Title 24, Insurance

§431S-3 Registration required. (a) Notwithstanding any law to the contrary, no person shall act or operate as a pharmacy benefit manager without first obtaining a valid registration issued by the commissioner pursuant to this chapter. (b) Each person seeking to register as a phar…

§431S-4 Annual renewal requirement. (a) Each pharmacy benefit manager shall renew its registration by March 31 each year. (b) When renewing its registration, a pharmacy benefit manager shall submit to the commissioner the following: (1) An application for renewal on a form prescr…

[§431S-5] Penalty. Any person who acts as a pharmacy benefit manager in this State without first being registered pursuant to this chapter shall be subject to a fine of $500 for each violation. [L 2017, c 44, pt of §2]

[§431S-6] Rules. The commissioner shall adopt, amend, or repeal rules pursuant to chapter 91 to carry out the purposes of this chapter. [L 2017, c 44, pt of §2]

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…

§432:1-103 Applicability of this article to existing societies and union mutual benefit societies. (a) None of the provisions of this article shall apply to, or in any way be held to affect, mutual benefit and fraternal societies which have been in existence and functioning withi…

§432:1-104 Definitions. For the purposes of this article: "Commissioner" means the insurance commissioner of the State. "Mutual benefit society" means any corporation, unincorporated association, society, or entity: (1) Organized and carried on for the primary benefit of its memb…

[§432:1-104.5] Bona fide trade associations. (a) At the option of a bona fide trade association, or its designated agent, a mutual benefit society that operates a health plan and sells health insurance to the bona fide trade association shall treat the bona fide trade association…

§432:1-105 Penalty. There shall be a fine of not more than $1,000 or imprisonment of not more than one year, or both, for: (1) Any person who is found in the State as officer, member, principal, agent, or in any other capacity, soliciting or conducting or operating the business o…

[§432:1‑107] Federal law compliance. A mutual benefit society shall comply with applicable federal law. The commissioner shall enforce the consumer protections and market reforms relating to insurance as set forth in the federal Patient Protection and Affordable Care Act, Public …

[§432:1-107.5] Prohibition on rescissions of coverage. (a) Notwithstanding sections 431:10-226.5 and 431:10A-106 to the contrary, a society shall not rescind coverage under a health benefit plan with respect to an individual, including a group to which the individual belongs or f…

§432:1-108 Fees. (a) The commissioner shall collect, in advance, the following fees: (1) Certificate of authority: (A) Application for a certificate of authority: $900; and (B) Issuance of certificate of authority: $600; (2) Organization of domestic mutual benefit societies: (A) …

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…

§432:1-202 Constitution and bylaws; officers; government of society. (a) Mutual benefit societies promising or offering to pay death, sick, disability, or other benefits in an amount equal to or in excess of $25 shall, subject to the approval of the commissioner, have the power t…

§432:1-203 Actions or proceedings. (a) An action or special proceeding may be maintained, by the president or treasurer of the society, to recover any property, or upon any cause of action, for or upon which all the associates may maintain an action or special proceeding, by reas…

§432:1-204 Foreign societies. Any foreign society subject to this article shall not be excused or relieved from compliance with this article by reason of the nonresidence of its members. Upon a showing to the satisfaction of the commissioner that it is impracticable and would wor…

PART III. AUTHORITY TO OFFER BENEFITS §432:1-301 Registration with commissioner: certificate of registration and certificate of authority. (a) Before doing business or engaging in any act, any mutual benefit society as defined in section 432:1-104 shall file with the commissioner…

§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 …

§432:1-306 Authority to offer death, sick, disability, or other benefits; deposit or bond. (a) The society shall deposit with the commissioner fifty per cent of the minimum net worth requirement provided in section 432:1-407(a)(2), either in cash or in securities approved by the …

[§432:1-308] Suspension, revocation, or denial of certificate of authority. (a) Any certificate of authority issued under this chapter may be suspended or revoked and any application for a certificate of authority may be denied if the commissioner finds that any of the conditions…

§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 …

§432:1-405 Annual audit. (a) Annually on or before June 1, or such later date as the commissioner upon request or for cause may specify, each domestic mutual benefit society shall file an audit by a designated independent certified public accountant or accounting firm of the fina…

§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: (1) Before issuing a certificate of authority pursuant to section 432:1-301, the commissioner shall require that the mutual benefit society has an initial net worth of $2,000,000 and the society …

[§432:1-408] Uncovered expenditures insolvency deposit. (a) If, at any time, uncovered expenditures exceeds ten per cent of total health care expenditures, a mutual benefit society shall place with the commissioner or with any organization or trustee acceptable to the commissione…

[§432:1-409] Rehabilitation, liquidation, or conservation of mutual benefit societies. (a) Any rehabilitation, liquidation, or conservation of a mutual benefit society shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be cond…

[§432:1-410] Reserve credit for reinsurance. Any society that takes credit for reserves on risks ceded to a reinsurer shall be subject to provisions of chapter 431 related to credit for reinsurance. [L 2000, c 74, §1]

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…

§432:1-502 Summary orders and supervision. (a) Whenever the commissioner determines that the financial condition of any mutual benefit society is such that its continued operation might be hazardous to its members, creditors, or the general public, or that it has violated any pro…

§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…

§432:1-602 Newborn children coverage. (a) All individual and group hospital and medical service corporation contracts which provide coverage for a family member of the subscriber shall, as to such family member's coverage, also provide that the benefits applicable for children sh…

§432:1-602.5 Coverage for child health supervision services. (a) All individual and group hospital and medical service corporation contracts which provide coverage for the children of the subscriber shall provide coverage for child health supervision services from the moment of b…

[§432:1-602.6] Newborn adoptee; coverage. (a) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides coverage for the children of the insured, that coverage shall also extend to the date of birth of any newborn child to be adopted …

§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…