reglab/housing_qa huggingface dataset:
MS Code § 83-9-32 (2020)
2020 Mississippi Code|Title 83 - Insurance|Chapter 9 - Accident, Health and Medicare Supplement Insurance|Accident and Health Insurance|§ 83-9-32. Coverage for medical benefits when dental care provided under physician-supervised anesthesia

 Every hospital, health or medical expenses insurance policy, hospital or medical service contract, health maintenance organization and preferred provider organization that is delivered or issued for delivery in this state and otherwise provides anesthesia benefits shall offer benefits for anesthesia and for associated facility charges when the mental or physical condition of the child or mentally handicapped adult requires dental treatment to be rendered under physician-supervised general anesthesia in a hospital setting, surgical center or dental office. This coverage shall be offered on an optional basis, and each primary insured must accept or reject such coverage in writing and accept responsibility for premium payment.   An insurer may require prior authorization for the anesthesia and associated facility charges for dental care procedures in the same manner that prior authorization is required for treatment of other medical conditions under general anesthesia. An insurer may require review for medical necessity and may limit payment of facility charges to certified facilities in the same manner that medical review is required and payment of facility charges is limited for other services. The benefit provided by this coverage shall be subject to the same annual deductibles or coinsurance established for all other covered benefits within a given policy, plan or contract. Private third party payers may not reduce or eliminate coverage due to these requirements.   A dentist shall consider the Indications for General Anesthesia as published in the reference manual of the American Academy of Pediatric Dentistry as utilization standards for determining whether performing dental procedures necessary to treat the particular condition or conditions of the patient under general anesthesia constitutes appropriate treatment.   The provisions of this section shall apply to anesthesia services provided by oral and maxillofacial surgeons as permitted by the Mississippi State Board of Dental Examiners.   The provisions of this section shall not apply to treatment rendered for temporal mandibular joint (TMJ) disorders.
MS Code § 83-9-33 (2020)
2020 Mississippi Code|Title 83 - Insurance|Chapter 9 - Accident, Health and Medicare Supplement Insurance|Accident and Health Insurance|§ 83-9-33. Coverage for newly born children

  All individual and group health insurance policies providing coverage on an expense incurred basis and individual and group service or indemnity type contracts issued after January 1, 1980, by an insurer or nonprofit corporation which provides coverage for a family member of the insured or subscriber shall, as to such family members' coverage, also provide that the health insurance benefits applicable for children shall be payable with respect to a newly born child of the insured or subscriber from the moment of birth.   The coverage for newly born children shall consist of coverage of injury or sickness including the necessary care and treatment of medically diagnosed congenital defects, prematurities and birth abnormalities, but need not include routine well baby care. For purposes of this section, "necessary care and treatment" shall include transportation of the newborn to and from the nearest appropriately staffed and equipped facility for the treatment of such newborn child, when the attending physician certifies that special transportation is necessary to protect the health and safety of the newborn child. Cost of such transportation shall not exceed usual and customary charges up to Two Hundred Dollars ($200.00).   If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that notification of birth of a newly born child must be furnished to the insurer or nonprofit service or indemnity corporation within thirty-one (31) days after the date of birth in order to have the coverage continue beyond such thirty-one day period, and may require that payment of the required premium or fee be made within thirty (30) days after the mailing by the insurer or nonprofit corporation of the notice of premium or fee to the insured.   The requirements of this section shall apply to all insurance policies and subscriber contracts delivered or issued for delivery in this state more than one hundred twenty (120) days after April 4, 1974.
MS Code § 83-9-34 (2020)
2020 Mississippi Code|Title 83 - Insurance|Chapter 9 - Accident, Health and Medicare Supplement Insurance|Accident and Health Insurance|§ 83-9-34. Child immunizations; optional coverage; written acceptance or rejection; application of section

