Title 33, Chapter 30, Section 4.1
( 33-30-4.1)
(a) Every insurer authorized to issue group accident and sickness
insurance benefit 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 group accident and
sickness insurance benefit plan, policy, or contract from issuing or
continuing to issue a group 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) The requirements of this Code section shall be satisfied if the
coverage specified in subsections (a) and (b) of this Code section
is made available to the master policyholder of the group plan,
policy, or contract. Nothing in this Code section shall be
construed to require the group insurer, nonprofit corporation,
health care plan, health maintenance organization, or master
policyholder to provide or to make available such coverage to any
insured under such group or blanket plan, policy, or contract. (e) 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. (f) The provisions of this Code section shall also apply to group
accident and sickness insurance policies or contracts issued by a
fraternal benefit society, a nonprofit hospital service corporation,
a nonprofit medical service corporation, a health care plan, a
health maintenance organization, or any other similar entity. |