reglab/housing_qa huggingface dataset:
SC Code § 38-71-1310 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1310. Short title.

 This article shall be known and may be cited as the "Small Employer Health Insurance Availability Act".  HISTORY: 1994 Act No. 339, Section 1.
SC Code § 38-71-1320 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1320. Purpose and intent.

 The purpose and intent of this article is to promote the availability of health insurance coverage to small employers, excluding individual health insurance plans, regardless of their health status or claims experience, to provide for development of "basic" and "standard" health insurance plans to be offered to all small employers, to provide for establishment of a reinsurance program, to improve the overall fairness and efficiency of the small group health insurance market, and to allow small employers to form cooperatives for the purpose of providing health insurance to their employees.  HISTORY: 1994 Act No. 339, Section 2; 2008 Act No. 180, Section 2, eff February 19, 2008.
SC Code § 38-71-1340 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1340. Application of article; group size for health group cooperative.

 (A) Except as provided in subsection (B), the provisions of this article apply to any health insurance plan that provides group coverage to groups of two to fifty.  (B) The provisions of this article do not apply to individual health insurance policies that are subject to policy form and premium rate approval as may be provided in this title.  (C) For health group cooperatives, the applicable group size is two to fifty. Health group cooperatives are permitted to attempt to obtain coverage for small employer groups that contain fewer than two eligible employees; however, such attempt to obtain coverage is subject to the medical underwriting requirements and policies of the small employer insurer.  HISTORY: 1994 Act No. 339, Section 4; 2008 Act No. 180, Section 2, eff February 19, 2008.
SC Code § 38-71-1350 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1350. Premium rates; requirements.

 (A) Except as provided in Section 38-71-1345(A)(7)(b), premium rates for health insurance plans subject to this article are governed by the rating restrictions provided for in this chapter.  (B) Premium rates for health insurance plans must comply with the requirements of this section notwithstanding any reinsurance premiums or assessments paid or payable by small employer insurers pursuant to Section 38-71-1410.  HISTORY: 1994 Act No. 339, Section 5; 2008 Act No. 180, Section 2, eff February 19, 2008.
SC Code § 38-71-1355 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1355. Health group cooperative; powers and duties.

 (1) shall arrange for group health insurance plan coverage for small employers who are members of the cooperative by contracting with small employer insurers who meet the criteria established by this chapter for coverage under group health insurance plans;  (2) shall collect premiums to cover the cost of:  (a) group health insurance plan coverage purchased through the cooperative; and  (b) the cooperative's administrative expenses;  (3) may contract with agents to market coverage issued through the cooperative;  (4) shall establish administrative and accounting procedures for the operation of the cooperative;  (5) shall establish procedures under which an applicant for or participant in coverage issued through the cooperative may have a grievance reviewed by an impartial person;  (6) may contract with a small employer insurer or third-party administrator to provide administrative services to the cooperative;  (7) shall contract with small employer insurers for the provision of services to small employers covered through the cooperative;  (8) shall develop and implement a plan to maintain public awareness of the cooperative and publicize the eligibility requirements and the procedures for enrollment in coverage through the cooperative;  (9) may negotiate the premiums paid by its members; and  (10) may offer other ancillary products and services to its members as are customarily offered in conjunction with group health insurance plans.  HISTORY: 2008 Act No. 180, Section 1, eff February 19, 2008.
SC Code § 38-71-1365 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1365. Small employer insurer requirements; compliance with federal laws applicable to cooperatives.

 (A) A health group cooperative shall contract only with a small employer insurer that demonstrates:  (1) that the insurer or health maintenance organization is licensed and in good standing with the Department of Insurance;  (2) the capacity to administer the group health insurance plans;  (3) the ability to monitor and evaluate the quality and cost effectiveness of care and applicable procedures;  (4) the ability to conduct utilization management and applicable procedures and policies;  (5) the ability to assure enrollees a sufficient number of health care providers, including specialty providers; and  (6) a satisfactory grievance procedure and the ability to respond to enrollees' calls, questions, and complaints.  (B) A health group cooperative shall comply with federal laws applicable to cooperatives and group health insurance plans issued through cooperatives, to the extent required by this title or regulations adopted under them.  HISTORY: 2008 Act No. 180, Section 1, eff February 19, 2008.
SC Code § 38-71-1370 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1370. Applicability of certain code sections; late enrollees.

