§ 23-99-413 — Disclosure requirements

Upon request, healthcare insurers must provide the following information in a clear and understandable form to all prospective policyholders, policyholders, and covered persons. Insurers shall notify policyholders and covered persons of their right to request the information, which must include: (1) Coverage provisions, benefits, and exclusions by category of service and provider; (2) A description of the prior authorization, precertification, and referral requirements; (3) The existence of prescription drug formularies and prior approval requirements for prescription drugs; (4) The name, number, type, specialty, and geographic location of participating providers; and (5) (A) Criteria by which providers are evaluated for network participation. (B) Proprietary information shall not be disclosed. (C) Criteria may include, but are not limited to, geographic limitations, geographic distribution of patients, specialty limitation, anticipated numbers and types of providers needed, and economic considerations. This information shall also be made available to providers upon request.

Legislative History

Acts 1997, No. 1196, § 13.