Note
Article heading amended by L 2002, c 155, §48.
State innovation waiver task force; health care reform plan; reports to 2015-2017 legislature (dissolved June 30, 2017). L 2014, c 158; L 2015, c 184.
Cross References
Conformance to federal law, see §431:2-201.5.
Federally qualified health centers; rural health clinics; reimbursement, see §346-53.6.
Health maintenance organization act, see chapter 432D.
Medicaid-related mandates, see chapter 431L.
Mental health and alcohol and drug abuse treatment insurance benefits, see chapter 431M.
Patients' bill of rights and responsibilities act, see chapter 432E.
Prescription drug benefits, see chapter 431R.
Prescription drugs; mail order opt out option, see §87A-16.3.
Proposed mandatory health insurance coverage and assessment report, see §§23-51, 52.
State health insurance program, see chapter 431N.
Attorney General Opinions
Section 431:10A-601 applied to all parts of article 10A if the category of policy under consideration included family coverage, as defined in §431:10A-103. Att. Gen. Op. 97-10.
The placement of §431:10A-601 in this article, regulating content of insurance contracts, makes clear that the legislative intent was to mandate benefits that must be made available by insurers that write contracts of insurance providing family coverage. Att. Gen. Op. 97-10.
Law Journals and Reviews
Tax Justice and Same-Sex Domestic Partner Health Benefits: An Analysis of the Tax Equity For Health Plan Beneficiaries Act. 32 UH L. Rev. 73 (2009).
Case Notes
As chapter 432D does not cover the field of managed care regulation and because §§432D-2, 432E-1, and this article can be read together and there is no explicit language or policy reason not to give each statute effect, chapter 432D does not repeal chapter 432E by implication. 126 H. 326, 271 P.3d 621 (2012).
Properly licensed HMOs, like plaintiff, were authorized pursuant to §432D-1 to "provide or arrange", at their option, for the closed panel health care services required under the managed care plan program; accident and health insurers were authorized under §431:10A-205(b) to arrange for medical services for members using a defined network of providers, i.e., particular "hospitals or persons"; thus, this article and chapter 432D authorized both accident and health insurers and HMOs, as risk-bearing entities, to provide the closed panel product required by the managed care plan contracts. 126 H. 326, 271 P.3d 621 (2012).
PART I. INDIVIDUAL ACCIDENT AND HEALTH
OR SICKNESS POLICIES
Note
Part heading amended by L 2002, c 155, §48.
Attorney General Opinions
Section 431:10A-601 applied to all parts of article 10A if the category of policy under consideration included family coverage, as defined in §431:10A-103. Att. Gen. Op. 97-10.
Case Notes
Under this article and §431:10A-105(2)(A)(ii), standard "incontestability clause" of contract precluded insurer from denying insured "total disability benefit" contracted for, notwithstanding that HIV infection that caused the disability arguably "manifested" itself prior to policy's effective date of coverage. 86 H. 262, 948 P.2d 1103.
§431:10A-116.5 In vitro fertilization procedure coverage. (a) All individual and group accident and health or sickness insurance policies which provide pregnancy-related benefits shall include in addition to any other benefits for treating infertility, a one-time only benefit for all outpatient expenses arising from in vitro fertilization procedures performed on the insured or the insured's dependent spouse; provided that:
(1) Benefits under this section shall be provided to the same extent as the benefits provided for other pregnancy-related benefits;
(2) The patient is the insured or covered dependent of the insured;
(3) The patient's oocytes are fertilized with the patient's spouse's sperm;
(4) The:
(A) Patient and the patient's spouse have a history of infertility of at least five years' duration; or
(B) Infertility is associated with one or more of the following medical conditions:
(i) Endometriosis;
(ii) Exposure in utero to diethylstilbestrol, commonly known as DES;
(iii) Blockage of, or surgical removal of, one or both fallopian tubes (lateral or bilateral salpingectomy); or
(iv) Abnormal male factors contributing to the infertility;
(5) The patient has been unable to attain a successful pregnancy through other applicable infertility treatments for which coverage is available under the insurance contract; and
(6) The in vitro fertilization procedures are performed at medical facilities that conform to the American College of Obstetricians and Gynecologists guidelines for in vitro fertilization clinics or to the American Society for Reproductive Medicine minimal standards for programs of in vitro fertilization.
(b) For the purposes of this section, the term "spouse" means a person who is lawfully married to the patient under the laws of the State.
(c) The requirements of this section shall apply to all new policies delivered or issued for delivery in this State after June 26, 1987. [L 1987, c 332, §1 and L 1989, c 276, §4; am L 2003, c 212, §72; am L 2013, c 47, §1]
Section: Previous 431-10a-112 431-10a-113 431-10a-114 431-10a-115 431-10a-115.5 431-10a-116 431-10a-116.2 431-10a-116.5 431-10a-116.6 431-10a-116.7 431-10a-117 431-10a-118 431-10a-119 431-10a-120 431-10a-121 NextLast modified: October 27, 2016