South Carolina Code 38-71-1365. Small employer insurer requirements; compliance with federal laws applicable to cooperatives
(1) that the insurer or health maintenance organization is licensed and in good standing with the Department of Insurance;
Terms Used In South Carolina Code 38-71-1365
- Contract: A legal written agreement that becomes binding when signed.
- cooperative: means a private purchasing cooperative composed of small employers formed under this article. See South Carolina Code 38-71-1330
- Department: means the Department of Insurance of South Carolina. See South Carolina Code 38-1-20
- insurance: includes annuities. See South Carolina Code 38-1-20
- Insurer: means an entity that provides health insurance in this State. See South Carolina Code 38-71-1330
- Small employer: means , in connection with a health insurance plan with respect to a calendar year and a plan year, any person, firm, corporation, partnership, association, or employer, as defined in Section 3(5) of the Employee Retirement Income Security Act of 1974, that is actively engaged in business that, on at least fifty percent of its working days during the preceding calendar year, employed no more than fifty eligible employees or employed an average of not more than fifty employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year. See South Carolina Code 38-71-1330
(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.