§ 27-20-66. Discretionary clauses.
(a) No new or existing policy or certificate may contain any provision:
(1) Purporting to reserve sole discretion to the insurer or healthcare entity to determine
eligibility for benefits or interpret the terms of a policy or certificate; or
(2) Specifying or affecting a standard of review upon which a court may review denial
of a claim or any other decision made by an insurance company with respect to a policyholder
or certificate holder.
(b) Any such clause or language included in a contract, polic
Free access — add to your briefcase to read the full text and ask questions with AI
§ 27-20-66. Discretionary clauses.
(a) No new or existing policy or certificate may contain any provision:
(1) Purporting to reserve sole discretion to the insurer or healthcare entity to determine
eligibility for benefits or interpret the terms of a policy or certificate; or
(2) Specifying or affecting a standard of review upon which a court may review denial
of a claim or any other decision made by an insurance company with respect to a policyholder
or certificate holder.
(b) Any such clause or language included in a contract, policy, or certificate issued
to or covering a resident of this state that is contrary to or inconsistent with the
provisions of this section is void and unenforceable.
(c) Nothing in this section prohibits an insurer from including a provision in a contract
that informs an insured that as part of its routine operations the insurer applies
the terms of its contracts for making decisions, including making determinations regarding
eligibility; receipt of benefits and claims; or explaining policies, procedures, and
processes, so long as the provision could not give rise to a deferential standard
of review by any reviewing court.