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South Carolina Code of Laws
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Accident And Health Insurance
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Section
38-71-10
Coverages which may be written by licensed accident and health insurers.
Section
38-71-20
Insurers may act as administering agency for government-sponsored health, hospital, and medical service programs.
Section
38-71-30
Whole contract, including application, must appear in policy; oral applications.
Section
38-71-40
Effect of false statement in application.
Section
38-71-46
Diabetes Mellitus coverage in health insurance policies; diabetes education.
Section
38-71-50
Alteration of application.
Section
38-71-60
Certain acts do not constitute a waiver by insurer.
Section
38-71-70
Certain policies may conform to laws of other states.
Section
38-71-80
Construction of policy issued in violation of chapter.
Section
38-71-90
Penalty for violation of chapter.
Section
38-71-100
Policies exempt from chapter.
Section
38-71-110
Notice of failure of employer to remit deducted premium required before forfeiture.
Section
38-71-125
Mastectomies; hospitalization requirements; early release provisions.
Section
38-71-130
Breast reconstruction and prosthetic devices; coverage following mastectomy surgery.
Section
38-71-135
Minimum postpartum hospitalization and attendant services for mothers and newborns.
Section
38-71-140
Coverage of newborn children.
Section
38-71-143
Health plans must provide same coverage for children placed for adoption.
Section
38-71-145
Required coverage for mammograms, pap smears, and prostate cancer examinations; limitations.
Section
38-71-147
Freedom of selection and participation in individual or group accident and health or health insurance policy or health maintenance organization plan.
Section
38-71-150
Required provision in policies as to examination and surrender of policy for return of premium.
Section
38-71-160
When policy sold on direct response basis considered to be returned.
Section
38-71-170
Required provision in policies for conversion privileges for former spouses.
Section
38-71-190
Subrogation of insurer to insured's rights against third party.
Section
38-71-200
Discrimination forbidden; benefits for services of podiatrist, oral surgeon, or optometrist.
Section
38-71-210
Health insurance policies to include chiropractic services.
Section
38-71-215
Dermatology referrals.
Section
38-71-220
Misrepresentations to induce termination or conversion of disability insurance policies.
Section
38-71-230
Written notice of health insurance claim policies and procedures; adoption of standardized claim forms; addition of logo to form.
Section
38-71-238
Abortion coverage prohibitions; exceptions.
Section
38-71-240
Coverage required for cleft lip and palate; certain policies exempt.
Section
38-71-241
Percentage copayment and deductible must be applied to negotiated rate or lesser charge of that provider.
Section
38-71-242
Specified disease insurance policies; payment of claims and benefits.
Section
38-71-243
Continuation of care; definitions; applicability; requirements.
Section
38-71-245
Prohibited grounds for denial of enrollment to child of health plan participant.
Section
38-71-246
Continuation of care; provider contract requirements.
Section
38-71-247
Continuation of care; plain language description requirement.
Section
38-71-250
Duties of insurer as to court-ordered health care coverage for child of eligible parent.
Section
38-71-255
Health insurer may not impose different requirements on state agency.
Section
38-71-260
Duties of health insurer of child to custodial parent.
Section
38-71-265
Health insurer not to consider State medical assistance; subrogation of state to right to insurance payment for health care.
Section
38-71-275
Insurance coverage for certain drugs not to be excluded from policy definitions.
Section
38-71-280
Autism spectrum disorder; coverage; eligibility for benefits.
Section
38-71-290
Mental health coverage; definitions; treatment requirements; exceptions
Section
38-71-310
Filing of forms and rates; approval or disapproval; withdrawal of approval; exceptions; loss ratio guarantee.
Section
38-71-315
Decrease of premium charges.
Section
38-71-320
Policies issued for delivery in another state.
Section
38-71-325
Requirements for approval of new individual major medical expense coverage policies.
Section
38-71-330
Form of policies.
Section
38-71-335
Accident and/or health insurance cancellation provision prohibited; optionally renewable policies prohibited; notice of nonrenewal.
Section
38-71-340
Required provisions.
Section
38-71-350
Required provision for continuation of coverage for handicapped and dependent children of policyholder.
