§ 63-313b

A. As used in this section: 1.a.'Health benefit plan' means a plan that:(1)provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, and(2)is offered by any insurance company, group hospital service corporation, the State and Education Employees Group Insurance Board, or a 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 U.S.C., Section 1001 et seq., by a multiple employer welfare arrangement as defined in Section 3 of the Employee Retirement Income Security Act of 1974, or any other analogous benefit arrangement, whether the payment is fixed or by indemnity.b.'Health benefit plan' shall not include:(1)a plan that provides coverage:(a)only for a specified disease or diseases or under an individual limited benefit policy,(b)only for accidental death or dismemberment,(c)for dental or vision care,(d)a hospital confinement indemnity policy,(e)disability income insurance or a

or under an individual limited benefit policy,(b)only for accidental death or dismemberment,(c)for dental or vision care,(d)a hospital confinement indemnity policy,(e)disability income insurance or a combination of accident-only and disability income insurance, or(f)as a supplement to liability insurance,(2)a Medicare supplemental policy as defined by Section 1882(g)(1) of the Social Security Act (42 U.S.C., Section 1395ss),(3)workers' compensation insurance coverage,(4)medical payment insurance issued as part of a motor vehicle insurance policy,(5)a long-term care policy, including a nursing home fixed indemnity policy, unless a determination is made that the policy provides benefit coverage so comprehensive that the policy meets the definition of a health benefit plan, or(6)short-term health insurance issued on a nonrenewable basis with a duration of six (6) months or less; and2. 'Prior authorization' means a utilization management criterion utilized to seek permission or waiver of a drug to be covered under a health prior authorization.B. Notwithstanding any other provision of law to the contrary, in order to establish uniformity in the submission of prior authorization forms,

a drug to be covered under a health prior authorization.B. Notwithstanding any other provision of law to the contrary, in order to establish uniformity in the submission of prior authorization forms, on or after January 1, 2015, a health benefit plan shall utilize prior authorization forms for obtaining any prior authorization for prescription drug benefits. A form shall not exceed three pages in length, excluding any instructions or guiding documentation and a health benefit plan may customize the content of the form specific to the prescription drug for which the prior authorization is being requested. A health benefit plan may make the form accessible through multiple computer operating systems. Additionally, upon request, the health benefit plan shall make a copy of the form available to the Insurance Commissioner.Added by Laws 2014, c. 264, § 1, eff. Nov. 1, 2014.