Title 58, INSURANCE

Each form for a policy of health insurance, including riders and endorsements, shall be identified by a form number in the lower left - hand corner of the first page thereof. Source: SL 1966, ch 111 , ch 25, § 2 (6).

Nothing in §§ 58-17-1 to 58-17-47 , inclusive, shall apply to or affect life insurance, endowment, or annuity contracts, or contracts supplemental thereto which contain only such provisions relating to health insurance as: (1) Provide additional benefits in case of dismemberment …

Nothing in §§ 58-17-1 to 58-17-47 , inclusive, shall apply to or affect reinsurance. Source: SL 1966, ch 111 , ch 25, § 1 (4).

The provisions of §§ 58-17-1 to 58-17-51 , inclusive, shall not apply to any contracts or policies entered into or issued prior to February 8, 1966, nor to any extensions, renewals, or modifications thereof or amendments thereto whenever made. Source: SL 1966, ch 111 , ch 25, § 2…

If an insurer provides by contract, policy, certificate, or any other means whatever, for a service, or for the partial or total reimbursement, payment, or cost of a service to or on behalf of any of its policyholders, group policyholders, subscribers, or group subscribers, or an…

Notwithstanding any provision of any policy of insurance subject to the general provisions of this title, if a policy or contract provides for reimbursement for any service which may be legally performed by a person licensed in this state for the practice of medicine, surgery, an…

No health insurer may impose any copayment or coinsurance amount on an insured for services rendered by a doctor of chiropractic licensed pursuant to chapter 36-5 , an occupational therapist licensed pursuant to chapter 36-31 , or a physical therapist licensed pursuant to chapter…

Notwithstanding any provision of any policy of insurance subject to the general provisions of this title, whenever such policy or contract provides for reimbursement for any service which may be legally performed by a hospital licensed in this state which has an organized medical…

Notwithstanding any provision of any policy of insurance subject to the general provisions of this title, whenever such policy or contract provides for reimbursement for any service rendered by or directly supervised by a qualified mental health professional as defined in § 27A-1…

A person who provides health care commits abuse of health insurance, if, as a regular business practice, he knowingly accepts from any third - party payor, as payment in full for services rendered, the amount the third - party payor covers, or submits a fee to a third - party pay…

However, a person may waive any required deductible or co - payment for charitable purposes if: (1) The person who provides the health care determines that the services are necessary for the immediate health and welfare of the insured; (2) The waiver is made on a case - by - case…

Any person who provides health care and who waives the deductible or co - payment for more than one - fourth of his patients during any calendar year, excluding waivers under § 58-17-58 , or who advertises that he will accept from any third - party payor, as payment in full for s…

The style, arrangement, and overall appearance of a policy of health insurance shall give no undue prominence to any portion of the text, and every printed portion of the text of the policy and of any endorsements or attached papers shall be plainly printed in light - faced type …

Payments made pursuant to federal medicare laws or payments made to the health - care provider according to a contract or agreement between an employer and employee which requires a third - party payor to pay the full amount for health - care services are exempt from §§ 58-17-57 …

Any person insured by a health insurance company, health maintenance organization, preferred provider organization, individual practice association, or nonprofit hospital service corporation may assign in writing benefits from such policy, contract, or certificate to a hospital l…

Every policy of health insurance that is delivered, issued for delivery or renewed in this state, except for policies that provide coverage for specified disease or other limited benefit coverage, shall offer coverage for testing, diagnosis, and treatment of phenylketonuria inclu…

For the purposes of §§ 58-17-64 , 58-18-63 , 58-38-36 , and 58-40-33 , a health benefit plan is any hospital or medical policy or certificate, hospital or medical service plan, or health maintenance organization subscriber contract. The term does not include specified disease, ho…

Premium rates for individual health benefit plans shall produce a minimum lifetime loss ratio of not less than sixty - five percent. The director may promulgate rules pursuant to chapter 1-26 which modify the minimum loss ratio required based on the specific design of the product…

If a managed care plan or utilization review organization is used in conjunction with an individual health insurance plan, the managed care plan or utilization review organization shall establish a written utilization review program, registering a utilization review organization,…

Terms used in §§ 58-17-66 to 58-17-87, inclusive, mean: (1) "Actuarial certification," any written statement by a member of the American Academy of Actuaries or other person approved by the director that a carrier is in compliance with the provisions of §§ 58-17-66 to 58-17-87 , …

For purposes of §§ 58-17-66 to 58-17-87 , inclusive, the term, professional association, means any association that meets all of the following criteria: (1) Serves a single profession that requires a significant amount of education, training, or experience or a license or certifi…

For purposes of §§ 58-17-66 to 58-17-87 , inclusive, the term, professional association plan, means a health benefit plan offered through a professional association that covers members of a professional association and their dependents, and not others, in this state regardless of…

For purposes of §§ 58-17-66 to 58-17-87 , inclusive, the term, creditable coverage, means benefits or coverage provided under: (1) An employer - based health insurance or health benefit arrangement that provides benefits similar to or exceeding benefits provided under the basic h…

