Chapter 432 — Chapter 432

ARTICLE 1 MUTUAL BENEFIT SOCIETIES PART I. GENERAL PROVISIONS §432:1-101 Scope; exemptions. The provisions of this article shall apply to mutual benefit societies as defined herein. Except as expressly provided in this article, mutual benefit societies shall be exempt from the pr…

§432:1-101.5 Disclosure of health care coverage and benefits. In order to ensure that all individuals understand their health care options and are able to make informed decisions, all mutual benefit societies shall provide current and prospective members with written disclosure o…

§432:1-101.6 Policies relating to domestic abuse cases. (a) No mutual benefit society shall deny or refuse to accept an application for insurance, refuse to insure, refuse to renew, cancel, restrict, or otherwise terminate a policy of insurance, or charge a different rate for the…

§432:1-102 Applicability of other laws. (a) Part III of article 10A, and article 10H of chapter 431 shall apply to nonprofit medical indemnity or hospital service associations. Such associations shall be exempt from the provisions of part I of article 10A; provided that such exem…

§432:1-106 REPEALED. L 2009, c 149, §12.

§432:1-108 Fees. (a) The commissioner shall collect, in advance, the following fees: The commissioner may, upon showing of good cause, waive or modify, in whole or part, all fees in this subsection by order. (b) No certificate of authority shall contain an expiration date, but al…

PART II. ORGANIZATION §432:1-201 Incorporation by charter. Any mutual benefit society may be or become incorporated by charter, notwithstanding any limitations under the corporation law as to the purposes for which charters may be granted. Any society so chartered as a corporatio…

§432:1-302 Commissioner refusal to authorize certificate or solicitation; appeal to circuit court. (a) If the commissioner reasonably believes that the financial plan of the society is unsound or not feasible from an actuarial or other accounting standpoint, the commissioner shal…

§432:1-303 Authority to offer death, sick, disability, or other benefits; conditions. (a) Each society promising or offering to pay death, sick, disability, or other benefits in an amount equal to or in excess of $25 may solicit members for the purpose of completing its organizat…

§432:1-304 Authority to offer death, sick, disability, or other benefits; special deposit and control of certain funds. Except as provided in this section and section 432:1-305, all regular payments received for account of death benefit, accident and health or sickness, or other …

§432:1-305 Authority to offer death, sick, disability, or other benefits; restrictions on use of funds. (a) At no time shall the society, except as provided in subsection (c), use more than twenty-five per cent of the payments up to $100,000 and seven per cent of the payments in …

§432:1-307 REPEALED. L 2012, c 251, §15.

PART IV. FINANCIAL AND REPORTING REQUIREMENTS §432:1-401 REPEALED. L 2011, c 81, §12.

§432:1-402 Investments of certain mutual benefit societies. No domestic mutual benefit society promising or offering to pay death, sick, disability, or other benefits in an amount equal to or in excess of $25 shall invest any of its assets other than as authorized and provided fo…

§432:1-403 Nonprofit medical, hospital indemnity associations; tax exemption. Every association or society organized and operating under this article solely as a nonprofit medical indemnity or hospital service association or society or both shall be, from the time of such organiz…

§432:1-404 Annual exhibits. (a) Each society shall file with the commissioner annually, on or before March 1 in each year, a statement under oath, and in such form and detail as the commissioner shall prescribe; provided that any association or society organized and operating as …

§432:1-406 Definitions. As used in this article: "Health care expenditures" means claims incurred. "Managed hospital payment basis" means agreements wherein the financial risk is primarily related to the degree of utilization rather than to the cost of services. "Member" means an…

§432:1-407 Protection against insolvency. (a) Net worth requirements are as follows: (b) Deposit requirements are as follows: (c) Every mutual benefit society, when determining liabilities, shall include an amount estimated in the aggregate to provide for any unearned premium, an…

PART V. EXAMINATION POWERS AND RECEIVERSHIP §432:1-501 Examination by commissioner, assistance of other officers. (a) The powers, authorities, and duties relating to examinations vested in and imposed upon the commissioner under article 2 of the insurance code are extended to and…

§432:1-503 Closing of doors without notice. If, upon the examination of any society, it is found to be insolvent, or if it is deemed necessary by the commissioner for the protection of the interests of its members or the public, the commissioner may at once close the doors of the…

PART VI. REQUIRED PROVISIONS AND BENEFITS §432:1-601 Contract limitations for handicapped children and children with intellectual disabilities. All individual and group hospital or medical service plan contracts, delivered or issued for delivery in this State after May 8, 1968, t…

§432:1-601.5 Coverage for telehealth. (a) [Repeal and reenactment on December 31, 2027. L 2025, c 217, §1.] It is the intent of the legislature to recognize the application of telehealth as a reimbursable service by which an individual shall receive medical services from a health…

§432:1-603 Reimbursement for psychological services. Notwithstanding any provision of any individual or group hospital or medical service plan contract, whenever the contract provides reimbursement or payment for any service which is within the lawful scope of practice of a psych…

§432:1-604 In vitro fertilization procedure coverage. (a) All individual and group hospital or medical service plan contracts which provide pregnancy-related benefits shall include in addition to any other benefits for treating infertility, a one-time only benefit for all outpati…

§432:1-604.5 Contraceptive services. (a) Notwithstanding any provision of law to the contrary, each employer group health policy, contract, plan, or agreement issued or renewed in this State on or after January 1, 2000, shall cease to exclude contraceptive services or supplies, a…

