H 4381 General Bill, By Bailey, Jennings, W.D. Keyserling, Richardson, Riser and 
Simrill

Similar(S 1019)
 A Bill to amend the Code of Laws of South Carolina, 1976, by adding Section
 38-71-215 so as to prohibit a health benefit policy from requiring as a
 condition for the coverage of dermatological services that the insured first
 obtain a referral from a primary care physician.

   12/20/95  House  Prefiled
   12/20/95  House  Referred to Committee on Labor, Commerce and Industry
   01/09/96  House  Introduced and read first time HJ-72
   01/09/96  House  Referred to Committee on Labor, Commerce and
                     Industry HJ-72

A BILL

TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-215 SO AS TO PROHIBIT A HEALTH BENEFIT POLICY FROM REQUIRING AS A CONDITION FOR THE COVERAGE OF DERMATOLOGICAL SERVICES THAT THE INSURED FIRST OBTAIN A REFERRAL FROM A PRIMARY CARE PHYSICIAN.

Whereas, it is the intent of the General Assembly 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 unfairly a patient's choice of direct access to providers of health care services and may not be in the public interest. Now, therefore,

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

SECTION 1. The 1976 Code is amended by adding:

"Section 38-71-215. (A) No health policy which is issued, delivered, issued for delivery, or renewed in this State may require as a condition for the coverage of dermatological services that an enrollee, subscriber, or insured first obtain a referral from a primary care physician.

(B) As used in this section:

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

(2) `Health benefit policy' means an 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 as defined in the health benefit policy."

SECTION 2. This act takes effect July 1, 1996, and applies to health benefit policies as defined in Section 38-71-215 of the 1976 Code, as added by Section 1 of this act, that are issued, delivered, issued for delivery, or renewed in this State after July 1, 1996.