58-33-108. Due diligence investigation required of preferred provider organization before contracting with offeror or provider of health benefit plan.
A preferred provider organization, prior to entering into any contract with a person offering or providing a health benefit plan in this state, shall carry out appropriate due diligence to establish that the health benefit plan is not unauthorized health insurance, including those measures reasonably appropriate to establish:
(1)Through initial inquiry, contract provisions, and measures to monitor and enforce compliance with the contract provisions, that for any insurance coverage that is represented as issued relating to the health benefit plan:
(a)The insurer issued the policy;
(b)The coverage is as represented;
(c)The insurer is an admitted insurer in this state; and
(d)The policy has been filed with and approved by the division or is exempt from filing requirements;
(2)For any health benefit plan that is represented as established or maintained pursuant to a collective bargaining agreement, the health benefit plan is established or maintained under or pursuant to a collective bargaining agreement under the criteria provided under 29 CFR 2510.3-40 as of January 1, 2007;
(3)For any health benefit plan that is represented as established or maintained by an employee leasing arrangement or professional employer organization, the health benefit plan is fully insured; or
(4)For any health benefit plan that is represented as established by a single employer, the health benefit plan is covering solely employees, and dependents of employees, of the employer and the employer controls and directs the work of the employee.
Source: SL 2007, ch 292, §16.