Section
38-71-355
Dependent child; medically necessary leave of absence.
Section
38-71-360
Continuation of coverage for nonhandicapped dependent children.
Section
38-71-370
Optional provisions.
Section
38-71-380
Medical expense policy; optional intoxicants and narcotics exclusion inapplicable.
Section
38-71-410
Omission or modification of required or optional provisions.
Section
38-71-420
Placement of required and optional provisions in policy.
Section
38-71-430
Additional provisions may not make policy less favorable.
Section
38-71-440
HMO's and health benefit plans offering medical eye care or vision care benefits; prohibited actions.
Section
38-71-510
Declaration of purpose.
Section
38-71-520
Definitions.
Section
38-71-530
Regulations establishing specific standards that set forth manner, content, and required disclosure for sale of individual policies.
Section
38-71-540
Regulations establishing minimum standards for benefits.
Section
38-71-550
Outline of coverage required.
Section
38-71-560
Effect of use of simplified application form.
Section
38-71-610
Notice of premiums due required.
Section
38-71-620
Advance notice required for increase in premium.
Section
38-71-630
Acceptance of premium for period beyond expiration date of policy.
Section
38-71-640
Person with insurable interest may take out policy on insured.
Section
38-71-650
Right to transfer to policy of equal or lesser benefits with same insurer.
Section
38-71-670
Definitions.
Section
38-71-675
Renewal or continuance of coverage at option of insurer; conditions for nonrenewal or discontinuance; modification of coverage.
Section
38-71-680
Application of Section 38-71-850(D).
Section
38-71-710
Definitions.
Section
38-71-720
Approval of forms required; refusal or withdrawal of approval; optional life insurance riders.
Section
38-71-730
Requirements for group accident, group health, and group accident and health policies.
Section
38-71-735
Required provisions.
Section
38-71-737
Requirement of coverage for psychiatric conditions in group health insurance policies; "psychiatric conditions" defined.
Section
38-71-740
Restrictions on mass-marketed insurance.
Section
38-71-750
Requirements of group policies extended to group policies issued outside State to residents; approval required for mass-marketed policies and certificates.
Section
38-71-760
Standards for group accident and health insurance coverage, discontinuance, and replacement.
Section
38-71-770
Mandatory continuation privileges.
Section
38-71-780
Required provision for continuation of coverage for handicapped and dependent children.
Section
38-71-785
Dependent child; medically necessary leave of absence.
Section
38-71-790
Payment of benefits.
Section
38-71-800
Hospital and medical expenses.
Section
38-71-810
Readjustment of rates or refunds or dividends.
Section
38-71-840
Definitions.
Section
38-71-850
Preexisting condition exclusion; limitations; creditable coverage; certification; enrollment for coverage.
Section
38-71-860
Health status-related factors in relation to individual enrollees and their dependents; restrictions on eligibility rules and premium charges.
Section
38-71-870
Coverage in small or large group market in connection with group health plan; nonrenewal or discontinuance; restrictions; modification of coverage; plan sponsor.
Section
38-71-880
Medical and surgical benefits and mental health or substance use disorder benefits; aggregate lifetime limits.
Section
38-71-910
Legislative intent.
Section
38-71-920
Definitions.
Section
38-71-930
Application of this subarticle.
Section
38-71-940
Premium rates for health insurance plans; rating factors; involuntary business class transfer prohibited.
Section
38-71-960
Required disclosure in solicitation and sales materials; proprietary or trade secret information.
Section
38-71-970
Insurer rating and renewal records; filing of certification; confidentiality.
Section
38-71-980
Suspension of premium rate restrictions upon request of certain insurers.
Section
38-71-990
Effective date of this subarticle.
Section
38-71-1010
"Blanket accident and health insurance" defined.
Section
38-71-1020
Requirements as to policies.
Section
38-71-1030
Individual applications and certificates not required.
Section
38-71-1040
Payment of benefits.
Section
38-71-1050
Legal liability of policyholders not affected.
Section
38-71-1110
"Franchise accident and health insurance" defined.
Section
38-71-1310
Short title.