  In this section, "health benefit plan" means a plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident or sickness and that is offered by any insurance company, group hospital service corporation or health maintenance organization that delivers or issues for delivery an individual, group, blanket or franchise insurance policy or insurance agreement, a group hospital service contract or an evidence of coverage or, to the extent permitted, by the Employee Retirement Income Security Act of 1974 (29 USCS Section 1001 et seq.), by a multiple employer welfare arrangement as defined by Section 3, Employee Retirement Income Security Act of 1974 (29 USCS Section 1002) or any other analogous benefit arrangement. The term does not include:   A plan that provides coverage:   Only for a specified disease;   Only for accidental death or dismemberment;   For wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury; or   As a supplement to liability insurance.     A Medicare supplemental policy as defined by Section 1882 (g)(1), Social Security Act (42 USCS Section 1395ss);   Workers' compensation insurance coverage;   Medical payment insurance issued as part of a motor vehicle insurance policy;   A long-term care policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy meets the definition of a health benefit plan; or   A hospital indemnity only policy.     A health benefit plan that provides benefits for a family member of the insured shall provide an option for the insured to elect coverage for each newly born child of the insured, from birth through the date the child is twenty-four (24) months of age, for:   Immunization against:   Diphtheria;   Hepatitis B;   Measles;   Mumps;   Pertussis;   Polio;   Rubella;   Tetanus;   Varicella; and   Hemophilus Influenza B (HIB).     Any other immunization that the Commissioner of Insurance determines to be required by law for the child.   The coverage shall be offered on an optional basis, and each primary insured must accept or reject such coverage in writing and accept responsibility for premium payment.     The benefits required to be offered under subsection (2) of this section may not be made subject to a deductible, copayment or coinsurance requirement.   This section applies only to a health benefit plan that is delivered, issued for delivery or renewed on or after January 1, 1999. A health benefit plan that is delivered, issued for delivery or renewed before January 1, 1999, is governed by the law as it existed immediately before January 1, 1999, and that law is continued in effect for this purpose.
MS Code § 83-9-36 (2020)
2020 Mississippi Code|Title 83 - Insurance|Chapter 9 - Accident, Health and Medicare Supplement Insurance|Accident and Health Insurance|§ 83-9-36. Process by which prescribing practitioner may request override of restriction on medication restricted for use by insurer step therapy or fail-first protocol; circumstances under which insurer to grant override

  When medications for the treatment of any medical condition are restricted for use by an insurer by a step therapy or fail-first protocol, the prescribing practitioner shall have access to a clear and convenient process to expeditiously request an override of that restriction from the insurer.An override of that restriction shall be expeditiously granted by the insurer under the following circumstances:   The prescribing practitioner can demonstrate, based on sound clinical evidence, that the preferred treatment required under step therapy or fail-first protocol has been ineffective in the treatment of the insured's disease or medical condition; or   Based on sound clinical evidence or medical and scientific evidence:   The prescribing practitioner can demonstrate that the preferred treatment required under the step therapy or fail-first protocol is expected or likely to be ineffective based on the known relevant physical or mental characteristics of the insured and known characteristics of the drug regimen; or   The prescribing practitioner can demonstrate that the preferred treatment required under the step therapy or fail-first protocol will cause or will likely cause an adverse reaction or other physical harm to the insured.       The duration of any step therapy or fail-first protocol shall not be longer than a period of thirty (30) days when the treatment is deemed clinically ineffective by the prescribing practitioner.When the prescribing practitioner can demonstrate, through sound clinical evidence, that the originally prescribed medication is likely to require more than thirty (30) days to provide any relief or an amelioration to the insured, the step therapy or fail-first protocol may be extended up to seven (7) additional days.   As used in this section:   "Insurer" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract or agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan.However, the term "insurer" does not include a preferred provider organization that is only a network of providers and does not define health care benefits for the purpose of coverage under a health care benefits plan.   "Practitioner" has the same meaning as defined in Section 73-21-73.
MS Code § 83-9-37 (2020)
2020 Mississippi Code|Title 83 - Insurance|Chapter 9 - Accident, Health and Medicare Supplement Insurance|Coverage for Treatment of Mental Illness, Temporomandibular Joint Disorder and Craniomandibular Disorder|§ 83-9-37. Definitions

