Title 26.1 — Insurance
118 chapters · 1,472 sections in this title.
N.D.C.C. § 26.1-36-01 Scope
0.9K chars
No section of this chapter applies to or affects any policy of workforce safety and insurance or any policy of liability insurance with or without supplementary expense coverage therein; or any policy or contract of reinsurance; or any blanket or group insurance policy, except wh…
N.D.C.C. § 26.1-36-01.1 Scope - Accident and health insurance policy mandates
0.3K chars
Unless expressly provided otherwise, an accident and health insurance policy health coverage mandate under this chapter does not apply to an accident and health insurance policy that is a high-deductible health plan under 26 U.S.C. 223 if the mandate would cause the policy to fai…
N.D.C.C. § 26.1-36-01.2 Examinations
0.9K chars
1. As used in this section, the terms "health carrier" and "health benefit plan" have the same meaning as provided under section 26.1-36.3-01. 2. Whenever the commissioner, in the commissioner's sole discretion, deems it appropriate, but at least once every five years, the commis…
N.D.C.C. § 26.1-36-02 Accident and health insurance policy defined
0.6K chars
"Accident and health insurance policy" includes any contract policy insuring against loss resulting from sickness or bodily injury, or death by accident, or both. 26.1-36-02.1. Accident and health policies and certificates - Notice of free examination. Accident and health policie…
N.D.C.C. § 26.1-36-02.2 Individual health plans - Open enrollment periods - Rules
2.5K chars
1. As used in this section: a. "Adverse selection" occurs when an individual who experiences greater than average health risks seeks to purchase an individual health plan. b. "Annual open enrollment period" means a period each year during which an individual may enroll or change …
N.D.C.C. § 26.1-36-03 Form of policy
2.8K chars
1. No accident and health insurance policy may be delivered or issued for delivery to any person in this state unless: a. The entire money and other considerations for the policy are expressed in the policy. b. The time at which the insurance takes effect and terminates is expres…
N.D.C.C. § 26.1-36-03.1 Information disclosure
4.9K chars
An insurance company, as defined in section 26.1-02-01, a health maintenance organization, or any other entity providing a plan of health insurance subject to state insurance regulation may not deliver, issue, execute, or renew a health insurance policy or health service contract…
N.D.C.C. § 26.1-36-04 Accident and health policy provisions
20.2K chars
1. Except as provided in subsection 3, each accident and health insurance policy delivered or issued for delivery to any person in this state must contain provisions described in this section. The provisions contained in any policy may not be less favorable in any respect to the …
N.D.C.C. § 26.1-36-05 Group health policy or service contract standard provisions
10.1K chars
Neither a group health insurance policy nor a group health service contract may be delivered in this state unless it contains in substance the following provisions, or provisions that in the opinion of the commissioner are more favorable to the persons insured and more favorable …
N.D.C.C. § 26.1-36-06.1 Coverage for off-label uses of drugs
10.1K chars
1. In this section: a. "Coverage of a drug" includes medically necessary services associated with the administration of the drug. b. "Medical literature" means scientific studies published in a peer review national medical journal. c. "Off-label use of drugs" means prescribing dr…
N.D.C.C. § 26.1-36-09 Group health policy and health service contract mental disorder coverage
9.1K chars
1. An insurance company, nonprofit health service corporation, or health maintenance organization may not deliver, issue, execute, or renew any health insurance policy or health service contract on a group or blanket or franchise or association basis unless the policy or contract…
N.D.C.C. § 26.1-36-09.11 Breast reconstruction surgery
0.6K chars
An insurance company, nonprofit health service corporation, or health maintenance organization may not deliver, issue, execute, or renew any health insurance policy, health service contract, or evidence of coverage on an individual, group, blanket, or franchise basis unless the p…
N.D.C.C. § 26.1-36-09.12 Medical services related to suicide
0.7K chars
An insurance company, nonprofit health service corporation, or health maintenance organization may not deliver, issue, execute, or renew any hospital, surgical, medical, or major medical benefit policy on an individual, group, blanket, franchise, or association basis unless the p…
N.D.C.C. § 26.1-36-09.13 Medical services related to intoxication
0.8K chars
An insurance company, nonprofit health service corporation, or health maintenance organization may not deliver, issue, execute, or renew any major medical expense policy on a group, individual, blanket, franchise, or association basis unless the policy, contract, or evidence of c…
N.D.C.C. § 26.1-36-09.14 Coverage of cancer treatment medications
1.5K chars
