LegalFix
Sign In

Section 38-71-1365. Small employer insurer requirements; compliance with federal laws applicable to cooperatives.

SC Code § 38-71-1365 (2019) (N/A)
Copy with citation
Copy as parenthetical citation

(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.

Previous Section
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.
Next Section
Section 38-71-1370. Applicability of certain code sections; late enrollees.