AI-assisted research summary: If a disability insurance contract covers eye care, the subscriber can choose either an optometrist or an eye specialist physician for eligible services.
20-1406 - Prohibiting denial of certain contract benefits 20-1406. Prohibiting denial of certain contract benefits A. Notwithstanding any provision of any group disability insurance contract or blanket 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 group disability insurance contract or blanket disability insurance contract provides for or offers eye medical care services, whether by a network of health care providers or by the selection of a health care provider by the subscriber, 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 which falls within the scope of practice of the optometrist or physician and surgeon. This subsection does not require that any specific optometrist or physician, or number or percentage of optometrists or physicians, be included on an insurer's provider network. Unless a group disability insurance contract or blanket disability insurance contract otherwise provides, there shall be no reimbursement for ophthalmic materials, lenses, spectacles or eyeglasses or appurtenances thereto. C. If any group disability insurance contract is written to provide coverage for psychiatric, drug abuse or alcoholism services, reimbursement for those 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.