Article 1 General Provisions
Article 3 Individual Accident and Health Policies
Article 5 Group Accident and Health Insurance
Article 9 Blanket Accident and Health Insurance
Article 11 Franchise Accident and Health Insurance
Article 13 Small Employer Health Insurance Availability Act
Article 15 Access to Emergency Medical Care Act
Article 17 Patients’ Insurance and Benefits Protection Act
Article 18 Pharmacy Audit Rights
Article 19 Health Carrier External Review Act
Article 20 Pharmacy Benefit Managers

Terms Used In South Carolina Code > Title 38 > Chapter 71

  • Accident and health insurance: means insurance of human beings against death or personal injury by accident, and each insurance of human beings against sickness, ailment, and any type of physical disability resulting from accident or disease, and prepaid dental service, but not including coverages required by the Workers' Compensation Law of this State. See South Carolina Code 31-3-580
  • Administrator: means the administrator of the Department of Consumer Affairs. See South Carolina Code 38-71-355
  • Administrator: means the individual to whom the director has delegated authority to administer the programs of a specific board or of a professional or occupational group for which the department has regulatory authority or has delegated authority to administer the programs of a specific board;

    (2) "Authorization to practice" or "Practice authorization" means the approval to practice the specified profession, engage in the specified occupation, or use a title protected under this article, which has been granted by the applicable board. See South Carolina Code 40-1-20
  • Admitted assets: means assets of an insurer considered admitted on the most recent statutory financial statement of the insurer filed with the department pursuant to Section 38-13-80. See South Carolina Code 31-3-580
  • Alarm business: means an entity that is licensed by the South Carolina Contractor's Licensing Board to engage in the burglar or fire alarm system business, or both. See South Carolina Code 38-71-1350
  • Alarm technician: means an individual that specializes in any activity or work related to the set-up or installation, repair, alteration, or connection of an alarm system to a client's property. See South Carolina Code 38-71-1350
  • Annuity: means each contract or agreement to make periodic payments, whether in fixed or variable dollar amounts, or both, at specified intervals. See South Carolina Code 31-3-580
  • Applicant: means a business seeking to be licensed under this chapter or seeking the renewal of a license under this chapter. See South Carolina Code 38-71-355
  • Appointment: means an individual designated by an official or authorized representative of an authorized insurer to act on its behalf as a producer. See South Carolina Code 31-3-580
  • ASHA: means the American Speech-Language Hearing Association. See South Carolina Code 38-71-190
  • Assigned employee: means a person performing services for a client company as affected by a contract between a licensee and client company in which employment responsibilities are shared. See South Carolina Code 38-71-355
  • Audiologist: means an individual who practices audiology. See South Carolina Code 38-71-190
  • Basic health insurance plan: means a lower cost health insurance plan developed pursuant to Section 38-71-1420. See South Carolina Code 38-71-1330
  • Bid: means an offer to furnish labor, equipment or materials, or other services regulated by this chapter. See South Carolina Code 38-71-1350
  • Board: means the South Carolina State Board of Examiners in Speech-Language Pathology and Audiology. See South Carolina Code 38-71-190
  • Board: means the State Board of Registration for Geologists. See South Carolina Code 38-71-750
  • Board: means the South Carolina Contractor's Licensing Board. See South Carolina Code 38-71-1350
  • Board: means the board of directors of the program established pursuant to Section 38-71-1410. See South Carolina Code 38-71-1330
  • Burglar alarm system business: means a person, firm, association, partnership, corporation, or other legal entity authorized by law and approved by the board that designs, installs, services, maintains, or alters burglar alarm systems and heat and smoke sensors installed within a burglar alarm system; a burglar alarm system detects intrusion, burglary, and breaking or entering but does not include home health care signaling devices. See South Carolina Code 38-71-1350
  • Certificate of insurance: means a memorandum copy, complete or abbreviated, of an insurance contract. See South Carolina Code 31-3-580
  • Claim: means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or device. See South Carolina Code 38-71-2110
  • Client company: means a person that contracts with a licensee and is assigned employees by the licensee under that contract. See South Carolina Code 38-71-355
  • Closed panel health plan: means a network plan that requires an insured or a member to seek covered health care services or supplies, except in the case of emergency, exclusively from network providers. See South Carolina Code 38-71-1720
  • Coinsurance: means a stipulation or requirement that the insured undertakes to be his own insurer to the extent that he fails to maintain insurance of a given percentage of the value of the property against loss or damage. See South Carolina Code 31-3-580
  • Commission: means the part of the premium paid to the producer as compensation for his services. See South Carolina Code 31-3-580
  • Commission: means the group of individuals charged by law with the responsibility of licensing or otherwise regulating an occupation or profession within the State. See South Carolina Code 40-1-20
  • Committee: means the advisory committee to the commissioner referred to in Section 38-71-1420. See South Carolina Code 38-71-1330
  • Company: includes a corporation, fraternal organization, burial association, other association, partnership, society, order, individual, or aggregation of individuals engaging or proposing or attempting to engage as principals in any kind of insurance or surety business, including the exchanging of reciprocal or interinsurance contracts between individuals, partnerships, and corporations. See South Carolina Code 31-3-580
  • Contractor: means an entity licensed to engage in the burglar or fire alarm system business. See South Carolina Code 38-71-1350
  • Controlling person: means :

