§ 26.1-36-47 — Internal claims and appeals procedures

An insurance company, nonprofit health services corporation, or health maintenance
organization may not deliver, issue, execute, or renew any health insurance policy, health
service contract, or evidence of coverage on an individual, group, blanket, franchise, or
association basis unless the policy, contract, or evidence of coverage meets the minimum

requirements of 42 U.S.C. 300gg-19 and complies with 29 U.S.C. 1133, 29 CFR 2560.503-1;
42 U.S.C. 300gg-19, 26 CFR 54.9815-2719T; 29 U.S.C. 1185d, 29 CFR 2590.715-2719; and
26 U.S.C. 9815, 45 CFR 147.136. The insurance commissioner may take steps necessary to
ensure compliance with this section. If federal laws or rules relating to internal claims and
appeals are amended, repealed, or otherwise changed, the insurance commissioner shall adopt
rules to ensure the internal claims and appeals procedure is in compliance with and
substantively equivalent to the federal requirements.