§432:1-605 Mammogram screening. (a) Notwithstanding any provision to the contrary, each policy, contract, plan, or agreement issued on or after February 1, 1991, except for policies that only provide coverage for specified diseases or other limited benefit coverage, but including…

§432:1-607.3 Nondiscrimination on the basis of actual gender identity or perceived gender identity; coverage for services. (a) No individual or group hospital or medical service policy, contract, plan, or agreement that provides health care coverage shall discriminate with respec…

§432:1-608 Hospice care coverage. (a) Any other law to the contrary notwithstanding, commencing on January 1, 2000, all mutual benefit societies issuing or renewing an individual and group hospital or medical service plan, policy, contract, or agreement in this State that provide…

§432:1-609 Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice. (a) All individual and group hospital and medical service plan contracts and medical service corporation contracts under this chapter shall provide coverage for medic…

§432:1-611 REPEALED. L 2019, c 70, §32.

§432:1-616 Cancer treatment. (a) All individual and group hospital and medical service plan contracts that include coverage or benefits for the treatment of cancer shall provide payment or reimbursement for all types of chemotherapy that are considered medically necessary as defi…

§432:1-620 Formulary; accessibility requirements. (a) Each mutual benefit society offering or renewing an individual and group hospital or medical service plan contract on or after January 1, 2017, shall provide the following information via a public website and through a toll-fr…

ARTICLE 2 FRATERNAL BENEFIT SOCIETIES PART I. STRUCTURE AND PURPOSE §432:2-101 Scope of article. This article relates only to fraternal benefit societies, as defined herein, which desire to be authorized to pay benefits in accordance with this article after July 10, 1961. This ar…

§432:2-103.5 Policies relating to domestic abuse cases. (a) No fraternal benefit society shall deny or refuse to accept an application for insurance, refuse to insure, refuse to renew, cancel, restrict, or otherwise terminate a policy of insurance, or charge a different rate for …

§432:2-105 Lodge system. (a) A society is operating on the lodge system if it has a supreme governing body and subordinate lodges into which members are elected, initiated or admitted in accordance with its laws, rules and ritual. Subordinate lodges shall be required by the laws …

§432:2-106 Representative form of government. A society has a representative form of government when:

§432:2-107 Purposes and powers. (a) A society shall operate for the benefit of members and their beneficiaries by: Such purposes may be carried out directly by the society, or indirectly through subsidiary corporations or affiliated organizations. (b) Every society shall have the…

§432:2-108 Fees. (a) The commissioner shall collect, in advance, the following fees: The commissioner may, upon showing of good cause, waive or modify, in whole or part, all fees in this subsection by order. (b) No certificate of authority shall contain an expiration date, but al…

PART II. MEMBERSHIP §432:2-201 Qualifications for membership. (a) A society shall specify in its laws or rules: (b) A society may also admit social members who shall have no voice or vote in the management of its insurance affairs. (c) Membership rights in the society are persona…

§432:2-202 Location of office, meetings, communications to members, grievance procedures. (a) The principal office of any domestic society shall be located in this State. The meetings of its supreme governing body may be held in any state, district, province or territory wherein …

§432:2-203 No personal liability. (a) The officers and members of the supreme governing body or any subordinate body of a society shall not be personally liable for any benefits provided by a society. (b) Any person may be indemnified and reimbursed by any society for expenses re…

§432:2-204 Waiver. The laws of the society may provide that no subordinate body, nor any of its subordinate officers or members shall have the power or authority to waive any of the provisions of the laws of the society. Such provision shall be binding on the society and every me…

PART III. GOVERNANCE §432:2-301 Organization. A domestic society organized on or after July 1, 1988, shall be formed as follows:

§432:2-303 Institutions. A society may create, maintain and operate, or may establish organizations to operate, not-for-profit institutions to further the purposes permitted by section 432:2-107(a)(2). Such institutions may furnish services free or at a reasonable charge. Any rea…

§432:2-305 Consolidations and mergers. (a) A domestic society may consolidate or merge with any other society by complying with the provisions of this section. It shall file with the commissioner: (b) If the commissioner finds that the contract is in conformity with the provision…

§432:2-306 Conversion of fraternal benefit society into mutual life insurance company. Any domestic fraternal benefit society may be converted and licensed as a mutual life insurance company by compliance with all the requirements of chapter 431 pertaining to mutual life insurers…

PART IV. CONTRACTUAL BENEFITS §432:2-401 Benefits. (a) A society may provide the following contractual benefits in any form: (b) A society shall specify in its rules those persons who may be issued, or covered by, the contractual benefits in subsection (a), consistent with provid…

§432:2-402 Beneficiaries. (a) The owner of a benefit contract shall have the right at all times to change the beneficiary or beneficiaries in accordance with the laws or rules of the society, unless the owner waives this right by specifically requesting in writing that the benefi…

§432:2-403 Benefits not attachable. No money or other benefit, charity, relief or aid to be paid, provided or rendered by a society, shall be liable to attachment, garnishment or other process, or to be seized, taken, appropriated or applied by any legal or equitable process or o…

§432:2-404 The benefit contract. (a) Every society authorized to do business in this State shall issue to each owner of a benefit contract a certificate specifying the amount of benefits provided thereby. The certificate, together with any riders or endorsements attached thereto,…