reglab/housing_qa huggingface dataset:
SC Code § 38-71-242 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-242. Specified disease insurance policies; payment of claims and benefits.

 (A)(1) When used in any individual or group specified disease insurance policy in connection with the benefits payable for goods or services provided by any health care provider or other designated person or entity, the terms "actual charge", "actual charges", "actual fee", or "actual fees" shall mean the amount that the health care provider or other designated person or entity:  (a) agreed to accept, pursuant to a network or other agreement with a health insurer, third-party administrator, or other third-party payor, as payment in full for the goods or services provided to the insured;  (b) agreed or is obligated by operation of law to accept as payment in full for the goods or services provided to the insured pursuant to a provider, participation agreement, or supplier agreement under Medicare, Medicaid, or any other government administered health care program, where the insured is covered or reimbursed by such program; or  (c) if both subitems (a) and (b) of this subsection apply, the lowest amount determined under these two subitems; and  (2) must include any applicable deductibles, coinsurance requirements, or co-pay requirements applicable to the insured under any government administered health care program or any private primary health insurance coverage for the health care provider's goods or services provided to the insured.  (B) This section applies to any individual or group specified disease insurance policy issued to any resident of this State that contains the terms "actual charge", "actual charges", "actual fee", or "actual fees" and does not contain an express definition for the terms "actual charge", "actual charges", "actual fee", or "actual fees".  (C) Notwithstanding any other provision of law, after the effective date of this section, an insurer or issuer of any individual or group specified disease insurance policy shall not pay any claim or benefits based upon an actual charge, actual charges, actual fee, or actual fees under the applicable policy in an amount in excess of the "actual charge", "actual charges", "actual fee", or "actual fees" as defined in this section.  HISTORY: 2008 Act No. 265, Section 1, eff June 4, 2008.
SC Code § 38-71-245 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-245. Prohibited grounds for denial of enrollment to child of health plan participant.

 No health insurer, including a group health plan, as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974 or health maintenance organization as defined in Section 38-33-20, may deny enrollment of a child under the health plan of the child's parent on the grounds that the child:  (1) was born out of wedlock;  (2) is not claimed as a dependent on the parent's federal tax return; or  (3) does not reside with the parent or in the insurer's service area.  HISTORY: 1994 Act No. 481, Section 3.
SC Code § 38-71-246 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-246. Continuation of care; provider contract requirements.

 (A) Each provider contract must contain a continuation of care provision consistent with the language of Section 38-71-243.  (B) Nothing in this section prohibits a provider contract from providing continuation of care services greater than those required to be offered pursuant to subsection (A) or more favorable to the covered person than those required to be offered pursuant to subsection (A).  HISTORY: 2010 Act No. 143, Section 1, eff March 31, 2010.  Editor's Note  2010 Act No. 143, Sections 2 and 4, provide:  "SECTION 2. The Department of Insurance may promulgate regulations necessary for implementation of this act."  "SECTION 4. This act takes effect upon approval by the Governor and applies to an individual health plan, a group health plan, or a health benefit plan, including the state health plan, issued, renewed, delivered, or entered into after December 31, 2010."
SC Code § 38-71-247 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-247. Continuation of care; plain language description requirement.

 Each health insurance issuer shall include a plain language description of the continuation of care provisions set forth in Section 38-71-243 in the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage it provides to covered persons.  HISTORY: 2010 Act No. 143, Section 1, eff March 31, 2010.  Editor's Note  2010 Act No. 143, Sections 2 and 4, provide:  "SECTION 2. The Department of Insurance may promulgate regulations necessary for implementation of this act."  "SECTION 4. This act takes effect upon approval by the Governor and applies to an individual health plan, a group health plan, or a health benefit plan, including the state health plan, issued, renewed, delivered, or entered into after December 31, 2010."
SC Code § 38-71-250 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-250. Duties of insurer as to court-ordered health care coverage for child of eligible parent.

