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 4s - Coverage for Prosthetic Devices and Repairs
Section 4t - Coverage for Eligible Dependents Under 26 Years of Age
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 - Coverage for Long-Term Antibiotic Therapy for Patients With Lyme Disease
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 Plans
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 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 Organization 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 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