2021 South Carolina Code of Laws
Title 38 - Insurance
Chapter 71 - Accident And Health Insurance

• 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 38-71-125. 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 38-71-290. Mental health coverage; definitions; treatment requirements; exceptions

Subarticle 1

Policy Forms and Rates

• 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 38-71-380. Medical expense policy; optional intoxicants and narcotics exclusion inapplicable.
• 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).

Subarticle 1

General Provisions

• 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 38-71-1110. "Franchise accident and health insurance" defined.

• 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 38-71-1545. Exclusion of certain insurance policies.
• 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.

Editor's Note

2016 Act No. 163, Section 2, provides as follows:

"SECTION 2. This article applies to contracts between pharmacies and pharmacy benefit managers that are entered into, renewed, or extended on or after the effective date of this act."

• Section 38-71-2110 to 38-71-2150. Repealed.

• Section 38-71-2200. Definitions.
• Section 38-71-2210. License requirement for pharmacy benefits managers.
• Section 38-71-2220. No restrictions or penalties against pharmacy for disclosing certain information.
• Section 38-71-2230. Pharmacy benefits manager prohibited from taking certain actions.
• Section 38-71-2240. Placement of drug on Maximum Allowable Cost List.
• Section 38-71-2250. Enforcement of article; penalties.
• Section 38-71-2260. Construction and application.