 If, pursuant to a court order which meets the specifications of Section 63-17-2110, a parent is required to provide health coverage for a child and the parent is eligible for family health coverage through a health insurer, including a group health plan as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974 or health maintenance organization as defined in Section 38-33-20, the insurer shall:  (1) permit the parent to enroll, under the family coverage, a child who is otherwise eligible for the coverage without regard to any enrollment season restrictions;  (2) if the parent is enrolled but fails to make application to obtain coverage for the child, enroll the child under family coverage upon application of:  (a) the child's other parent;  (b) the state agency administering the Medicaid program; or  (c) the state agency administering 42 U.S.C. Sections 651 to 669, the child support enforcement program; and  (3) continue coverage of the child unless the insurer is provided satisfactory written evidence that the:  (a) court order is no longer in effect;  (b) child is or will be enrolled in comparable health coverage through another insurer which will take effect not later than the effective date of disenrollment; or  (c) employer has eliminated family health coverage for all of its employees.  HISTORY: 1994 Act No. 481, Section 3.
SC Code § 38-71-255 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-255. Health insurer may not impose different requirements on state agency.

 A health insurer, including a group health plan as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974 or health maintenance organization as defined in Section 38-33-20, may not impose requirements on a state agency, which has been assigned the rights of an individual eligible for medical assistance under Medicaid who is also covered under a plan issued by the health insurer, that are different from requirements applicable to an agent or assignee of any other individual so covered.  HISTORY: 1994 Act No. 481, Section 3.
SC Code § 38-71-260 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-260. Duties of health insurer of child to custodial parent.

 If a child has health coverage through the health insurer including a group health plan, as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974 or health maintenance organization as defined in Section 38-33-20, of a noncustodial parent, the insurer shall:  (1) provide information to the custodial parent as may be necessary for the child to obtain benefits through that coverage;  (2) permit the custodial parent or the health care provider, with the custodial parent's approval, to submit claims for covered services without the approval of the noncustodial parent; and  (3) make payments on claims submitted in accordance with item (2) directly to the custodial parent, the provider, or the state Medicaid agency.  HISTORY: 1994 Act No. 481, Section 3.
SC Code § 38-71-265 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-265. Health insurer not to consider State medical assistance; subrogation of state to right to insurance payment for health care.

 (A) In enrolling a person or in making any payments for benefits to a person or on behalf of a person, no health insurer, including a group health plan as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974 or health maintenance organization as defined in Section 38-33-20, may take into account that the person is eligible for or is provided medical assistance under a State Plan for Medical Assistance pursuant to Title XIX of the Social Security Act.  (B) In a case where a health insurer, including a group health plan as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974 or health maintenance organization as defined in Section 38-33-20, has a legal liability to make payments for medical assistance to or on behalf of a person, to the extent that payment has been made under a State Plan for Medical Assistance pursuant to Title XIX of the Social Security Act for health care items or services furnished to the person, the State is considered to have acquired the rights of the person to the payment for the health care items or services.  HISTORY: 1994 Act No. 481, Section 3.
SC Code § 38-71-275 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-275. Insurance coverage for certain drugs not to be excluded from policy definitions.

 (A) No insurance policy which provides coverage for drugs shall exclude coverage of any such drug used for the treatment of cancer on the grounds that the drug has not been approved by the Federal Food and Drug Administration for the treatment of the specific type of cancer for which the drug has been prescribed; provided, that such drug is recognized for treatment of that specific type of cancer in one of the standard reference compendia or in the medical literature.  (B) This section shall not be construed to:  (1) alter existing law with regard to provisions limiting the coverage of drugs that have not been approved by the Federal Food and Drug Administration;  (2) require coverage for any drug when the Federal Food and Drug Administration has determined its use to be contraindicated;  (3) require coverage for experimental drugs not otherwise approved for any indication by the Federal Food and Drug Administration;  (4) create, impair, alter, limit, modify, enlarge, abrogate, or prohibit reimbursement for drugs used in the treatment of any other disease or condition.  (C) For purposes of this section:  (1) "Insurance policy" means an individual, group, or blanket policy written by a medical expense indemnity corporation, a hospital service corporation, a health care service plan contract, or a private insurance plan issued, amended, delivered, or renewed in this State or which provides insurance for residents of this State.  (2) "Standard reference compendia" means:  (a) the United States Pharmacopoeia Drug Information;  (b) the American Medical Association Drug Evaluations; or  (c) the American Hospital Formulary Service Drug Information.  (3) "Medical literature" means two articles from major peer-reviewed professional medical journals that have recognized, based on scientific or medical criteria, the drug's safety and effectiveness for treatment of the indication for which it has been prescribed unless one article from major peer-reviewed professional medical journals has concluded, based on scientific or medical criteria, that the drug is unsafe or ineffective or that the drug's safety and effectiveness cannot be determined for the treatment of the indication for which it has been prescribed.  HISTORY: 1996 Act No. 351, Section 1.
SC Code § 38-71-315 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-315. Decrease of premium charges.

