Title 58, INSURANCE

A utilization review organization or health carrier shall conduct an annual review and submit the findings in a report to the Division of Insurance, at the time and in the manner directed by the division. The report must contain the following information for the previous calendar…

A utilization review organization or health carrier shall annually review each health care service for which a health benefit plan requires prior authorization and shall eliminate the prior authorization requirement for any health care service if prior authorization requests are …

A utilization review organization or health carrier shall submit an annual report to the Division of Insurance, at the time and in the manner requested by the division, regarding the review required in accordance with § 58-17H-58 . The report must set forth: (1) The number of pri…

Coverage of in-network emergency services are subject to applicable copayments, coinsurance, and deductibles. Source: SL 2011, ch 219 , § 31. Commission Note: SL 2012, ch 239, § 1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Pa…

For purposes of §§ 58-17H-57 to 58-17H-59 , inclusive, “health care services” do not include dental services, pharmaceutical services, or the provision of prescription drug products or supplies. Source: SL 2026, ch 201 , § 4.

Cost-sharing requirements for out-of-network emergency services expressed as a copayment amount or coinsurance rate imposed with respect to a covered person cannot exceed the cost-sharing requirement imposed with respect to a covered person if the services were provided in-networ…

Notwithstanding § 58-17H-7 , a covered person may be required to pay, in addition to the in-network cost-sharing, the excess of the amount the out-of-network provider charges over the amount the health carrier is required to pay pursuant to this section. A health carrier complies…

For capitated or other health benefit plans that do not have a negotiated per-service amount for in-network providers, subdivision 58-17H-8 (1) does not apply. Source: SL 2011, ch 219 , § 34. Commission Note: SL 2012, ch 239, § 1 provides: "The provisions of chapter 219 of the 20…