1. As used in this section: a. "Cancer treatment medications" means prescription drugs and biologics that are used to kill, slow, or prevent the growth of cancerous cells. b. "Insurer" means an insurance company, nonprofit health service corporation, or health maintenance organiz…
N.D.C.C. § 26.1-36-09.15 Coverage of telehealth services
8.7K chars
1. As used in this section: a. "Distant site" means a site at which a health care provider or health care facility is located while providing medical services by means of telehealth. b. "E-visit" means a face-to-face digital communication initiated by a patient to a provider thro…
N.D.C.C. § 26.1-36-09.17 Out-of-pocket expenses - Prescription drugs
5.5K chars
1. As used in this section: a. "Cost-sharing" means any coinsurance, copayment, or deductible under a health benefit plan. b. "Enrollee" means an individual entitled to prescription drug coverage under a health benefit plan. c. "Health benefit plan" has the same meaning as provid…
N.D.C.C. § 26.1-36-09.3 Coverage for treatment of certain disorders
1.0K chars
Except for policies that only provide coverage for specified diseases, no policy or certificate of health, medical, hospitalization, or accident and sickness insurance regulated under this chapter, or a subscriber contract provided by a nonprofit health service corporation, prefe…
N.D.C.C. § 26.1-36-09.4 Preventive health care - Copayments
1.6K chars
Repealed by S.L. 2013, ch. 236, § 6. 26.1-36-09.5. Service of advanced registered nurse practitioner - Direct reimbursement required. The insured or any person covered by a health insurance policy, health service contract, or evidence of coverage on an individual, group, blanket,…
N.D.C.C. § 26.1-36-09.7 Foods and food products for inherited metabolic diseases
5.3K chars
1. As used in this section: a. "Inherited metabolic disease" means maple syrup urine disease or phenylketonuria. b. "Low-protein modified food product" means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be used u…
N.D.C.C. § 26.1-36-09.9 Dental anesthesia and hospitalization coverage
2.7K chars
An insurance company, nonprofit health service corporation, or health maintenance organization may not deliver, issue, execute, or renew any health insurance policy, health service contract, or evidence of coverage on an individual, group, blanket, franchise, or association basis…
N.D.C.C. § 26.1-36-12.2 Freedom of choice for pharmacy services
1.8K chars
1. No third-party payer, including a health care insurer as defined in section 26.1-47-01, providing pharmacy services and prescription drugs to any beneficiary may: a. Prevent a beneficiary from selecting the pharmacy or pharmacist of the beneficiary's choice to provide pharmace…
N.D.C.C. § 26.1-36-12.3 Basic health insurance coverage - Exception to required coverages
0.0K chars
Expired under S.L. 1991, ch. 319, § 3.
N.D.C.C. § 26.1-36-12.4 Confidentiality of medical information
3.7K chars
1. An insurance company, as defined in section 26.1-02-01, health maintenance organization, or any other entity providing a plan of health insurance subject to state insurance regulation may not deliver, issue, execute, or renew a health insurance policy or health service contrac…
N.D.C.C. § 26.1-36-12.5 Basic health insurance coverage - Exceptions to required coverage
1.2K chars
1. An insurance company, a nonprofit health service corporation, or a health maintenance organization may deliver, issue, execute, and renew a basic health insurance policy, health service contract, or evidence of coverage on an individual basis or an employer group, blanket, fra…
N.D.C.C. § 26.1-36-12.6 Ambulance services classifications
0.2K chars
For purposes of classifying ambulance services for an accident and health insurance policy, the classifications established under section 50-24.1-16 apply.
N.D.C.C. § 26.1-36-12.7 Freedom of choice for health care services
1.0K chars
1. As used in this section: a. "Health benefit plan" has the same meaning as provided in section 26.1-36.3-01. b. "Health care provider" includes an individual licensed under chapter 43-05, 43-06, 43-12.1 as a registered nurse or as an advanced practice registered nurse, 43-13, 4…
N.D.C.C. § 26.1-36-13 Applicability of accident and health policy simplification standards
2.0K chars
1. Except as provided in subsection 3, sections 26.1-36-13 through 26.1-36-16 apply to all individual and group accident and health insurance contracts, policies, plans, or agreements, insurance certificates under group accident and health insurance policies, and disability benef…
N.D.C.C. § 26.1-36-14 Minimum accident and health policy language simplification standards
4.5K chars
1. No policy form may be delivered or issued for delivery in this state unless: a. The text achieves a minimum score of forty on the Flesch reading ease test or an equivalent score on any other comparable test as provided in subsection 3. b. It is printed, except for specificatio…
N.D.C.C. § 26.1-36-15 Approval of accident and health policy forms
0.6K chars
A policy form meeting the requirements of subsection 1 of section 26.1-36-14 must be approved notwithstanding any other law which specifies the contents of a policy, if the policy form provides the policyholders and claimants protection not less favorable than they would be entit…