A policy of health insurance shall contain no provision purporting to make any portion of the charter, rules, Constitution, or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of, or referen…

Sections 58-17-66 to 58-17-87 , inclusive, apply to any individual health benefit plan or certificate delivered or issued for delivery in the state. Sections 58-17-66 to 58-17-87 , inclusive, apply to any certificate issued to an eligible person that evidences coverage under a po…

A carrier may establish a separate class of individual business only to reflect substantial differences in expected claims experience or administrative costs related to the following reasons: (1) The carrier used more than one type of system for the marketing and sale of health b…

The director may provide for a period of transition in order for a carrier to come into compliance with § 58-17-71 in the instance of acquisition of an additional class of business from another carrier. Source: SL 1996, ch 286 , § 7.

The director may approve the establishment of additional classes of business upon application to the director and a finding by the director that such action would enhance the efficiency and fairness of the individual marketplace. Nothing in §§ 58-17-66 to 58-17-87 , inclusive, re…

Premium rates for individual health benefit plans subject to §§ 58-17-66 to 58-17-87 , inclusive, are subject to the following provisions: (1) Any new policy issued after the effective date of §§ 58-17-66 to 58-17-87 , inclusive, is subject to the provisions of §§ 58-17-66 to 58-…

Any health benefit plan issued before July 1, 1996, is subject to the rating limitations provided in this section. For a class of business, the premium rates charged during a rating period to individuals with similar case characteristics for the same or similar coverage, or the r…

The director shall promulgate rules pursuant to chapter 1-26 to ensure that rating practices used by carriers are consistent with the purposes of §§ 58-17-66 to 58-17-87 , inclusive, including rules that ensure that differences in rates charged for individual health benefit plans…

No carrier may transfer a person involuntarily into or out of a class of business. No carrier may offer to transfer a person into or out of a class of business unless such an offer is made to transfer all persons in the class of business without regard to claim experience or dura…

The director may suspend for a specified period the application of subdivision 58-17-74(2) as to the premium rates for one or more rating periods upon a filing by the carrier and a finding by the director either that the suspension is reasonable in light of the financial conditio…

In connection with the offering for sale of any individual health benefit plan to a person, a carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of: (1) The extent to which premium rates for a specified person are established or adjusted …

Each carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly ac…

The exceptions and reductions of indemnity shall be set forth in a policy of health insurance and, other than those contained in §§ 58-17-14 to 58-17-39 , inclusive, shall be printed, at the insurer's option, either included with the benefit provision to which they apply, or unde…

A carrier shall make the information and documentation described in § 58-17-79 available to the director upon request. Except in cases of violations of §§ 58-17-66 to 58-17-87 , inclusive, the information is proprietary and trade secret information and may not be disclosed by the…

An individual health benefit plan subject to §§ 58-17-66 to 58-17-87 , inclusive, is renewable with respect to any person or dependent at the option of the person and may not be terminated by the insurer at any time, except as provided in § 58-17-15 or in any of the following cas…

No carrier that elects not to renew an individual health benefit plan under subdivision 58-17-82(4) may write new business in the individual health benefit plan market in the state for a period of five years from the date of notice to the director. Source: SL 1996, ch 286 , § 18.

Any health carrier providing individual coverage, other than excepted benefits, shall comply with the following provisions: (1) No individual coverage may deny, exclude, or limit benefits for a covered individual for claims incurred more than twelve months following the effective…

Any health benefit plan as defined by § 58-17-63 shall cover anesthesia and hospital charges for dental care provided to a covered person who: (1) Is a child under age five; or (2) Is severely disabled or otherwise suffers from a developmental disability as determined by a licens…

The director shall promulgate rules pursuant to chapter 1-26 to cover: (1) Terms or renewability; (2) Conditions of eligibility; (3) Benefit limitations, exceptions, and reductions; (4) Definition of terms; (5) Filing requirements for forms, rates, and rate schedules; (6) Marketi…

If a health insurance policy that is issued or renewed on or after July 1, 1996, provides maternity coverage, the policy shall provide coverage for a minimum of forty - eight hours of inpatient care following a vaginal delivery and a minimum of ninety - six hours of inpatient car…

Source: SL 1996, ch 292 , § 1; SL 1998, ch 290 , § 1. 58-17-89 . Shorter hospital stay permitted--Follow - up visit within forty - eight hours required. If the treating physician determines that the mother and the newborn meet medical criteria contained in Guidelines for Perinata…

In any case where a policy of health insurance is subject to renewal at the option of the insurer there shall be prominently printed both on the cover page and on the first page of such policy a statement so informing the policyholder. Source: SL 1966, ch 111 , ch 25, § 2 (9).

The health insurer shall provide notice to policyholders regarding the coverage required by §§ 58-17-88 and 58-17-89 in accordance with rules adopted by the director of the Division of Insurance pursuant to chapter 1-26 . The notice shall be in writing and prominently positioned …