Title 58 — INSURANCE

A step therapy override exception shall be approved by a health carrier, health benefit plan, or utilization review organization if any of the following circumstances apply: (1) The prescription drug required under the step therapy protocol is contraindicated pursuant to the drug…

Nothing in §§ 58-17H-53 to 55-17H-56 shall be construed to prevent: (1) A health carrier, health benefit plan, or utilization review organization from requiring a covered person to try a prescription drug with the same generic name and demonstrated bioavailability or biological p…

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Commission Note: SL 2012, ch 239, § 1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Pa…

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…