§ 27-60-5 - Justification of adverse insurance decisions.
SECTION 27-60-5
§ 27-60-5 Justification of adverseinsurance decisions. – A health carrier that takes an action that adversely affects a subject of abuseon the basis of a medical condition that the health carrier knows or has reasonto know is abuse-related shall explain the reason for its action to theapplicant or insured, in writing, and shall be able to demonstrate that itsaction, and any applicable plan provision:
(1) Does not have the purpose or effect of treating abusestatus as a medical condition or underwriting criterion;
(2) Is not based upon any actual or perceived correlationbetween a medical condition and abuse;
(3) Is permissible by law and applies in the same manner andto the same extent to all applicants and the insured with a similar medicalcondition without regard to whether the condition or claim is abuse-related; and
(4) Is based on a determination, made in conformance withsound actuarial principles and supported by reasonable statistical evidence,that there is a correlation between the medical condition and a materialincrease in insurance risk.