 Any insurer of individual accident and health insurance may at any time, except when required by law or order of the director or his designee, voluntarily decrease its premium charge for any approved policy form without the prior approval of the director or his designee. However, the insurer must notify the director or his designee and the consumer advocate for information thirty days prior to the use of the revised premium charge. Notwithstanding any other provision of law, any time within one year after using such revised premium charge, the insurer may return its premium charge back to the previously approved level by informing the director or his designee and the consumer advocate of the revision thirty days prior to the effective date. The director or his designee may not disapprove such revision.  HISTORY: 1989 Act No. 90, Section 2; 1993 Act No. 181, Section 754.
SC Code § 38-71-320 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-320. Policies issued for delivery in another state.

 If a policy is issued by an insurer domiciled in this State for delivery to a person residing in another state and if the official having responsibility for the administration of the insurance laws of the other state has advised the director or his designee that the policy is not subject to approval or disapproval by the official, the director or his designee may by ruling require that the policy meet the standards set forth in Sections 38-71-330, 38-71-340, and 38-71-370.  HISTORY: Former 1976 Code Section 38-35-430 [1956 (49) 2029; 1962 Code Section 37-473] recodified as Section 38-71-320 by 1987 Act No. 155, Section 1; 1993 Act No. 181, Section 755.
SC Code § 38-71-330 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-330. Form of policies.

 No policy of accident and health insurance may be delivered or issued for delivery to any person in this State unless:  (1) The entire money and other considerations therefor are expressed therein.  (2) The time at which the insurance takes effect and terminates is expressed therein.  (3) It purports to insure only one individual, except that a policy may insure, originally or by subsequent amendment, upon the application of an adult member of a family who is considered the policyholder, any two or more eligible members of that family, including husband, wife, dependent children, or any children under a specified age which may not exceed nineteen years, and any other individual dependent upon the policyholder.  (4) The style, arrangement, and overall appearance of the policy give no undue prominence to any portion of the text and every printed portion of the text of the policy and of any endorsements or attached papers is plainly printed in light-faced type of a style in general use, the size of which must be uniform and not less than ten-point with a lower-case unspaced alphabet length not less than one-hundred-and-twenty-point (the "text" includes all printed matter except the name and address of the insurer, name or title of the policy, the brief description, if any, and captions and subcaptions).  (5) The exceptions and reductions of indemnity are set forth in the policy and, except those which are set forth in Sections 38-71-340 and 38-71-370, are printed, at the insurer's option, either included with the benefit provision to which they apply or under an appropriate caption such as "EXCEPTIONS" or "EXCEPTIONS AND REDUCTIONS". However, if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of the exception or reduction must be included with the benefit provision to which it applies.  (6) Each form, including riders and endorsements, is identified by a form number in the lower left-hand corner of the first page thereof.  (7) It contains no provision purporting to make any portion of the charter, rules, constitution, or bylaws of the insurer a part of the policy unless that portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks or short-rate table filed with the department.  HISTORY: Former 1976 Code Section 38-35-420 [1947 (45) 322; 1948 (45) 1734; 1952 Code Section 37-472, 37-500; 1956 (49) 2029; 1962 Code Section 37-472] recodified as Section 38-71-330 by 1987 Act No. 155, Section 1; 1993 Act No. 181, Section 757.
SC Code § 38-71-335 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-335. Accident and/or health insurance cancellation provision prohibited; optionally renewable policies prohibited; notice of nonrenewal.

