State Law

North Dakota Century Code-Title 26.1-Chapter. 26.1-36. Accident and Health Insurance

08/15/2023 North Dakota Section 26.1-36-47

Internal claims and appeals procedures

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines

This N.D. law incorporates the requirements of ERISA’s requirements, including requirements pertaining to the categories of Medical Necessity Decisions-Deadlines and Medical Necessity Appeals-Deadlines

An insurance company, nonprofit health services corporation, or health maintenance organization may not deliver, issue, execute, or renew any health insurance policy, health service contract, or evidence of coverage on an individual, group, blanket, franchise, or association basis unless the policy, contract, or evidence of coverage meets the minimum requirements of 42 U.S.C. 300gg-19 and complies with 29 U.S.C. 1133, 29 CFR 2560.503-1; 42 U.S.C. 300gg-19, 26 CFR 54.9815-2719T; 29 U.S.C. 1185d, 29 CFR 2590.715-2719; and 26 U.S.C. 9815, 45 CFR 147.136. The insurance commissioner may take steps necessary to ensure compliance with this section. If federal laws or rules relating to internal claims and appeals are amended, repealed, or otherwise changed, the insurance commissioner shall adopt rules to ensure the internal claims and appeals procedure is in compliance with and substantively equivalent to the federal requirements.