 As used in Sections 83-9-37 through 83-9-43, Mississippi Code of 1972:   "Alternative delivery system" means a health maintenance organization (HMO), preferred provider organization (PPO), exclusive provider organization (EPO), individual practice association (IPA), medical staff hospital organization (MESH), physician hospital organization (PHO), and any other plan or organization which provides health care services through a mechanism other than insurance and is regulated by the State of Mississippi.   "Covered benefits" means the health care services or treatment available to an insured party under a health insurance policy for which the insurer will pay part or all of the costs.   "Hospital" means a facility licensed as a hospital by the Mississippi Department of Health.   "Health service provider" means a physician or psychologist who is authorized by the facility in which services are delivered to provide mental health services in an inpatient or outpatient setting, within his or her scope of licensure.   "Inpatient services" means therapeutic services which are available twenty-four (24) hours a day in a hospital or other treatment facility licensed by the State of Mississippi.   "Mental illness" means any psychiatric disease identified in the current edition of The International Classification of Diseases or The American Psychiatric Association Diagnostic and Statistical Manual.   "Outpatient services" means therapeutic services which are provided to a patient according to an individualized treatment plan which does not require the patient's full-time confinement to a hospital or other treatment facility licensed by the State of Mississippi. The term "outpatient services" refers to services which may be provided in a hospital, an outpatient treatment facility or other appropriate setting licensed by the State of Mississippi.   "Outpatient treatment facility" means (i) a clinic or other similar location which is certified by the State of Mississippi as a qualified provider of outpatient services for the treatment of mental illness or (ii) the office of a health service provider.   "Partial hospitalization" means inpatient treatment, other than full twenty-four-hour programs, in a treatment facility licensed by the State of Mississippi; the term includes day, night and weekend treatment programs.   "Physician" means a physician licensed by the State of Mississippi to practice therein.   "Psychologist" means a psychologist licensed by the State of Mississippi to practice therein.
MS Code § 83-9-39 (2020)
2020 Mississippi Code|Title 83 - Insurance|Chapter 9 - Accident, Health and Medicare Supplement Insurance|Coverage for Treatment of Mental Illness, Temporomandibular Joint Disorder and Craniomandibular Disorder|§ 83-9-39. Coverage

    Except as otherwise provided herein, all alternative delivery systems and all group health insurance policies, plans or programs regulated by the State of Mississippi shall provide covered benefits for the treatment of mental illness, except for policies which only provide coverage for specified diseases and other limited benefit health insurance policies and negotiated labor contracts.   Health insurance policies, plans or programs of any employer of one hundred (100) or fewer eligible employees and all individual health insurance policies which are regulated by the State of Mississippi which do not currently offer benefits for treatment of mental illness shall offer covered benefits for the treatment of mental illness, except for policies which only provide coverage for specified diseases and other limited benefit health insurance policies and negotiated labor contracts.     Covered benefits for inpatient treatment of mental illness in insurance policies and other contracts subject to Sections 83-9-37 through 83-9-43 shall be limited to inpatient services certified as necessary by a health service provider.   Covered benefits for outpatient treatment of mental illness in insurance policies and other contracts subject to Sections 83-9-37 through 83-9-43 shall be limited to outpatient services certified as necessary by a health service provider.   Before an insured party may qualify to receive benefits under Sections 83-9-37 through 83-9-43, a health service provider shall certify that the individual is suffering from mental illness and refer the individual for the appropriate treatment.   All mental illness, treatment or services with respect to such treatment eligible for health insurance coverage shall be subject to professional utilization and peer review procedures.   The provisions of this section shall apply only to alternative delivery systems and individual and group health insurance policies, plans or programs issued or renewed after July 1, 1991.   The exclusion period for coverage of a preexisting mental condition shall be the same period of time as that for other medical illnesses covered under the same plan, program or contract.
MS Code § 83-9-41 (2020)
2020 Mississippi Code|Title 83 - Insurance|Chapter 9 - Accident, Health and Medicare Supplement Insurance|Coverage for Treatment of Mental Illness, Temporomandibular Joint Disorder and Craniomandibular Disorder|§ 83-9-41. Mental illness benefits

  Covered benefits for services in this section shall be limited to coverage of treatment of clinically significant mental illness.   Treatment under this section shall be covered for a minimum of thirty (30) days per year for inpatient services, a minimum of sixty (60) days per year for partial hospitalization, and a minimum of fifty-two (52) outpatient visits per year.   The rate of payment for inpatient services, outpatient services, and partial hospitalization shall be the same as provided for any other condition.
MS Code § 83-9-43 (2020)
2020 Mississippi Code|Title 83 - Insurance|Chapter 9 - Accident, Health and Medicare Supplement Insurance|Coverage for Treatment of Mental Illness, Temporomandibular Joint Disorder and Craniomandibular Disorder|§ 83-9-43. Nondiscrimination

 Methods of determining levels of payment or reimbursement for services or for the type of facility charges eligible for payment or reimbursement pursuant to Sections 83-9-37 through 83-9-43 shall be consistent with those for medical illnesses in general and shall take into consideration customary charges for those services. Deductible or co-payment plans, methods of determination, and limits on total amounts payable to an individual in a calendar year or lifetime payment limits may be applied to benefits paid to or on behalf of patients during the course of treatment as described in Sections 83-9-37 through 83-9-43, but in any case shall not be less favorable than those applied to medical illnesses generally in each policy or contract, except as provided under Section 83-9-41, Mississippi Code of 1972.
MS Code § 83-9-45 (2020)
2020 Mississippi Code|Title 83 - Insurance|Chapter 9 - Accident, Health and Medicare Supplement Insurance|Coverage for Treatment of Mental Illness, Temporomandibular Joint Disorder and Craniomandibular Disorder|§ 83-9-45. Coverage and benefits for treatment of temporomandibular joint disorder and craniomandibular disorder