 (A) No individual or family accident, health, or accident and health insurance policy may contain a provision which gives the insurer the right to cancel the policy. "To cancel" means to terminate a policy at a date other than the policy anniversary date or the premium due date.  (B) For individual or family accident, health, or accident and health insurance policies, excluding individual health insurance coverage as defined in Section 38-71-670, individual or family accident, health, or accident and health insurance policies may not be written on an optionally renewable basis. "Optionally renewable" means a contract of insurance in which the insurer reserves the right to terminate the coverage at the policy anniversary date. Optionally renewable does not include the following categories of policies as defined by the department by regulation: (1) "nonrenewable for stated reasons only"; and (2) "conditionally renewable". Term insurance is not considered insurance written on an optionally renewable basis. For individual health insurance coverage as defined in Section 38-71-670, Section 38-71-675 relating to guaranteed renewability of individual health insurance coverage shall apply.  (C) An individual or family accident, health, or accident and health insurance policy which may be nonrenewed, may be nonrenewed at the policy anniversary date or premium due date. The insurer shall give the insured at least thirty-one days' written notice of nonrenewal. Nonrenewal by the insurer is without prejudice to any claims originating before the effective date of nonrenewal. No written notice shall be required for failure to pay premiums except as provided in Section 38-71-110. For individual health insurance coverage as defined in Section 38-71-670, the notification requirements of Section 38-71-675(C) shall apply.  HISTORY: 1988 Act No. 394, Section 2; 1993 Act No. 181, Section 758; 1997 Act No. 5, Section 5.
SC Code § 38-71-350 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-350. Required provision for continuation of coverage for handicapped and dependent children of policyholder.

 An individual hospital or medical expense insurance policy, hospital service plan contract, or medical service plan contract delivered or issued for delivery in this State which provides that coverage of a dependent child terminates upon attainment of the limiting age for dependent children specified in the policy or contract shall also provide in substance that attainment of the limiting age does not operate to terminate the coverage of the child while the child is and continues to be both (a) incapable of self-sustaining employment by reason of intellectual disability or physical handicap and (b) chiefly dependent upon the policyholder or subscriber for support and maintenance, so long as proof of the incapacity and dependency is furnished to the insurer by the policyholder or subscriber within thirty-one days of the child's attainment of the limiting age and subsequently as may be required by the insurer but not more frequently than annually after the two-year period following the child's attainment of the limiting age.  HISTORY: Former 1976 Code Section 38-35-450 [1962 Code Section 37-474.1; 1970 (56) 2464] recodified as Section 38-71-350 by 1987 Act No. 155, Section 1.
SC Code § 38-71-360 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-360. Continuation of coverage for nonhandicapped dependent children.

 An individual hospital, medical, or surgical expense incurred insurance policy, hospital service plan contract, or medical service plan contract, other than a limited classification policy, delivered or issued for delivery in this State which provides that coverage of a nonhandicapped dependent child terminates upon attainment of the limiting age for the child as specified in the policy or contract shall also contain a provision to the effect that upon the attainment of the limiting age the child is entitled to have issued to him, without evidence of insurability, upon application made to the insurer within thirty days following the attainment of the age, and upon payment of the appropriate premium, an individual policy of accident and health insurance. The policy shall provide the coverage then being issued by the insurer which is closest to, but not greater than, the terminated coverage. Any probationary or waiting period set forth in the policy must be considered as met to the extent coverage was in force under the prior policy. For purposes of this section, "limited classification policy" means an accident-only policy, a limited accident policy, a travel accident policy, or a specified disease policy.  HISTORY: Former 1976 Code Section 38-35-455 [1983 Act No. 59] recodified as Section 38-71-360 by 1987 Act No. 155, Section 1.
SC Code § 38-71-380 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-380. Medical expense policy; optional intoxicants and narcotics exclusion inapplicable.

 (A) For purposes of this section, "medical expense policy" means an accident and sickness insurance policy that provides hospital, medical, and surgical expense coverage.  (B) The provisions of Section 38-71-370(9) may not be used with respect to a medical expense policy.  (C) This section applies to policies issued or renewed after December 31, 2017.  HISTORY: 2017 Act No. 42 (S.9), Section 1, eff May 19, 2017.
SC Code § 38-71-410 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 71 - Accident And Health Insurance|Section 38-71-410. Omission or modification of required or optional provisions.

 If any provision of Sections 38-71-340 and 38-71-370 is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the director or his designee, shall omit from the policy any inapplicable provision or part of a provision and shall modify any inconsistent provision or part of the provision in a manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.  HISTORY: Former 1976 Code Section 38-35-470 [1947 (45) 322; 1952 Code Section 37-499; 1956 (49) 2029; 1962 Code Section 37-476] recodified as Section 38-71-410 by 1987 Act No. 155, Section 1; 1993 Act No. 181, Section 761.