    (a) an officer or director of a corporation seeking to offer professional employer services, a shareholder holding ten percent or more of the voting stock of a corporation seeking to offer professional employer services, or a partner of a partnership seeking to offer professional employer services;

    (b) an individual who possesses, directly or indirectly, the power to direct or cause the direction of the management or policies of a company seeking to offer professional employer services through the ownership of voting securities, by contract or otherwise, and who is actively involved in the day-to-day management of the company; or

    (c) an individual employed, appointed, or authorized by a business seeking to offer professional employer services to enter into a contractual relationship with a client company on behalf of the business. See South Carolina Code 38-71-355
  • cooperative: means a private purchasing cooperative composed of small employers formed under this article. See South Carolina Code 38-71-1330
  • Customer service personnel: means an individual working for a licensed alarm entity that provides support for customer problems, complaints, questions, and concerns involving an alarm system. See South Carolina Code 38-71-1350
  • Department: means the Department of Labor, Licensing and Regulation. See South Carolina Code 38-69-260
  • Department: means the South Carolina Department of Consumer Affairs. See South Carolina Code 38-71-355
  • Department: means the Department of Insurance of South Carolina. See South Carolina Code 31-3-580
  • Department: means the Department of Labor, Licensing and Regulation. See South Carolina Code 38-71-1350
  • Department: means the Department of Labor, Licensing and Regulation;

    (5) "Director" means the Director of the Department of Labor, Licensing and Regulation or the director's official designee;

    (6) "Licensee" means a person granted an authorization to practice pursuant to this article and refers to a person holding a license, permit, certification, or registration granted pursuant to this article;

    (7) "Licensing act" means the individual statute or regulations, or both, of each regulated profession or occupation which include, but are not limited to, board governance, the qualifications and requirements for authorization to practice, prohibitions, and disciplinary procedures;

    (8) "Person" means an individual, partnership, or corporation;

    (9) "Profession" or "occupation" means a profession or occupation regulated or administered, or both, by the department pursuant to this article. See South Carolina Code 40-1-20
  • Dependent: means a spouse, an unmarried child under the age of nineteen years, an unmarried child who is a full-time student between the ages of nineteen and twenty-two and who is financially dependent upon the parent, and an unmarried child of any age who is medically certified as disabled and dependent upon the parent. See South Carolina Code 38-71-1330
  • Designee or deputy director: means the person or persons appointed by the director, serving at the will and pleasure of the director as his designee, to supervise and carry out the functions and duties of the department as provided by law. See South Carolina Code 31-3-580
  • Director: means the Director of the Department of Labor, Licensing and Regulation. See South Carolina Code 38-71-190
  • Director: means the person who is appointed by the Governor upon the advice and consent of the Senate and who is responsible for the operation and management of the department. See South Carolina Code 31-3-580
  • Director: means the Director of the Department of Insurance of this State. See South Carolina Code 38-71-1330
  • Domestic insurer: means an insurer incorporated or organized under the laws of this State. See South Carolina Code 31-3-580
  • Eligible employee: means an employee:

    (a) as defined in Section 38-71-710(1) or Section 38-71-840(7) who works on a full-time basis and has a normal workweek of thirty or more hours; or

