Chapter 176G: HEALTH MAINTENANCE ORGANIZATIONS
- Section 1 Definitions
- Section 2 Application of laws
- Section 3 Organization; accounting; contracts
- Section 4 Required coverage for certain conditions and groups
- Section 4A Employees terminated due to plant closings; coverage
- Section 4B Confidentiality of information; mental or nervous condition; exceptions
- Section 4C Home care benefits
- Section 4D Nonprescription enteral formulas for home use
- Section 4E Off-label drug use; cancer treatment
- Section 4F Group health maintenance contracts; coverage for bone marrow transplants
- Section 4G Off-label use of prescription drugs for HIV/AIDS treatment
- Section 4H Items medically necessary for diagnosis and treatment of diabetes
- Section 4I Abortion, abortion-related care, prenatal care, childbirth and postpartum care benefits; minimum coverage for in-patient care; exemptions
- Section 4J Scalp hair prostheses necessary due to cancer or leukemia treatment
- Section 4K Newborn hearing screening tests
- Section 4L Coverage for hospice services
- Section 4M Mental health benefits; biologically-based mental disorders; rape-related mental disorders; non-biologically-based mental disorders of children and adolescents under age 19
- Section 4N Coverage for speech, hearing and language disorders; hearing aids
- Section 4O Outpatient services; hormone replacement therapy for peri and post menopausal women; contraceptive services; approved prescription contraceptive drugs or devices; exception
- Section 4P Patient care services provided pursuant to qualified clinical trials
- Section 4Q Coverage for human leukocyte or histocompatibility locus antigen testing
- Section 4R Repealed, 2008, 451, Sec. 140
- Section 4S Coverage for prosthetic devices and repairs
- Section 4T Coverage for eligible dependents under 26 years of age or dependents mentally or physically incapable of earning their own living due to disability
- Section 4U Coverage for medically necessary hypodermic syringes or needles
- Section 4V Coverage for diagnosis and treatment of autism spectrum disorder
- Section 4W Coverage for children under age 18 for cleft lip and cleft palate
- Section 4X Coverage for orally administered anticancer medications
- Section 4Y Coverage for abuse deterrent opioid drug products
- Section 4Z Preauthorization for substance abuse treatment not to be required
- Section 4AA Coverage for medically necessary acute treatment and clinical stabilization services
- Section 4BB Repealed, 2016, 133, Sec. 116
- Section 4CC Coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome
- Section 4DD Filling of remaining portion of prescription for covered drug that is a narcotic substance earlier filled in lesser quantity
- Section 4EE Pain management access plan; non-medication and nonsurgical treatment; review; educational materials
- Section 4FF Coverage for tobacco use cessation counseling and tobacco cessation products
- Section 4GG Coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome
- Section 4HH Repealed, 2021, 29, Sec. 27
- Section 4II Coverage for prescription eye drops
- Section 4JJ Coverage for mental health or substance use disorder services delivered through psychiatric collaborative care model
- Section 4KK Coverage for medically necessary mental health acute treatment, community-based acute treatment and intensive community-based acute treatment
- Section 4LL Benefits for medically necessary emergency services programs
- Section 4MM Coverage for annual mental health wellness examination
- Section 4NN Coverage for federally-defined preventive services
- Section 4OO Coverage for standard fertility preservation services
- Section 4PP Coverage for postpartum depression and major depressive disorder screenings
- Section 4QQ Coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products
- Section 4RR Coverage for universal postpartum home visiting services
- Section 4SS Coverage for diagnostic examinations for breast cancer; digital breast tomosynthesis screening, MRIs and ultrasounds
- Section 4TT Coverage for prescribed, ordered or dispensed opioid antagonists
- Section 4UU Coverage for the provision of services by a recovery coach
- Section 4V1/2 Coverage for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services
- Section 4VV Coverage for identified generic and brand name drug used to treat diabetes, asthma, and certain heart conditions
- Section 5 Emergency services provided to members for emergency medical conditions
- Section 5A Divorced or separated spouses; coverage
- Section 6 Contracts
- Section 6A Group health maintenance contracts; contribution percentages
- Section 6B Retroactive claims denials for behavioral health services
- Section 7 Repealed, 2000, 141, Sec. 21
- Section 8 Public dissemination of deceptive or misleading materials
- Section 9 Trade regulation practices; application of law
- Section 10 Reports; audits, examinations or inspections; confidentiality and privilege
- Section 10A Applicability of chapter 176V to health maintenance organizations governed by this chapter
- Section 10B Applicability of chapter 176W to health maintenance organizations governed by this chapter
- Section 11 Contracts with group insurance commission or local governments
- Section 11A Alternative dental coverage option
- Section 12 Health regulations not limited
- Section 13 Name restriction
- Section 14 Licensure applicants; documents required; approval by commissioner
- Section 15 Bond; waiver
- Section 16 Contracts, rates, evidence of coverage; disapproval of commissioner
- Section 16A Disapproval of certain health maintenance contracts based on high deductibles
- Section 16B Disapproval of certain health maintenance contracts for coverage of young adults
- Section 17 Rules and regulations; standardized claim form
- Section 17A Open enrollment for nongroup medicare beneficiaries; period, notice of termination
- Section 18 Repealed, 1993, 110, Sec. 214
- Section 19 Discrimination against abuse victims in terms of health maintenance contract
- Section 20 Insolvent health maintenance organization; administrative supervision, rehabilitation or liquidation; priority of claims
- Section 20A Administrative supervision, rehabilitation or liquidation of health maintenance organizations; revocation or suspension of license
- Section 21 Participating provider; contracts with health maintenance organizations; hold harmless clause; limitation on collection actions
- Section 22 Health care providers; liability of member of health maintenance organization; limitation on collection of amounts owed
- Section 23 Insolvency of health maintenance organization; replacement coverage
- Section 24 Health maintenance contracts; genetic tests; discrimination based on genetic information
- Section 25 Net worth of health maintenance organization
- Section 26 Deposit maintained with trustee acceptable to commissioner
- Section 27 Merger or acquisition of control
- Section 28 Registration with commissioner
- Section 29 Violations of Secs. 27 to 29; application for order enjoining violations of Secs. 27 to 29; penalties
- Section 30 Statement for individuals provided with creditable coverage; reporting
- Section 31 Attribution of members to a primary care provider
- Section 32 Disclosure of patient-level data and contracted prices of individual health care services by carriers to providers
- Section 33 Coverage for health care services delivered via telehealth by a contracted health care provider