N.D.C.C. § 26.1-36-17 Application for accident and health policy
1.5K chars
1. The insured is not bound by any statement made in an application for an accident and health insurance policy unless a copy of the application is attached to or endorsed on the policy. If any policy delivered or issued for delivery to any person in this state is to be reinstate…
N.D.C.C. § 26.1-36-18 Notice under accident and health policy - Waiver
0.3K chars
The acknowledgment by any insurer of the receipt of notice given under an accident or health insurance policy, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim does not operate as a waiver of any of the righ…
N.D.C.C. § 26.1-36-19 Age limit in accident and health policy
0.9K chars
If an accident and health insurance policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if the date falls within a period for which premium is accepted by the insurer or if the i…
N.D.C.C. § 26.1-36-20 Juvenile's accident and health coverage to continue - Conditions
0.7K chars
Insurance companies and nonprofit health service corporations licensed in this state shall continue coverage of a juvenile insured under an accident and health insurance policy or a health service contract while the legal custody of the juvenile has been given by a court, under c…
N.D.C.C. § 26.1-36-21 Prisoner's accident and health coverage to continue - Conditions
0.6K chars
Insurance companies and nonprofit health service corporations licensed in this state shall continue coverage of a prisoner insured under an accident and health insurance policy or a health service contract while the prisoner is incarcerated and under state supervision to the same…
N.D.C.C. § 26.1-36-22 Individual and group health insurance for dependents
12.6K chars
An individual or group health insurance policy may be extended to insure the individuals, employees, or members with respect to their family members or dependents, including dependents of dependents, or any class or classes thereof, subject to the following: 1. The premium for th…
N.D.C.C. § 26.1-36-24 Health policy transferable
1.2K chars
A health insurance policy may pass by transfer, will, or succession to any person, whether that person has an insurable interest or not, and that person may recover any benefit payable under the policy in accordance with the terms of the policy, but in no event shall such transfe…
N.D.C.C. § 26.1-36-25 Notice of transfer of health policy unnecessary - Exception
3.8K chars
Notice to an insurer of a transfer or bequest of a health insurance policy is not necessary to preserve the validity of the policy unless notice is required by the policy. 26.1-36-26. Dual choice option on group health coverage - Minimum conditions - Transfer of coverage. If an e…
N.D.C.C. § 26.1-36-28 Measure of indemnity in health policy
3.4K chars
Unless the interest of a person insured is susceptible of exact pecuniary measurement, the measure of indemnity under a health insurance policy is the sum fixed in the policy. 26.1-36-29. Coordination of benefits in individual and group accident and health policies - Limitations.…
N.D.C.C. § 26.1-36-31 Medicare supplement policies - Definitions
0.0K chars
Repealed by S.L. 1991, ch. 304, § 14.
N.D.C.C. § 26.1-36-32 Standards for Medicare supplement policies
0.0K chars
Repealed by S.L. 1991, ch. 304, § 14.
N.D.C.C. § 26.1-36-33 Medicare supplement policy benefit standards
0.0K chars
Repealed by S.L. 1991, ch. 304, § 14.
N.D.C.C. § 26.1-36-34 Medicare supplement policy loss ratio standards
0.0K chars
Repealed by S.L. 1991, ch. 304, § 14.
N.D.C.C. § 26.1-36-35 Medicare supplement policy disclosure standards
0.0K chars
Repealed by S.L. 1991, ch. 304, § 14.
N.D.C.C. § 26.1-36-36 Medicare supplement policies - Notice of free examination
0.0K chars
Repealed by S.L. 1991, ch. 304, § 14.
N.D.C.C. § 26.1-36-36.1 Filing requirements for advertising
0.0K chars
Repealed by S.L. 1991, ch. 304, § 14.
N.D.C.C. § 26.1-36-36.2 Noncustodial care coverage
1.6K chars
An insurer offering convalescent nursing home, extended care facility, or skilled nursing facility coverage under chapter 26.1-36.1 or 26.1-45 shall cover intermediate care confinements in the same manner as skilled care confinements. 26.1-36-37. Nursing home policy - Guaranteed …
N.D.C.C. § 26.1-36-37.2 Loss ratios - Rules
1.0K chars
For all policies providing hospital, surgical, medical, or major medical benefit, an insurance company, a nonprofit health service corporation, a fraternal benefit society, and any other entity providing a plan of health insurance or health benefit subject to state insurance regu…
N.D.C.C. § 26.1-36-38 Rulemaking authority
0.1K chars
The commissioner may adopt reasonable rules necessary, proper, or advisable to administer this chapter.
N.D.C.C. § 26.1-36-39 Effect of policy not conforming to chapter
0.4K chars
A policy delivered or issued for delivery to any person in this state in violation of this chapter is valid but must be construed as provided in this chapter. When any provision in a policy subject to this chapter is in conflict with this chapter, the rights, duties, and obligati…