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  • PART I ADMINISTRATION OF THE GOVERNMENT
  • TITLE XXII CORPORATIONS
  • 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 - Prenatal, childbirth and postpartum care benefits; minimum coverage for in-patient care

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Section 4R - Repealed, 2008, 451, Sec. 140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 persons under age 26 or for 2 years after end of calendar year in which persons last qualified as dependents

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 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 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

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