A. For purposes of this section:
1. "Covered person" means a policyholder, subscriber, enrollee, member or individual covered by a health benefit plan;
2. "Health benefit plan" means a policy, contract, certificate, or agreement entered into, offered or issued by a health carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services. Health benefit plan shall not include a plan providing coverage for excepted benefits and short term policies that have a term of less than twelve (12) months; and
3. "Health carrier" means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the Insurance Commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services including through a health benefit plan as defined in this section, and shall include a sickness and accident insurance company, a health maintenance organization, a preferred provider organization or any similar entity, or any other entity providing a plan of health insurance or health benefits.
B. A health carrier that provides coverage for anatomical gifts, organ transplants or related treatment and services shall not:
1. Deny coverage to a covered person solely on the basis of the person's disability;
2. Deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the health benefit plan, solely for the purpose of avoiding the requirements of this section;
3. Penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide monetary or nonmonetary incentives to an attending provider, to induce such provider to provide care to an insured or enrollee in a manner inconsistent with this section; or
4. Reduce or limit coverage benefits to a patient for the medical services or other services related to organ transplantation performed pursuant to this section as determined in consultation with the attending physician and patient.
C. In the case of a health benefit plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers, any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement imposed pursuant to this section shall not be treated as a termination of the collective bargaining agreement.
D. Nothing in this section shall be construed to require a health carrier to provide coverage for a medically inappropriate organ transplant.
E. The Insurance Commissioner shall promulgate rules to implement the provisions of this section.
Added by Laws 2021, c. 87, § 5, eff. Nov. 1, 2021.