44-779. Group sickness and accident insurance; coverage for the treatment of alcoholism; requirements.

343 words·~2 min read·/ne/chapter-44/44-779

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

After January 1, 1981, all policies or contracts of group sickness and accident insurance written or issued by insurance companies and all group contracts or certificates written or issued by a health maintenance organization as to which there is a premium change or which are delivered or issued for delivery in this state, which do not provide at least basic coverage for the treatment of alcoholism, shall be subject to the following:

(1)The written sales and advertising literature, the descriptive brochures, and the exclusion sections of such policy, contract, or certificate shall contain a notice in all capital letters in the following language or in words of similar effect as approved by the Director of Insurance: This agreement does not provide basic coverage for the treatment of alcoholism. Coverage for treatment of alcoholism is available if you specifically request it and then only upon such terms and conditions as you and the company agree;

(2)The written sales and advertising literature, the descriptive brochures, and such policy, contract, or subscription agreement itself shall not, in describing the plan, contract, coverage, or benefits, use the words comprehensive;

(3)The definition of a facility, program, or agency in or through which covered alcoholism services may be rendered contained in any optional coverage shall not be more restrictive than the definitions contained in sections 44-771 to 44-775 if the effect of such definitions would be to limit, deny, or withhold benefits which would be available if the definitions used in sections 44-769 to 44-781 were applied;

(4)Such policy, contract, or subscription agreement shall provide benefits to any person covered thereunder for the treatment of alcoholism under such terms and conditions as may be agreed upon between the subscriber or insured and the insurer or health maintenance organization; and

(5)In the case of policies, contracts, and subscription agreements issued before January 1, 1981, as to which there is a premium change after January 1, 1981, the notification requirements of this section may be met by written endorsement to such policy, contract, or subscription agreement.