ARTICLE 10A

ACCIDENT AND HEALTH OR SICKNESS INSURANCE CONTRACTS

 

Note

 

  Affordable health insurance working group; report to 2018 legislature.  L 2017, c 43.

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

 

Cross References

 

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

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

  Health and dental insurance data; mandatory reporting for certain insurers, see §323D-18.5.

  Health maintenance organization act, see chapter 432D.

  Medicaid-related mandates, see chapter 431L.

  Mental health and alcohol and substance use disorder 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 and 23-52.

  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 (1997).

 

     §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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