There is a newer version of the South Carolina Code of Laws
2012 South Carolina Code of Laws
Title 38 - Insurance
Chapter 71 - ACCIDENT AND HEALTH INSURANCE
ARTICLE 1 GENERAL PROVISIONS- 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- Section 38-71-120 - Repealed by 2006 Act No. 332, Section 31, eff June 1, 2006.
- 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 38-71-285 - Repealed by 2002 Act No. 338, Section 2, eff June 30, 2007.
- 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 38-71-410 - 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 38-71-1310 - 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 38-71-1550 - 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.
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