 (A) Except to the extent inconsistent with specific provisions of this article, all provisions of Article 5, are applicable to any insurance plans required to be offered by small employer insurers.  (B) Late enrollees may be excluded from coverage for the greater of eighteen months or an eighteen month preexisting condition exclusion; however, if both a period of exclusion from coverage and a preexisting condition exclusion are applicable to a late enrollee, the combined period may not exceed eighteen months.  HISTORY: 1994 Act No. 339, Section 7; 1997 Act No. 5, Section 14; 2001 Act No. 82, Section 26, eff July 20, 2001.
SC Code § 38-71-1380 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1380. Notification of intent to operate; certain reinsuring insurers not permitted to continue to reinsure health insurance plan.

 (A)(1) Within sixty days after the plan of operation is approved by the director under Section 38-71-1410, each small employer insurer shall notify the director of the insurer's intention to operate as a risk-assuming insurer or a reinsuring insurer. A small employer insurer seeking to operate as a risk-assuming insurer shall make an application pursuant to Section 38-71-1390.  (2) The decision shall be binding for a five-year period except that the initial decision shall be binding for two years. The director may permit an insurer to modify its decision at any time for good cause shown.  (3) The director shall establish an application process for small employer insurers seeking to change their status under this subsection. In the case of a small employer insurer that has been acquired by another such insurer, the director may waive or modify the time periods established in item (2).  (B) A reinsuring insurer that applies and is approved to operate as a risk-assuming insurer shall not be permitted to continue to reinsure any health insurance plan with the program. Such an insurer shall pay a prorated assessment based upon business issued as a reinsuring insurer for any portion of the year that the business was reinsured.  HISTORY: 1994 Act No. 339, Section 8.
SC Code § 38-71-1390 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1390. Application to become risk-assuming insurer; approval or denial; factors to consider.

 (A) Any small employer insurer may elect to become a risk-assuming insurer upon application to and approval by the director. A small employer insurer shall not be approved as a risk-assuming insurer if the director finds that the insurer is not capable of assuming that status pursuant to the criteria set forth in subsection (B) of this section. The insurer shall provide public notice of its application to become a risk-assuming insurer. A small employer insurer's application to be a risk-assuming insurer shall be approved unless disapproved by the director within sixty days after the insurer's application. A small employer insurer that has had its application to be a risk-assuming insurer disapproved may request and shall be granted a public hearing within sixty days after the disapproval.  (B) In determining whether or not to approve an application by a small employer insurer to become a risk-assuming insurer, the director shall consider the insurer's financial condition and the financial condition of its parent or guaranteeing corporation, if any; its history of assuming and managing risk; its ability to assume and manage the risk of enrolling small employers without the protection of the reinsurance provided in Section 38-71-1410; and its commitment to fairly market to all small employers.  HISTORY: 1994 Act No. 339, Section 9.
SC Code § 38-71-1400 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1400. Election to become reinsuring insurer.

 (A) A small employer insurer may elect to become a reinsuring insurer and operate under the provisions of this section and Section 38-71-1410.  (B) Each reinsuring insurer shall conduct business with its members and subscribers, and administer claims for coverage reinsured by the program, in the same manner as it would administer health claims that it writes without reinsurance.  HISTORY: 1994 Act No. 339, Section 10, eff July 1, 1995.
SC Code § 38-71-1420 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1420. Advisory committee.

