ARTICLE 10A

ACCIDENT AND HEALTH OR SICKNESS INSURANCE CONTRACTS

 

Note

 

Article heading amended by L 2002, c 155, 48.

Health care transformation program within the office of the governor (terminated July 1, 2015); reports to 2014-2015 legislature. L 2013, c 224.

Prescription drug benefits, mail order opt out; reports to 2014-2015 legislature; applicability. L 2013, c 226, 4, 5, 8.

State innovation waiver task force; health care reform plan; reports to 2015-2017 legislature (dissolved June 30, 2017). L 2014, c 158.

 

Cross References

 

Conformance to federal law, see 431:2-201.5.

Federally qualified health centers; rural health clinics; reimbursement, see 346-53.6.

Health maintenance organization act, see chapter 432D.

Medicaid-related mandates, see chapter 431L.

Mental health and alcohol and drug abuse treatment insurance benefits, see chapter 431M.

Patients' bill of rights and responsibilities act, see chapter 432E.

Prescription drug benefits, see chapter 431R.

Prescription drugs; mail order opt out option, see 87A-16.3.

Proposed mandatory health insurance coverage and assessment report, see 23-51, 52.

State health insurance program, see chapter 431N.

 

Attorney General Opinions

 

Section 431:10A-601 applied to all parts of article 10A if the category of policy under consideration included family coverage, as defined in 431:10A-103. Att. Gen. Op. 97-10.

The placement of 431:10A-601 in this article, regulating content of insurance contracts, makes clear that the legislative intent was to mandate benefits that must be made available by insurers that write contracts of insurance providing family coverage. Att. Gen. Op. 97-10.

 

Law Journals and Reviews

 

Tax Justice and Same-Sex Domestic Partner Health Benefits: An Analysis of the Tax Equity For Health Plan Beneficiaries Act. 32 UH L. Rev. 73 (2009).

 

Case Notes

 

As chapter 432D does not cover the field of managed care regulation and because 432D-2, 432E-1, and this article can be read together and there is no explicit language or policy reason not to give each statute effect, chapter 432D does not repeal chapter 432E by implication. 126 H. 326, 271 P.3d 621 (2012).

Properly licensed HMOs, like plaintiff, were authorized pursuant to 432D-1 to "provide or arrange", at their option, for the closed panel health care services required under the managed care plan program; accident and health insurers were authorized under 431:10A-205(b) to arrange for medical services for members using a defined network of providers, i.e., particular "hospitals or persons"; thus, this article and chapter 432D authorized both accident and health insurers and HMOs, as risk-bearing entities, to provide the closed panel product required by the managed care plan contracts. 126 H. 326, 271 P.3d 621 (2012).

 

 

PART I. INDIVIDUAL ACCIDENT AND HEALTH

OR SICKNESS POLICIES

 

Note

 

Part heading amended by L 2002, c 155, 48.

 

Attorney General Opinions

 

Section 431:10A-601 applied to all parts of article 10A if the category of policy under consideration included family coverage, as defined in 431:10A-103. Att. Gen. Op. 97-10.

 

Case Notes

 

Under this article and 431:10A-105(2)(A)(ii), standard "incontestability clause" of contract precluded insurer from denying insured "total disability benefit" contracted for, notwithstanding that HIV infection that caused the disability arguably "manifested" itself prior to policy's effective date of coverage. 86 H. 262, 948 P.2d 1103.

 

431:10A-101 Applications and exceptions. This part shall apply to all policies of accident and health or sickness insurance delivered or issued for delivery in this State, except that nothing in this part shall apply to or affect:

(1) Any policy of workers' compensation insurance or any policy of vehicle or liability insurance with or without supplementary coverage therein;

(2) Any policy or contract of reinsurance;

(3) Any blanket or group policy of insurance; or

(4) Life insurance, endowment, or annuity contracts, or contracts supplemental thereto which contain only such provisions relating to accident and health or sickness insurance as:

(A) Provide additional benefits in case of death, dismemberment, or loss of sight by accident; or

(B) Operate to safeguard such contracts against lapse, or to give a special surrender value, special benefit, or an annuity in the event that the insured or annuitant shall become totally and permanently disabled, as defined by the contract or supplemental contract. [L 1987, c 347, pt of 2; am L 2002, c 155, 49]

 

 

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