Health insurance plans - Certification or contract with

certified private review agent - Exceptions. Every health insurance plan which proposes to administer a health benefits program that provides for the coverage of hospital and/or medical benefits and the utilization review of those benefits shall: 1. Be certified in accordance with the Hospital and Medical Services Utilization Review Act; or 2. Contract with a private review agent who is certified in accordance with the Hospital and Medical Services Utilization Review Act. The provisions of this section shall not apply to insurance companies and not-for-profit hospital services and medical indemnity plans, licensed by the Commissioner to transact insurance in this state, that perform in-house utilization review. Added by Laws 1991, c. 294, § 6, eff. Nov. 1, 1991.