    (b) who is a licensed real estate person engaged in the sale, leasing, or rental of real estate for a licensed real estate broker on a straight commission basis, who has signed a valid independent contractor agreement with the broker who works on a full-time basis and has a normal workweek of thirty or more hours. See South Carolina Code 38-71-1330
  • Emergency medical care: means those health care services provided in a hospital emergency facility to evaluate and treat an emergency medical condition. See South Carolina Code 38-71-1520
  • Emergency medical condition: means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in:

    (a) placing the health of the individual, or with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy;

    (b) serious impairment to bodily functions; or

    (c) serious dysfunction of any bodily organ or part. See South Carolina Code 38-71-1520
  • Employees: as used in this article includes, for the purposes of insurance hereunder, as employees of a single employer, the officers, managers, and employees of the employer and of subsidiary or affiliated corporations of a corporate employer and the individual proprietors, partners, and employees of individuals and firms the business of which is controlled by the insured employer through stock ownership, contract, or otherwise. See South Carolina Code 38-71-710
  • Employer: as used in this article may include any municipal corporation or the proper officers, as such, of any unincorporated municipality or any department of the municipal corporation or unincorporated municipality determined by conditions pertaining to the employment. See South Carolina Code 38-71-710
  • Entire work force: means all persons engaged by a client company and are employees as defined in Title 42 including persons considered employees under Sections 42-1-400, 42-1-410, and 42-1-420. See South Carolina Code 38-71-355
  • Entity: means a sole proprietorship, partnership, limited liability partnership, limited liability company, association, joint venture, cooperative, corporation, or other legal entity authorized by law and approved by the board. See South Carolina Code 38-71-1350
  • Fire alarm system business: means an individual, firm, association, partnership, corporation, or other legal entity authorized by law and approved by the board that designs, installs, services, maintains, or alters fire alarm systems. See South Carolina Code 38-71-1350
  • Foreign insurer: means an insurer incorporated or organized under the laws of the United States or of any jurisdiction within the United States other than this State. See South Carolina Code 31-3-580
  • Geologist: means a person with special knowledge of the science of geology, hydrology, geophysics, and related earth sciences and principles and methods of geological analysis acquired by professional education and practical experience. See South Carolina Code 38-71-750
  • Geologist-in-training: means a person who possesses the qualifications prescribed in Section 40-77-230 and who has been certified as a geologist-in-training. See South Carolina Code 38-71-750
  • Geology: means the science dealing with the earth and its history; investigation, prediction, and location of the materials and structures which compose it; the natural processes that cause change in the earth; and the applied science of utilizing knowledge of the earth and its constituent rocks, minerals, liquids, gases, and other materials for the benefit of mankind. See South Carolina Code 38-71-750
  • group health insurance policy: is a policy or contract which insures against disablement, disease, or sickness of the insured, excluding disablement which results from accident or from accidental means, which covers more than one person, except blanket health policies, family health policies, franchise health policies, and accident and health policies. See South Carolina Code 38-71-710
  • Health insurance coverage: means coverage as defined in Section 38-71-840(14). See South Carolina Code 38-71-1720
  • Individual: means a natural person. See South Carolina Code 38-71-1350
  • Installs: means activity or work which involves the set-up, installation, or connection of alarm system equipment in any manner to a client's property. See South Carolina Code 38-71-1350
  • insurance: includes annuities. See South Carolina Code 31-3-580
  • Insurance company: means an "insurer". See South Carolina Code 31-3-580
  • insured: as used in this article may not be construed as preventing a person other than the insured, with a proper insurable interest, from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits, and rights provided therein. See South Carolina Code 38-71-640
