Title 33, Chapter 24, Section 55
( 33-24-55)
(a) Any health insurer under this title, including a group health
plan, as defined in Section 607(1) of the federal Employee
Retirement Income Security Act of 1974, is prohibited from
considering the availability or eligibility for medical assistance
in this or any other state under 42 U.S.C. 1396(a), Section 1902 of
the Social Security Act, herein referred to as Medicaid, when
considering eligibility for coverage or making payments under its
plan for eligible enrollees, subscribers, policyholders, or
certificate holders. (b) To the extent that payment for covered expenses has been made
under the state Medicaid program for health care items or services
furnished to an individual, in any case where a third party has a
legal liability to make payments, the state is considered to have
acquired the rights of the individual to payment by any other party
for those health care items or services. (c) An insurer shall not deny enrollment of a child under the health
plan of the child's parent on the ground that the child was born out
of wedlock, is not claimed as a dependent on the parent's federal
income tax return, or does not reside with the parent or in the
insurer's service area. (d) Where a child has health coverage under this title through an
insurer of a noncustodial parent, the insurer shall: (1) Provide such information to the custodial parent as may be
necessary for the child to obtain benefits through that coverage; (2) Permit the custodial parent or the provider, with the
custodial parent's approval, to submit claims for covered services
without the approval of the noncustodial parent; and (3) Make payments on claims submitted in accordance with paragraph
(2) of this subsection directly to the custodial parent, the
provider, or the state Medicaid agency. (e) Where a parent is required by a court or administrative order to
provide health coverage for a child and the parent is eligible for
family health coverage, the insurer shall be required: (1) To permit the parent to enroll, under the family coverage, a
child who is otherwise eligible for the coverage without regard to
any enrollment season restrictions; (2) If the parent is enrolled but fails to make application to
obtain coverage for the child, to enroll the child under the
family coverage upon application of the child's other parent, the
state agency administering the Medicaid program, or the state
agency administering 42 U.S.C. Sections 651 through 669, the child
support enforcement program; and (3) Not to disenroll or eliminate coverage of any child unless the
insurer is provided satisfactory written evidence that: (A) The court or administrative order is no longer in effect; or (B) The child is or will be enrolled in comparable health
coverage through another insurer which will take effect not
later than the effective date of disenrollment. (f) An insurer may not impose requirements on a state agency which
has been assigned the rights of an individual eligible for medical
assistance under Medicaid and covered for health benefits from the
insurer that are different from requirements applicable to an agent
or assignee of any other individual so covered. (g) In any case in which a group health insurance plan provides
coverage for dependent children of participants or beneficiaries,
the plan shall provide benefits to dependent children placed with
participants or beneficiaries for adoption under the same terms and
conditions as apply to the natural, dependent children of the
participants and beneficiaries, irrespective of whether the adoption
has become final. (h) A group health plan may not restrict coverage under the plan for
any dependent child adopted by a participant or beneficiary, or
placed with a participant or beneficiary for adoption, solely on the
basis of a preexisting condition of the child at the time that the
child would otherwise become eligible for coverage under the plan,
if the adoption or placement for adoption occurs while the
participant or beneficiary is eligible for coverage under the plan. |