H 4326 General Bill, By D.C. Waldrop, Bailey, Inabinett, W.D. Keyserling, 
Richardson, Seithel and Simrill

Similar(S 1020)
 A Bill to amend the Code of Laws of South Carolina, 2976, by adding Section
 38-71-273 so as to provide that a health benefit policy of insurance may not
 require as a condition to the coverage of dermatological services that an
 enrollee, subscriber, or insured first obtain a referral from a primary care
 physician.

   12/06/95  House  Prefiled
   12/06/95  House  Referred to Committee on Labor, Commerce and Industry
   01/09/96  House  Introduced and read first time HJ-56
   01/09/96  House  Referred to Committee on Labor, Commerce and
                     Industry HJ-56

A BILL

TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-273 SO AS TO PROVIDE THAT A HEALTH BENEFIT POLICY OF INSURANCE MAY NOT REQUIRE AS A CONDITION TO THE COVERAGE OF DERMATOLOGICAL SERVICES THAT AN ENROLLEE, SUBSCRIBER, OR INSURED FIRST OBTAIN A REFERRAL FROM A PRIMARY CARE PHYSICIAN.

Be it enacted by the General Assembly of the State of South Carolina:

SECTION 1. The intent of the General Assembly in enacting this act is to encourage health care cost containment while preserving the quality of care offered to citizens of this State. The General Assembly finds that there is an increasing number of health insurance benefit providers which require a referral from a primary care physician to a dermatologist as a condition of the payment of benefits to an insured patient. The General Assembly finds that such a requirement blocks a patient's choice of direct access to cost-effective dermatological services and may not be in the public interest.

SECTION 2. The 1976 Code is amended by adding:

"Section 38-71-273. (A) As used in this section, the term:

(1) `Dermatological services' means services ordinarily and customarily rendered by a physician specializing in the practice of dermatology.

(2) `Health benefit policy' means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, or renewed in this State by a health care corporation, health maintenance organization, accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit medical service corporation, or similar entity.

(3) `Primary care physician' means a physician who is so defined by a health benefit policy or elsewhere.

(B) Notwithstanding any other provision of law, a health benefit policy of insurance issued, delivered, issued for delivery, or renewed in this State may not require as a condition to the coverage of dermatological services that an enrollee, subscriber, or insured first obtain a referral from a primary care physician."

SECTION 3. This act takes effect upon approval by the Governor and applies to health benefit policies of insurance issued, delivered, issued for delivery, or renewed in this State on or after July 1, 1996.