  • Insurer: includes a corporation, fraternal organization, burial association, other association, partnership, society, order, individual, or aggregation of individuals engaging or proposing or attempting to engage as principals in any kind of insurance or surety business, including the exchanging of reciprocal or interinsurance contracts between individuals, partnerships, and corporations. See South Carolina Code 31-3-580
  • Insurer: means an entity that provides health insurance in this State. See South Carolina Code 38-71-1330
  • Intern: means an individual who has met the requirements for licensure as a speech-language pathology or audiology intern under this chapter and has been issued this license by the board. See South Carolina Code 38-71-190
  • License: means an authorization to practice speech-language pathology or audiology issued by the board pursuant to this chapter and includes an authorization to practice as a speech-language pathology intern, an audiology intern, and a speech-language pathology assistant. See South Carolina Code 38-71-190
  • License: means a document issued by the state's director or his designee authorizing a person to act as an insurance producer for the lines of authority specified in the document. See South Carolina Code 31-3-580
  • Licensee: means an individual who has met the requirements for licensure under this chapter and has been issued a license for speech language pathology or audiology or for speech language pathology or audiology intern or speech-language pathology assistant. See South Carolina Code 38-71-190
  • Licensee: means a person licensed under this chapter as a professional employer organization to provide professional employer services. See South Carolina Code 38-71-355
  • Licensee: means an alarm business that has been issued a license by the board pursuant to this chapter. See South Carolina Code 38-71-1350
  • Life insurance: means a contract of insurance upon the lives of human beings. See South Carolina Code 31-3-580
  • List: means the list of drugs for which a pharmacy benefit manager has established a maximum allowable cost. See South Carolina Code 38-71-2110
  • Managed care organization: means a licensed insurance company, a hospital or medical services plan contract, a health maintenance organization, or any other entity which is subject to regulation by the department and which operates a managed care plan. See South Carolina Code 38-71-1520
  • Maximum allowable cost: means the maximum amount that a pharmacy benefit manager will reimburse a pharmacist or pharmacy for the cost of a generic drug. See South Carolina Code 38-71-2110
  • Monitoring personnel: means an individual that performs daily office functions observing the operation and activation of alarm systems from a monitoring station. See South Carolina Code 38-71-1350
  • Negotiate: means the act of conferring directly with or offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance concerning substantive benefits, terms, or conditions of the contract, provided that the person engaged in that act either sells insurance or obtains insurance from insurers for purchasers. See South Carolina Code 31-3-580
  • Network plan: means a health insurance plan issued by an insurer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the insurer. See South Carolina Code 38-71-1330
  • Network plan: means a plan as defined in Section 38-71-840(24). See South Carolina Code 38-71-1720
  • Network providers: means those entities and individuals who provide covered health care services or supplies to an insured or a member pursuant to a contract with a network plan to act as a participating provider. See South Carolina Code 38-71-1720
  • Network providers: means those pharmacists and pharmacies who provide covered health care services or supplies to an insured or a member pursuant to a contract with a network plan to act as a participating provider. See South Carolina Code 38-71-2110
  • Person: means an individual, organization, or corporation, except that only individuals can be licensed under this chapter. See South Carolina Code 38-71-190
  • Person: means an individual, association, corporation, partnership, or other private legal entity. See South Carolina Code 38-71-355
  • Person: means a corporation, agency, partnership, association, voluntary organization, individual, or another entity, organization, or aggregation of individuals. See South Carolina Code 31-3-580
  • Pharmacy benefit manager: means an entity that contracts with pharmacists or pharmacies on behalf of an insurer, third party administrator, or the South Carolina Public Employee Benefit Authority to:

