For the purposes of this section, unless the context otherwise indicates, the following
terms have the following meanings.
A. "Dependent children" means children who are under 19 years of age and are children,
stepchildren or adopted children of, or children placed for adoption with, the enrollee,
member or spouse of the enrollee or member. [1993, c. 666, Pt. A, §7 (NEW).]
B. "Placed for adoption" means the assumption and retention of a legal obligation by
a person for the total or partial support of a child in anticipation of adoption of
the child. If the legal obligation ceases to exist, the child is no longer considered
placed for adoption. [1993, c. 666, Pt. A, §7 (NEW).]
1993, c. 666, Pt. A, §7 (RPR)
All individual or group coverage subject to this chapter must provide unmarried
enrollees with the same benefits or option of benefits for dependent children as is
extended to dependent children of married enrollees, at appropriate rates and under
the same terms and conditions.
1991, c. 200, Pt. B, §5 (NEW)
Financial dependency of dependent children on the enrollee or the spouse of the
enrollee may not be required as a condition for eligibility for coverage.
1991, c. 200, Pt. B, §5 (NEW)
All individual or group contracts issued in accordance with the requirements of
this section must provide the same benefits to dependent children placed for adoption
with the enrollee or spouse of the enrollee under the same terms and conditions as
apply to natural dependent children or stepchildren of the enrollee or spouse of the
enrollee, irrespective of whether the adoption has become final.
1993, c. 666, Pt. A, §8 (NEW)
Health maintenance organizations may not consider the availability or eligibility
for medical assistance under 42 United States Code, Section 13969, referred to as
"Medicaid," when considering coverage eligibility or benefit calculations for enrollees
and covered family members.
A. To the extent that payment for coverage expenses has been made under the Medicaid
program for health care items or services furnished to an individual, the State is
considered to have acquired the rights of the enrollee or family member to payment
by the health maintenance organization for those health care items or services. Upon
presentation of proof that the Medicaid program has paid for covered items or services,
the health maintenance organization shall make payment to the Medicaid program according
to the coverage provided in the contract or certificate. [1993, c. 666, Pt. B, §3 (NEW).]
B. A health maintenance organization may not impose requirements on a state agency
that has been assigned the rights of an individual eligible for Medicaid and covered
by an enrollee contract that are different from requirements applicable to an agent
or assignee of any other covered individual. [1993, c. 666, Pt. B, §3 (NEW).]
1993, c. 666, Pt. B, §3 (NEW)
1991, c. 200, §B5 (NEW).
1993, c. 666, §§A7,8,B3 (AMD).
Data for this page extracted on 12/03/2013 11:59:41.
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