Title 20, Insurance

All policies issued, delivered or renewed on or after July 1, 2017 by a disability insurer in this state must provide coverage for lawful health care services that are provided by a health care provider to an insured regardless of the familial relationship of the health care prov…

A. A disability insurer that issues, amends, delivers or renews a policy on or after January 1, 2023 shall provide coverage for biomarker testing. B. A policy shall cover biomarker testing for the purposes of diagnosis, treatment, appropriate management or ongoing monitoring of a…

A. A policy of disability insurance delivered or issued for delivery in this state shall provide for the right of covered family members to continue coverage on the death of the named insured, the entry of a decree of dissolution of marriage of the named insured and any other con…

A. Except as specifically provided in sections 20-1379 and 20-1380, with respect to the determination of whether a person is an eligible individual, an insurer issuing disability insurance contracts shall not consider the availability of or a person's eligibility for medical assi…

A. Every health care insurer that offers individual health insurance coverage in the individual market in this state shall provide guaranteed availability of coverage to an eligible individual who desires to enroll in individual health insurance coverage and shall not: 1. Decline…

A. Except as provided in this section, on request of the insured individual, a health care insurer that provides individual health coverage to the individual shall renew or continue that coverage. B. A health care insurer may nonrenew or discontinue the health insurance coverage …

A. A health care insurer may apply to the director to suspend its obligation to issue coverage to eligible individuals pursuant to section 20-1379 for a specified period if all of the following conditions are met: 1. The health care insurer can demonstrate to the director that it…

A. On or before March 1 of each year, each health care insurer shall submit to the director a written report that contains the following information: 1. The number of eligible individuals covered by policies that were written by that health care insurer in the individual market d…

A. A disability insurer may issue a policy to an uninsured individual that is not subject to the requirements of any of the following: 1. Section 20-461, subsection A, paragraph 17 and subsection B. 2. Section 20-1342, subsection A, paragraphs 11 and 12. 3. Section 20-1342, subse…

A. All policies or certificates issued, delivered or renewed in this state for short-term limited duration insurance shall display on the policy's fact page and in any application materials provided in connection with enrollment in such coverage the following federal disclosure i…

A. Group disability insurance is that form of disability insurance covering groups of persons as defined below, with or without one or more members of their families or one or more of their dependents, or covering one or more members of the families or one or more dependents of p…

A. No person or insurer may deliver or issue for delivery to an employer in this state a certificate of insurance or other evidence of coverage of a group disability policy issued outside this state unless the certificate or other evidence of coverage contains the following notic…

A. Each group disability policy shall contain in substance the following provisions: 1. A provision that, in the absence of fraud, all statements made by the policyholder or by any insured person shall be deemed representations and not warranties, and that no statement made for t…

A. A group disability insurer is not obligated to pay any costs, other than covered patient costs, that are directly associated with a cancer clinical trial that is offered in this state and in which the insured participates voluntarily. A cancer clinical trial is a course of tre…

A. Any group disability policy that is offered by a group disability insurer and that contains a prescription drug benefit shall cover amino acid-based formula that is ordered by a physician or a registered nurse practitioner if: 1. The insured has been diagnosed with an eosinoph…

A. A group disability insurer shall not: 1. Exclude or deny coverage for a treatment or impose dollar limits, deductibles and coinsurance provisions based solely on the diagnosis of autism spectrum disorder. For the purposes of this paragraph, "treatment" includes diagnosis, asse…

A. A contract, entered into or renewed on or after January 1, 2011, between a group disability insurer and a dentist who is licensed to practice in this state shall not require the dentist to provide services to an individual covered under a group disability policy based on a fee…

A. Except as provided in subsection C of this section, a contract, entered into or renewed on or after January 1, 2022, between a group disability insurer and an optometrist who is licensed to practice in this state shall not: 1. Require the optometrist to provide a service to an…

Any group disability policy may provide that all or any portion of any indemnities provided by any such policy on account of hospital, nursing, medical or surgical services may, at the insurer's option, be paid directly to the hospital or person rendering such services, but the p…

A. Blanket disability insurance is that form of disability insurance covering special groups of persons as enumerated in one of the following paragraphs: 1. Under a policy or contract issued to any common carrier or to any operator, owner or lessee of a means of transportation, w…

A. A blanket disability insurer is not obligated to pay any costs, other than patient costs, that are directly associated with a cancer clinical trial that is offered in this state and in which the insured participates voluntarily. A cancer clinical trial is a course of treatment…

A. Any policy or contract that is offered by a blanket disability insurer and that contains a prescription drug benefit shall cover amino acid-based formula that is ordered by a physician or a registered nurse practitioner if: 1. The insured has been diagnosed with an eosinophili…

A. A blanket disability insurer shall not: 1. Exclude or deny coverage for a treatment or impose dollar limits, deductibles and coinsurance provisions based solely on the diagnosis of autism spectrum disorder. For the purposes of this paragraph, "treatment" includes diagnosis, as…

