2013 South Carolina Code of Laws
Title 38 - Insurance
CHAPTER 71 - ACCIDENT AND HEALTH INSURANCE
SECTION 38-71-1365. Small employer insurer requirements; compliance with federal laws applicable to cooperatives.
(A) A health group cooperative shall contract only with a small employer insurer that demonstrates:
(1) that the insurer or health maintenance organization is licensed and in good standing with the Department of Insurance;
(2) the capacity to administer the group health insurance plans;
(3) the ability to monitor and evaluate the quality and cost effectiveness of care and applicable procedures;
(4) the ability to conduct utilization management and applicable procedures and policies;
(5) the ability to assure enrollees a sufficient number of health care providers, including specialty providers; and
(6) a satisfactory grievance procedure and the ability to respond to enrollees' calls, questions, and complaints.
(B) A health group cooperative shall comply with federal laws applicable to cooperatives and group health insurance plans issued through cooperatives, to the extent required by this title or regulations adopted under them.
HISTORY: 2008 Act No. 180, Section 1, eff February 19, 2008.
Disclaimer: These codes may not be the most recent version. South Carolina may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