 Except for policies which only provide coverage for specified diseases and other limited benefit health insurance policies, no policy or certificate of health, medical, hospitalization or accident and sickness insurance and no subscriber contract provided by a nonprofit health service plan corporation or health maintenance organization shall be issued, renewed, continued, issued for delivery or executed in this state after July 1, 1991, unless the policy, plan or contract specifically offers coverage for diagnostic and surgical treatment of temporomandibular joint disorder and craniomandibular disorder. Coverage for diagnostic services and surgery shall be the same as that for treatment to any other joint in the body and shall apply if the treatment is administered or prescribed by a physician or dentist. The minimum lifetime coverage for temporomandibular joint disorder and craniomandibular treatment shall be no less than Five Thousand Dollars ($5,000.00).
MS Code § 83-9-46 (2020)
2020 Mississippi Code|Title 83 - Insurance|Chapter 9 - Accident, Health and Medicare Supplement Insurance|Coverage for Treatment of Mental Illness, Temporomandibular Joint Disorder and Craniomandibular Disorder|§ 83-9-46. Diabetes treatment; coverage; service providers; enforcement; application to other policies

  Except as otherwise provided herein, from and after January 1, 1999, all individual and group health insurance policies or plans, pooled risk policies and all other forms of managed/capitated care plans or policies regulated by the State of Mississippi shall offer coverage for diabetes treatments, including, but not limited to, equipment, supplies used in connection with the monitoring of blood glucose and insulin administration and self-management training/education and medical nutrition therapy in an outpatient, inpatient or home health setting. An amount of coverage not to exceed Two Hundred Fifty Dollars ($250.00) shall be offered annually for self-management training/education and medical nutrition therapy under this section. The coverage shall be offered on an optional basis, and each primary insured must accept or reject such coverage in writing and accept responsibility for premium payment. The coverage shall include treatment of all forms of diabetes, including, but not limited to, Type I, Type II, Gestational and all secondary forms of diabetes regardless of mode of treatment if such treatment is prescribed by a health care professional legally authorized to prescribe such treatment and regardless of the age of onset or duration of the disease. Such health insurance plans and policies shall not reduce, eliminate or delay coverage due to the requirements of this section.   The services provided in an outpatient, inpatient or home health setting shall be provided by a Certified Diabetes Educator (CDE), who is appropriately certified, licensed or registered to practice in the State of Mississippi. Medical nutrition therapy shall be provided by a Registered Dietician (RD) appropriately licensed to practice in the State of Mississippi. All services shall be based on nationally recognized standards including, but not limited to, the American Diabetes Association Practice Guidelines.   The benefits provided in this section shall be subject to the same annual deductibles or coinsurance established for all other covered benefits within a given policy.   The Commissioner of Insurance shall enforce the provisions of this section.   Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care or other limited benefit health insurance policies.
MS Code § 83-9-47 (2020)
2020 Mississippi Code|Title 83 - Insurance|Chapter 9 - Accident, Health and Medicare Supplement Insurance|Notice of Payment for Services Made Directly to Patient|§ 83-9-47. Third-party payors required to notify health care providers of payment for services made directly to patient

  As used in this section, the following terms shall be defined as follows:   "Third-party payor" means any insurer, nonprofit hospital service plan, health care service plan, health maintenance organization, self-insurer or any person or other entity which provides payment for medical and related services.   "Health care provider" means a physician, optometrist, chiropractor, dentist, podiatrist, pharmacist, psychologist or hospital licensed by the State of Mississippi.   "Patient" means any natural person who has received medical care or services from any medical care provider within the State of Mississippi.     Any third-party payor who pays a patient or policyholder on behalf of a patient directly for medical care or services rendered by a health care provider shall provide information concerning the amount, date and nature of any such payment to the provider of services. The information may be provided by telephone, facsimile or by mailing a copy of the "explanation of benefits" to the provider. If the information is provided by sending a copy of the "explanation of benefits" to the provider, then the third-party payor may require that the reasonable cost of producing and mailing the information be paid by the provider. The requirements of this subsection shall not apply to the following: a fixed-indemnity policy, a limited benefit health insurance policy, medical payment coverage or personal injury protection coverage in a motor vehicle policy, coverage issued as a supplement to liability insurance or workers' compensation.