Title 24, Insurance

[§432:1-612] Diabetes coverage. All group health care contracts under this chapter shall provide, to the extent provided under section 431:10A-121, coverage for outpatient diabetes self-management training, education, equipment, and supplies. [L 2000, c 243, §3]

§432:1-613 Orthodontic services for orofacial anomalies; benefits and coverage; notice. (a) Notwithstanding any law to the contrary, each individual and group hospital or medical service plan contract issued or renewed in this State after December 31, 2015, shall provide to the m…

[§432:1-614] Autism benefits and coverage; notice; definitions. (a) Each hospital and medical service plan contract issued or renewed in this State after January 1, 2016, shall provide to the member and individuals under fourteen years of age covered under the plan contract cover…

[§432:1-615] Primary care provider; advanced practice registered nurse. (a) Each policy of insurance delivered or issued for delivery in this State by a mutual benefit society shall recognize advanced practice registered nurses, as defined under section 457-8.5(a), as participati…

§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…

[§432:1-617] Colon cancer screening coverage. (a) All individual and group hospital and medical service contracts providing health care coverage shall provide coverage for colorectal-cancer screening by all A and B grade screening modalities as recommended by the United States Pr…

[§432:1-618] Human immunodeficiency virus and acquired immunodeficiency syndrome screening coverage. (a) Each hospital or medical service plan contract issued or renewed in this State, except for plan contracts that only provide coverage for specified diseases or other limited be…

§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…

[§432:1-621] Medication synchronization; proration; dispensing fees. (a) Each hospital or medical service plan contract that provides prescription drug coverage in the State shall apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy f…

[§432:1-622] Extension of dependent coverage. Each individual or group hospital or medical service plan contract and each mutual benefit society offering individual or group hospital or medical service plan contracts that provide dependent coverage of children shall continue to m…

[§432:1-623] Prohibition of preexisting condition exclusions. (a) No individual or group hospital or medical service plan contract issued or renewed in this State shall impose any preexisting condition exclusion. (b) For purposes of this section, a "preexisting condition exclusio…

[§432:1-624] Prohibited discrimination in premiums or contributions. No individual or group hospital or medical service plan contract and no mutual benefit society offering individual or group hospital or medical service plan contracts issued or renewed in this State shall requir…

[§432:1-625] Reimbursement to providers. (a) Coverage for services required by this part shall include reimbursement to health care providers who perform services required by this article, or to the insured member, as appropriate. (b) Whenever an individual or group policy, contr…

[§432:1-626] Services provided by participating registered pharmacists; coverage. (a) Each individual or group hospital or medical service plan contract delivered or issued for delivery in the State on or after July 1, 2026, shall: (b) For the purposes of this section, "participa…

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…

§432:2-102 Applicability of other laws. (a) Except as herein provided, societies shall be governed by this article and shall be exempt from all other provisions of the insurance laws of this State unless they are expressly designated therein, or unless it is specifically made app…

§432:2-103 Definitions. For the purposes of this article: "Benefit contract" means the agreement for provision of benefits authorized by section 432:2-401, as that agreement is described in section 432:2-404(a). "Benefit member" means an adult member who is designated by the laws…

§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 …

§432:2-104 Fraternal benefit societies. Any incorporated society, order or supreme lodge, without capital stock, including one exempted under the provisions of section 432:2-704(a)(2) whether incorporated or not, conducted solely for the benefit of its members and their beneficia…

§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:

§432:2-302 Amendments to laws. (a) A domestic society may amend its laws in accordance with the provisions thereof by action of its supreme governing body at any regular or special meeting, or, if its laws so provide, by referendum. Such referendum may be held in accordance with …

§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…

§432:2-304 Reinsurance. (a) A domestic society may, by a reinsurance agreement, cede any individual risk or risks in whole or in part to an insurer (other than another fraternal benefit society) having the power to make such reinsurance and authorized to do business in this State…

§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,…

[§432:2-404.5] Genetic information nondiscrimination in health insurance coverage. (a) No fraternal benefit society may: (b) As used in this section: "Family member" means, with respect to the individual, another individual related by blood to that individual. "Genetic informatio…

§432:2-405 Nonforfeiture benefits, cash surrender values, certificate loans and other options. (a) For certificates issued prior to one year after July 1, 1988, the value of every paid-up nonforfeiture benefit and the amount of any cash surrender value, loan or other option grant…

[§432:2-406] Mammogram coverage required; referral not required. (a) A fraternal benefit society shall provide coverage for an annual screening mammogram to the same extent as required under section 431:10A-116; provided that no fraternal benefit society shall require a covered p…

[§432:2-410] Primary care provider; advanced practice registered nurse. (a) Each policy of insurance delivered or issued for delivery in this State by a fraternal benefit society shall recognize advanced practice registered nurses, as defined under section 457-8.5(a), as particip…

PART V. FINANCIAL §432:2-501 Investments. A society shall invest its funds only in such investments as are authorized by the laws of this State for the investment of assets of life insurers and subject to the limitations thereon. Any foreign or alien society permitted or seeking …

§432:2-502 Funds. (a) All assets shall be held, invested and disbursed for the use and benefit of the society. No member or beneficiary shall have or acquire individual rights therein or become entitled to any apportionment on the surrender of any part thereof, except as provided…

§432:2-503 Taxation. Every society organized and operating or licensed under this article shall be, from the time of such organization, exempt from every state, county, and municipal tax, except real property taxes and unemployment compensation taxes; provided that nothing in thi…

PART VI. REGULATION §432:2-601 Valuations. (a) Standards of valuation for certificates issued prior to one year after July 1, 1988, shall be those provided by the laws applicable immediately prior to July 1, 1988. (b) The minimum standards of valuation for certificates issued on …

§432:2-602 Reports. (a) Every society transacting business in this State shall annually, on or before March 1, unless for cause shown such time has been extended by the commissioner, file with the commissioner a true statement of its financial condition, transactions and affairs …