The national Medical Plans guide covers major medical design, managed care, HSAs and the ACA essential health benefits. This guide covers Mississippi's own health insurance statutes in Miss. Code 83-9. They include prompt payment with 3% monthly interest, newborn and immunization mandates, assignment of benefits and coordination of benefits.

Prompt payment of claims (83-9-5(1)(h))

Mandated benefits

• Newborns under family coverage are covered from the moment of birth, including congenital defects, prematurity and birth abnormalities (83-9-33).
  • If a specific premium is required, the policy may require notice within 31 days.
  • Newborn transportation is covered at usual and customary charges up to $200.
• Childhood immunizations: insurers must offer coverage from birth through 24 months, with no deductible, copay or coinsurance (83-9-34).

Other policy rules (83-9-3)

• A policy can't limit or exclude payment because the insured is eligible for Medicaid.
• A policy can't restrict assignment of benefits to licensed providers. The insurer must honor an assignment for 1 year.
• Policies are printed in at least 10-point type.

Coordination of benefits (Reg. 88-102)

• "Other plans" may include group and individual policies, HMOs, self-insured plans and auto med pay. They don't include Medicaid, hospital indemnity or specified-disease policies.
• Insurers using coordination provisions must disclose them in point-of-sale advertising and define "other health plans" in the policy.

Renewability labels (Reg. LA&H 62-1)

• Noncancelable may be used only when the insured can continue the policy to at least age 50 (or for 5 years if issued after 44), with no unilateral changes.
• Guaranteed renewable policies may have premiums changed by class.

Common exam traps

• Clean claims: 25 days electronic, 35 paper. Late payments earn 3% per month.
• Bad faith: up to 3 times the unpaid benefits.
• Newborn transport: $200. Immunizations to 24 months with no cost sharing.
• Medicaid eligibility can't be used to cut benefits.