spectrum disorders.

58-17-158    Authorization, prior approval, and other care management requirements--Annual maximum benefit.

58-17-159    Qualifications of person performing or supervising applied behavior analysis.

58-17-160    Review of treatment.

58-17-161    Services under individualized service plan, family service plan, or education program.

58-17-162    Effective date of §§ 58-17-154 to 58-17-161.

58-17-163    Dental care insurers to honor assignment of benefits.

58-17-164    Revocation of assignment of dental insurance benefits.

58-17-165    Reimbursement of payment from insured following receipt of payment from insurer.

58-17-166    Scope of benefits not affected--Medical benefits not included .

58-17-167    Definitions pertaining to telehealth coverage.

58-17-168    Coverage for health care services provided through telehealth.

58-17-169    Discrimination between coverage for services provided in person and through telehealth prohibited.

58-17-170    Application of telehealth coverage requirements.


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