44-32,129. Group and individual contracts; required provisions.
Every group and individual contract holder shall be entitled to a group or individual contract. The contract shall not contain provisions or statements which are unjust, unfair, inequitable, misleading, or deceptive or which encourage misrepresentation as described by section 44-1525. The contract shall contain a clear statement of the following:
(1) Name and address of the health maintenance organization;
(2) Eligibility requirements;
(3) Benefits and services within the service area;
(4) Emergency care benefits and services;
(5) Out-of-area benefits and services, if any;
(6) Copayments, deductibles, or other out-of-pocket expenses;
(7) Limitations and exclusions;
(8) Enrollee termination;
(9) Enrollee reinstatement, if any;
(10) Claims procedures;
(11) Enrollee grievance procedures;
(12) Continuation of coverage;
(13) Conversion;
(14) Extension of benefits, if any;
(15) Coordination of benefits, if applicable;
(16) Subrogation, if any;
(17) Description of the service area;
(18) Entire contract provision;
(19) Term of coverage;
(20) Cancellation of group or individual contract holder;
(21) Renewal;
(22) Reinstatement of group or individual contract holder, if any;
(23) Grace period; and
(24) Conformity with state law.
An evidence of coverage may be filed as part of the group contract to describe the provisions required in subdivisions (1) through (17) of this section.
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