20-1376. Prohibiting denial of certain
contract benefits
A. Notwithstanding any provision of any disability insurance contract, benefits
shall not be denied under the contract for any medical or surgical service performed by a
holder of a license issued pursuant to title 32, chapter 7 or 11, or a registered nurse
practitioner who is licensed pursuant to title 32, chapter 15, if the service performed
is within the lawful scope of such person's license, and if the service is surgical, such
person is a member of the staff of an accredited hospital, and if such contract would
have provided benefits if such service had been performed by a holder of a license issued
pursuant to title 32, chapter 13.
B. If any disability insurance contract provides for or offers eye care services,
the subscriber shall have freedom of choice to select either an optometrist or a
physician and surgeon skilled in diseases of the eye to provide the examination, care, or
treatment for which the subscriber is eligible and that falls within the scope of
practice of the optometrist or physician and surgeon. Unless such disability insurance
contract otherwise provides, there shall be no reimbursement for ophthalmic materials,
lenses, spectacles, eyeglasses or appurtenances to these materials or items.
C. If any individual disability insurance contract is written to provide coverage
for psychiatric, drug abuse or alcoholism services, reimbursement for such services shall
be made in accordance with the terms of the contract without regard to whether the
covered services are rendered in a psychiatric special hospital or general
hospital. Reimbursement for the cost of the service may be made directly to the person
licensed or certified pursuant to title 32, chapter 13 or 19.1 or to the subscriber if
the cost of the service has not been reimbursed to another provider or health care
institution.
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