Title 33, Chapter 29, Section 3.1
( 33-29-3.1)
(a) Every insurer authorized to issue individual accident and
sickness insurance plans, policies, or contracts shall be required
to make available, either as a part of or as an optional endorsement
to all such policies providing major medical insurance coverage
which are issued, delivered, issued for delivery, or renewed on or
after July 1, 1988, coverage for human heart transplants, including
any charges for acquisition, transportation, or donation of a human
heart when a human heart transplant is performed. Such coverage
shall be at least as extensive and provide at least the same degree
of coverage as that provided by the respective plan, policy, or
contract for the treatment of other types of physical illnesses.
Such an optional endorsement shall also provide that the coverage
required to be made available pursuant to this Code section shall
also cover the spouse and the dependents of the insured if the
insured's spouse and dependents are covered under such benefit plan,
policy, or contract. (b) The optional endorsement required to be made available under
subsection (a) of this Code section shall not contain any
exclusions, reductions, or other limitations as to coverages,
deductibles, or coinsurance provisions which apply to human heart
transplants unless such provisions apply generally to other similar
benefits provided or paid for under the accident and sickness
insurance benefit plan, policy, or contract; provided, however, the
optional endorsement may contain a waiting period for the coverage
or a delayed eligibility date of not more than 12 months from the
effective date of the endorsement. (c) Nothing in this Code section shall be construed to prohibit an
insurer, nonprofit corporation, health care plan, health maintenance
organization, or other person issuing any similar individual
accident and sickness insurance benefit plan, policy, or contract
from issuing or continuing to issue an individual accident and
sickness insurance benefit plan, policy, or contract which provides
benefits greater than the minimum benefits required to be made
available under this Code section or from issuing any such plans,
policies, or contracts which provide benefits which are generally
more favorable to the insured than those required to be made
available under this Code section. (d) Nothing in this Code section shall be construed to prohibit the
inclusion of coverage for human heart transplants that differs from
the coverage provided in the same insurance plan, policy, or
contract for physical illnesses if the policyholder does not
purchase the optional coverage made available pursuant to this Code
section. |