Section
38-71-1320
Purpose and intent.
Section
38-71-1330
Definitions.
Section
38-71-1340
Application of article; group size for health group cooperative.
Section
38-71-1345
Formation of health group cooperative; requirements; registration; organization as nonprofit corporation.
Section
38-71-1350
Premium rates; requirements.
Section
38-71-1355
Health group cooperative; powers and duties.
Section
38-71-1360
Insurers required to offer all plans actively marketed to small employers; availability to all eligible employees; network plans; denial of coverage.
Section
38-71-1365
Small employer insurer requirements; compliance with federal laws applicable to cooperatives.
Section
38-71-1370
Applicability of certain code sections; late enrollees.
Section
38-71-1380
Notification of intent to operate; certain reinsuring insurers not permitted to continue to reinsure health insurance plan.
Section
38-71-1390
Application to become risk-assuming insurer; approval or denial; factors to consider.
Section
38-71-1400
Election to become reinsuring insurer.
Section
38-71-1410
South Carolina Small Employer Insurer Reinsurance Program.
Section
38-71-1420
Advisory committee.
Section
38-71-1430
Annual public report.
Section
38-71-1440
Requirements upon small employer insurers.
Section
38-71-1445
Report on effectiveness of health group cooperatives.
Section
38-71-1450
Promulgation of regulations.
Section
38-71-1510
Short title.
Section
38-71-1520
Definitions.
Section
38-71-1530
Screening; initial intervention; role of managed care organization; payments to providers.
Section
38-71-1540
Practice of discouraging use of 911 telephone system prohibited.
Section
38-71-1545
Exclusion of certain insurance policies.
Section
38-71-1550
Severability.
Section
38-71-1710
Short title.
Section
38-71-1720
Definitions.
Section
38-71-1730
Employers offering closed panel health plans; employee options and payments; use of provider who has discontinued participation in plan; exclusion of certain providers; services of pharmacists and advanced practice nurses; effect of this article on other plans and coverages.
Section
38-71-1740
Responsibility for errors and omissions by parties to managed care participating provider agreements; limitations on network providers to discuss treatments, risks and legal obligations with an insured or member prohibited; permissible limitations.
Section
38-71-1750
Disclosures required of network plans.
Section
38-71-1760
Promulgation of regulations.
Section
38-71-1810
Pharmacy audit rights.
Section
38-71-1820
Appeals process; dismissal; copy of audit findings.
Section
38-71-1830
Recoupment.
Section
38-71-1840
Exemptions.
Section
38-71-1910
Short title.
Section
38-71-1920
Definitions.
Section
38-71-1930
Application of this article.
Section
38-71-1940
Notice of right to request a review; notice of adverse determination.
Section
38-71-1950
Requests for external review.
Section
38-71-1960
Exhaustion of internal appeal process.
Section
38-71-1970
Requests for external review.
Section
38-71-1980
Expedited external review.
Section
38-71-1990
External review decisions final; exceptions.
Section
38-71-2000
Approval of independent review organizations.
Section
38-71-2010
Standards for approval of independent review organizations.
Section
38-71-2020
Liability of independent review organizations and personnel.
Section
38-71-2030
External review; written records; reports.
Section
38-71-2040
Health carrier to pay for external review.
Section
38-71-2050
Health carrier to inform covered persons of rights related to external review.
Section
38-71-2060
Regulations.
Section
38-71-2110
Definitions; application of article.
Section
38-71-2120
Placement of drug on maximum allowable cost list.
Section
38-71-2130
Duties of pharmacy benefit manager.
Section
38-71-2140
Process for appeals.
Section
38-71-2150
Prohibited acts.
Section
38-71-2200
Definitions.
Section
38-71-2210
License requirement for pharmacy benefits managers.
Section
38-71-2220
No restrictions or penalties against pharmacy for disclosing certain information.
Section
38-71-2230
Pharmacy benefits manager prohibited from taking certain actions.
Section
38-71-2240
Placement of drug on Maximum Allowable Cost List.
Section
38-71-2250
Enforcement of article; penalties.
Section
38-71-2260
Construction and application.