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Selected State Laws

ARKANSAS: Contracts for health and accident insurance must include those dental services that would have been covered if performed by a physician (23-79-114). Health care plans or disability insurance policies that cover families must include coverage for newborn children (23-79-129). Disability insurance may not discriminate between inpatient or outpatient coverage for the same procedure (23-85-133). Exclusions for preexisting conditions are strictly regulated (23-86-304).

CONNECTICUT: The state has extensive provisions governing health and accident insurance. Some key provisions include mandated coverage for some preexisting conditions (38a-476), limitations on offset provisions as defined under 38a-519, and a provision that married couples working for the same employer under the same group policy do not have to pay double premiums unless it results in greater coverage (38a-540, 541).

INDIANA: No policy for accident or health insurance may be issued until a copy of the form, the classification of risk, and the premium rate have been filed with the state commissioner (IC27-8-5-1). The state maintains a Life and Health Insurance Guarantee Association that protects insureds, beneficiaries, annuitants, etc. from insolvency or failure in performance of contractual obligations owed by the insurer that issued the policy (IC27-8-8-1 to 18).

MAINE: The state has a special provision prohibiting discrimination in maternity benefits coverage for unmarried women (T. 24-A-2741).

MARYLAND: Specific provisions are for AIDS/HIV positive individuals (15-201 to 205), breast implants (15-105), preexisting conditions (16-214, 15-208) and mental illness (19-703). Self-employed individuals must have annual open enrollment periods (15-411, 15-210).

MASSACHUSETTS: Policies providing supplemental coverage to Medicare must meet certain standards, with exceptions for employers and trade unions (175, Section 205).

MISSOURI: Insurers may not deny or cancel coverage because of incarceration of insured (595.047(1)). Health care service claims must be paid within 30 days of receipt by insurer of all necessary documents (376.427).

NEW JERSEY: New Jersey has a statutory Life and Health Insurance Guaranty Association to protect insureds and beneficiaries against insolvent or defaulting insurers. (T.17B, c. 32A.1) It also has a Health Care Quality Act providing consumer protections through “plain language” disclosure requirements, etc. (T.26. c.25.1).

NEW MEXICO: Health insurance policies must provide coverage for handicapped children, newborns, adopted children, childhood immunizations, home health care options, mammograms, cytologic screening, diabetes, and minimum hospital stays for certain conditions (59A-22-1).

OKLAHOMA: State Health Care Freedom of Choice Act provides certain rights to select the practitioner of choice for providing certain services (36-6053 to 6057). Genetic Nondiscrimination in Insurance Act restricts disclosure and/or use of genetic tests or information by employers or insurers (36-3614.1).

PENNSYLVANIA: Multiple statutory provisions cover various issues. Specific provision mandates coverage for serious mental illnesses (40-764g). False statements in applications are not automatic bars to coverage (40-757).

TENNESSEE: Health benefits coverage cannot be denied to victims of abuse (56-8-301). Policies may not exclude coverage for drugs not yet approved by FDA if the drug is used to treat life-threatening illness (56-7-2352).

WASHINGTON: Group policies must offer optional coverage for temporomandibular joint disorders (TMJ) (48.21-320) and mammograms (48.21.225). Employer-sponsored group contracts must provide coverage for neuro-developmental therapies (48.21- 310).

Inside Selected State Laws