 (A) The Governor shall appoint an advisory committee to the director which shall recommend the form and level of coverages to be made available by small employer insurers pursuant to Section 38-71-1360. At least one member of the committee shall be a licensed independent insurance agent who represents multiple health and accident insurance carriers. In preparing its initial recommendations, the advisory committee shall build on the work of the Governor's Committee on Basic Health Services.  (B) The committee shall recommend benefit levels, cost-sharing levels, exclusions and limitations for the basic health insurance plan and the standard health insurance plan. The committee shall specifically recommend which, if any, mandated coverages of health care services or health care providers should be included in the basic and standard health insurance plans and shall recommend as well whether the plans should be exempt from any other statutory provisions otherwise applicable to group health insurance policies. Section 38-71-200 is applicable to the basic and standard health insurance plans and is not subject to exemption. The committee also shall design a basic health insurance plan and a standard health insurance plan which contain benefit and cost-sharing levels that are consistent with the basic method of operation and the benefit plans of health maintenance organizations, including any restrictions imposed by federal law.  (1) The plans recommended by the committee may include cost containment features such as:  (a) utilization review of health care services, including review of medical necessity of hospital and physician services;  (b) case management;  (c) selective contracting with hospitals, physicians, and other health care providers;  (d) reasonable benefit differentials applicable to providers that participate or do not participate in arrangements using restricted network provisions; and  (e) other managed care provisions.  (2) The committee shall submit the health insurance plans described in paragraphs (A) and (B) to the director for approval by January 1, 1995. If, for any reason, the committee does not provide the director with a recommendation as to the form and level of coverages to be made available pursuant to this article, the board shall make such recommendation to the director. If, subsequent to the approval of the benefit levels of the basic and standard health insurance plans, amendments to the plans become necessary, the board shall make such recommendations to the director for his approval.  HISTORY: 1994 Act No. 339, Section 12.
SC Code § 38-71-1430 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1430. Annual public report.

 The board, in consultation with members of the committee, shall study and make a public report each year to the director on the effectiveness of this article. The report shall analyze the effectiveness of the act in promoting rate stability, product availability, and coverage affordability. The report shall include the total number of basic and standard policies sold in the State noting whether these insureds have ever been denied coverage before July 1, 1995. The report shall contain a detailed analysis of the financial condition of the reinsurance pool including losses and assessments by year. The report may contain recommendations for actions to improve the overall effectiveness, efficiency, and fairness of the small group health insurance marketplace. The report shall address whether insurers and agents are fairly marketing or issuing health insurance plans to small employers in fulfillment of the purposes of this article. The report may contain recommendations for market conduct or other regulatory standards or action.  HISTORY: 1994 Act No. 339, Section 13.
SC Code § 38-71-1445 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1445. Report on effectiveness of health group cooperatives.

 The South Carolina Department of Insurance and Revenue and Fiscal Affairs Office shall submit to the Office of the Governor and the General Assembly by January 1, 2010, a report on the effectiveness of the health group cooperative in expanding the availability of health insurance coverage for small employers.  HISTORY: 2008 Act No. 180, Section 1, eff February 19, 2008.  Code Commissioner's Note  At the direction of the Code Commissioner, references in this section to the offices of the former State Budget and Control Board, Office of the Governor, or other agencies, were changed to reflect the transfer of them to the Department of Administration or other entities, pursuant to the directive of the South Carolina Restructuring Act, 2014 Act No. 121, Section 5(D)(1).
SC Code § 38-71-1450 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1450. Promulgation of regulations.

 The Director of Insurance may promulgate regulations as may be necessary or appropriate to carry out the provisions of this article.  HISTORY: 1997 Act No. 5, Section 18.
SC Code § 38-71-1510 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1510. Short title.

 This article may be cited as the "Access to Emergency Medical Care Act".  HISTORY: 1998 Act No. 326, Section 1.
SC Code § 38-71-1520 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1520. Definitions.

