§ 36-6556. Health insurance plans - Certification or contract with certified private review agent - Exceptions.  


Latest version.
  • Every health insurance plan which proposes to administer a health benefits program that provides for the coverage of hospital and/or medical benefits and the utilization review of those benefits shall:

    1.  Be certified in accordance with the Hospital and Medical Services Utilization Review Act; or

    2.  Contract with a private review agent who is certified in accordance with the Hospital and Medical Services Utilization Review Act.

    The provisions of this section shall not apply to insurance companies and not-for-profit hospital services and medical indemnity plans, licensed by the Commissioner to transact insurance in this state, that perform in-house utilization review.

Added by Laws 1991, c. 294, § 6, eff. Nov. 1, 1991.