A. A contract, entered into or renewed on or after January 1, 2011, between a blanket disability insurer and a dentist who is licensed to practice in this state shall not require the dentist to provide services to an individual covered under a blanket disability policy based on a…

A. Except as provided in subsection C of this section, a contract, entered into or renewed on or after January 1, 2022, between a blanket disability insurer and an optometrist who is licensed to practice in this state shall not: 1. Require the optometrist to provide a service to …

A. A group or blanket disability insurance policy may limit coverage to an insured for a human organ transplant or posttransplant care if either of the following applies: 1. The transplant operation is performed in the People's Republic of China or the Hong Kong special administr…

The provisions of article 4 of chapter 6 of this title shall not apply to group disability or blanket disability insurance policies, but no such policy of group or blanket disability insurance shall contain any provision relative to notice or proof of loss, or to the time for pay…

A. Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract, benefits shall not be denied under the contract for any medical or surgical service performed by a holder of a license issued pursuant to title 32, chapter 7 or 1…

If a group disability insurance contract or blanket disability insurance contract provides for or offers reimbursement for any service which is within the lawful scope of the practice of a chiropractor holding a certificate or license issued by the state in which the services are…

If a group disability insurance contract or blanket disability insurance contract provides for or offers reimbursement for any service which is within the lawful scope of the practice of a psychologist holding a certificate or license issued by the state in which the services are…

If a group disability or blanket disability insurance contract provides or offers reimbursement for any service which is within the scope of the practice of a registered nurse practitioner or a certified registered nurse qualified under the rules adopted by the state board of nur…

If a group disability or blanket disability insurance contract provides coverage for occupational or physical therapy services, and provides both an in-network and out-of-network benefit, an insurer shall not deny a claim for covered occupational or physical therapy services obta…

A. All policies issued, delivered or renewed by a group disability insurer or a blanket disability insurer in this state must provide coverage for health care services that are provided through telehealth if the health care service would be covered were it provided through an in-…

A. A group or blanket disability policy that is issued, delivered or renewed by a group or blanket disability insurer on or after January 1, 2016 and that provides coverage both for cancer treatment medications that are injected or intravenously administered by a health care prov…

A. A group or blanket disability insurance contract that is issued or renewed on or after January 1, 2017 and that provides coverage for prescription drugs: 1. May not deny coverage and shall prorate the cost sharing rate for a prescription drug covered by the contract that is di…

A. Beginning January 1, 2018, any policy that is issued, delivered or renewed by a group or blanket disability insurer and that provides coverage for prescription eyedrops to treat glaucoma or ocular hypertension may not deny coverage for a refill of a prescription for eyedrops t…

All policies issued, delivered or renewed on or after July 1, 2017 by a group or blanket disability insurer in this state must provide coverage for lawful health care services that are provided by a health care provider to an insured regardless of the familial relationship of the…

A. A group or blanket disability insurer that issues, amends, delivers or renews a policy on or after January 1, 2023 shall provide coverage for biomarker testing. B. A policy shall cover biomarker testing for the purposes of diagnosis, treatment, appropriate management or ongoin…

A group hospital or medical expense insurance policy delivered or issued for delivery in this state more than one hundred twenty days after August 27, 1977 that provides that coverage of a dependent child of an employee or other member of the covered group shall terminate on atta…

A. Each group disability insurance policy delivered or issued for delivery in this state shall provide for the right of all persons covered under the group contract to convert to an individual disability policy on the death of the named insured, the entry of a decree of dissoluti…

A. With respect to insureds who are members of a group with more than one carrier, if there is an insolvency of an insurer, all other carriers that participated in an open enrollment with the insolvent insurer at a group's last regular open enrollment period shall offer insureds …

From and after September 30, 1990, no medical benefits contract on a group basis delivered or issued for delivery in this state, whether issued by an insurance company, a hospital service corporation, a medical service corporation or a health care services organization, may requi…

A. An insurer issuing group disability or blanket disability insurance contracts shall not consider the availability of or a person's eligibility for medical assistance pursuant to title XIX of the social security act (P.L. 89-97; 79 Stat. 344; 42 United States Code section 1396a…

A. Except as provided in sections 20-1379 and 20-2304, a group disability insurer or a blanket disability insurer may offer one or more disability insurance policies or contracts that contain a choice of deductibles, coinsurance, copayments, out-of-pocket and any other cost shari…

In this article, unless the context otherwise requires: 1. "Certificate holder" means the individual named insured group member under a group excess liability insurance policy. 2. "Certificate of insurance" means the certificate of insurance, evidence of coverage or other summary…

A. An authorized insurer or an unauthorized insurer as provided in chapter 2, article 5 of this title may offer group excess liability insurance in this state. An authorized insurer that issues a group excess liability insurance policy in this state shall file the group policy an…