 As used in this article:  (1) "Emergency medical care" means those health care services provided in a hospital emergency facility to evaluate and treat an emergency medical condition.  (2) "Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in:  (a) placing the health of the individual, or with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy;  (b) serious impairment to bodily functions; or  (c) serious dysfunction of any bodily organ or part.  (3) "Emergency medical provider" means hospitals licensed by the South Carolina Department of Health and Environmental Control, hospital-based services, physicians licensed by the State Board of Medical Examiners, and oral surgeons and dentists licensed by the State Board of Dentistry who provide emergency medical care.  (4) "Managed care organization" means a licensed insurance company, a hospital or medical services plan contract, a health maintenance organization, or any other entity which is subject to regulation by the department and which operates a managed care plan.  (5) "Managed care plan" means a plan operated by a managed care organization which provides for the financing and delivery of health care and treatment services to individuals enrolled in the plan through its own employed health care providers or contracting with selected specific providers that conform to explicit selection standards, or both. A managed care plan also customarily has a formal organizational structure for continual quality assurance, a certified utilization review program, dispute resolution, and financial incentives for individual enrollees to use the plan's participating providers and procedures.  HISTORY: 1998 Act No. 326, Section 1; 2016 Act No. 172 (H.5100), Section 1, eff May 12, 2016.  Effect of Amendment  2016 Act No. 172, Section 1, in (3), inserted reference to oral surgeons and dentists.
SC Code § 38-71-1530 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1530. Screening; initial intervention; role of managed care organization; payments to providers.

 (A) A patient who presents to an emergency department, by the Federal Social Security Act, must be screened to determine whether an emergency medical condition exists. This evaluation may include, but is not limited to, diagnostic testing to assess the extent of the condition, sickness, or injury and radiographic procedures and interpretation.  (B) Appropriate intervention must be initiated by medical personnel to stabilize any emergency medical condition before requesting authorization for the treatment by a managed care organization.  (C) A managed care organization shall inform its insureds, enrollees, patients, and affiliated providers about all policies related to emergency medical care access, coverage, payment, and grievance procedures. It is the ultimate responsibility of the managed care organization to inform any contracted third party administrator, independent contractor, or primary care provider about the emergency medical care provisions contained in this subsection.  (D) A managed care organization which includes emergency medical care services as part of its policy or contract shall provide coverage and shall subsequently pay providers for emergency medical care services provided to an insured, enrollee, or patient who presents an emergency medical condition. This subsection must not be construed to require coverage for illnesses, diseases, equipment, supplies, or procedures or treatments which are not otherwise covered under the terms of the insured's policy or contract.  (E) A managed care organization may not retrospectively deny or reduce payments to providers for emergency medical care of an insured, enrollee, or patient even if it is determined that the emergency medical condition initially presented is later identified through screening not to be an actual emergency, except in these cases:  (1) material misrepresentation, fraud, omission, or clerical error;  (2) a payment reduction due to applicable co-payments, coinsurance, or deductibles which may be the responsibility of the insured;  (3) cases in which the insured does not meet the emergency medical condition definition, unless the insured has been referred to the emergency department by the insured's primary care physician or other agent acting on behalf of the insurer.  HISTORY: 1998 Act No. 326, Section 1.
SC Code § 38-71-1540 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1540. Practice of discouraging use of 911 telephone system prohibited.

 No managed care organization may engage in any practice to prohibit or discourage the appropriate use of the 911 emergency telephone system which may adversely impact the health of its enrollees.  HISTORY: 1998 Act No. 326, Section 1.
SC Code § 38-71-1545 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1545. Exclusion of certain insurance policies.

 The provisions of this article do not apply to a policy which provides disability or income protection coverage, hospital confinement indemnity coverage, accident-only coverage, specified disease or specified accident coverage, long-term care coverage, vision-only coverage, or coverage issued as a supplement to Medicare.  HISTORY: 2016 Act No. 172 (H.5100), Section 2, eff May 12, 2016.
SC Code § 38-71-1550 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1550. Severability.

 If any provision of this article or the application of any provision to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the article which can be given effect without the invalid provision or application, and to this end the provisions of this article are severable.  HISTORY: 1998 Act No. 326, Section 1.
SC Code § 38-71-1710 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-1710. Short title.

 This article may be cited as the "South Carolina Patients' Insurance and Benefits Protection Act".  HISTORY: 1998 Act No. 441, Section 1.