    (a) process claims for prescription drugs or medical supplies or provide retail network management for pharmacies or pharmacists;

    (b) pay pharmacies or pharmacists for prescription drugs or medical supplies; or

    (c) negotiate rebates with manufacturers for drugs paid for or procured as described in this section. See South Carolina Code 38-71-2110
  • plan: means any hospital or medical policy or certificate, major medical expense insurance, hospital or medical service plan contract, or health maintenance organization subscriber contract that provides benefits consisting of medical care provided directly through insurance or reimbursement, or otherwise and including items and services paid for medical care. See South Carolina Code 38-71-1330
  • Plan of operation: means the plan of operation of the program established pursuant to Section 38-71-1410. See South Carolina Code 38-71-1330
  • Point-of-service option: means a network plan that provides benefits for services or supplies provided by network providers and provides benefits for services or supplies provided by nonparticipating network providers. See South Carolina Code 38-71-1720
  • Policy: means a contract of insurance. See South Carolina Code 31-3-580
  • practice of audiology: means the rendering of or the offering to render any audiology service to an individual, group, organization, or the public. See South Carolina Code 38-71-190
  • practice of speech-language pathology: means the rendering of or the offering to render any speech-language pathology services to an individual, group, organization, or the public. See South Carolina Code 38-71-190
  • Premium: means payment given in consideration of a contract of insurance. See South Carolina Code 31-3-580
  • Primary qualifying party: means a qualifying party who is an owner, partner, or officer of a burglar alarm system business, or a full-time employee holding a managerial or supervisory position within the alarm system business and who qualifies the licensee to engage in the burglar or fire alarm business and is registered as a qualifying party with the department in accordance with this chapter. See South Carolina Code 38-71-1350
  • Professional employer organization: means an individual business entity that offers professional employer services. See South Carolina Code 38-71-355
  • Professional employer organization group: means a combination of professional employer services companies that operates under a group license issued under Section 40-68-80. See South Carolina Code 38-71-355
  • Professional employer services: means an arrangement by which employees of a licensee are assigned to work at a client company and in which employment responsibilities are shared by the licensee and the client company. See South Carolina Code 38-71-355
  • professional soil classifier: means a person who, by reason of his special knowledge of the physical, chemical, and biological sciences applicable to soils as natural bodies and of the methods and principles of soil classification as acquired by soil education and soil classification experience in the formation, morphology, description, and mapping of soils, is qualified to practice soil classifying, who has been licensed by the Department of Labor, Licensing and Regulation, and who has passed an examination in the fundamental soil and related subjects as provided for in this chapter. See South Carolina Code 38-69-260
  • Program: means the South Carolina Small Employer Insurer Reinsurance Program pursuant to Section 38-71-1410. See South Carolina Code 38-71-1330
  • Public practice of geology: means the performance of geological service or work in the nature of consultation, investigation, surveys, evaluations, planning, mapping, and inspection of geologic work required for or supporting compliance with municipal, county, State of South Carolina, or federal regulations. See South Carolina Code 38-71-750
  • Qualifying party: means an individual, owner, partner, officer, or employee of an alarm system business who has met the necessary requirements of a qualifying party and is registered with the department in accordance with this chapter. See South Carolina Code 38-71-1350
  • Regionally accredited institution: means a school, college, or university which is a candidate for accreditation or is accredited by any accreditation body established to serve six defined geographic areas in the United States. See South Carolina Code 38-71-190
  • Registered: means an owner, partner, principle officer, qualifying party, or registered employee of an alarm business whose name and address has been listed or registered with the department as an individual who has access to a client's property or burglar alarm records that can reveal, but not be limited to, the type of burglar alarm system, burglar alarm security numbers or code, or any other information pertaining to the system that could compromise the client's burglar alarm system. See South Carolina Code 38-71-1350
  • Registered employee: means an individual of an alarm system business who has not met the requirements of a qualifying party and is employed more than thirty days in any given calendar year and is registered with the department in accordance with this chapter. See South Carolina Code 38-71-1350
  • Registered professional geologist: means a person registered as a professional geologist by the board pursuant to Section 40-77-230. See South Carolina Code 38-71-750
  • Reinsuring insurer: means a small employer insurer participating in the reinsurance program pursuant to Section 38-71-1410. See South Carolina Code 38-71-1330
  • Risk-assuming insurer: means a small employer insurer whose application is approved by the commissioner pursuant to Section 38-71-1390. See South Carolina Code 38-71-1330
  • Sell: means to exchange a contract of insurance by any means, for money or its equivalent, on behalf of an insurance company. See South Carolina Code 31-3-580
  • Small employer: means , in connection with a health insurance plan with respect to a calendar year and a plan year, any person, firm, corporation, partnership, association, or employer, as defined in Section 3(5) of the Employee Retirement Income Security Act of 1974, that is actively engaged in business that, on at least fifty percent of its working days during the preceding calendar year, employed no more than fifty eligible employees or employed an average of not more than fifty employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year. See South Carolina Code 38-71-1330
  • Small employer insurer: means an insurer that offers health insurance plans covering eligible employees of one or more small employers in this State. See South Carolina Code 38-71-1330
  • Soil: means all of the groups of natural bodies occupying the unconsolidated portion of the earth's surface capable of supporting plant life and having properties due to the combined effect of climate and living organisms, as modified by topography and time, upon parent materials. See South Carolina Code 38-69-260
  • SPE: means a minimum of thirty hours a week of professional employment in speech-language pathology or audiology for at least nine months whether or not for wages or other compensation under the supervision of a speech-language pathologist or audiologist licensed under this chapter. See South Carolina Code 38-71-190
  • Speech-language pathologist: means an individual who practices speech-language pathology. See South Carolina Code 38-71-190
  • Speech-language pathology assistant: means an individual who provides speech-language pathology services as prescribed, directed, and supervised by a speech-language pathologist licensed under this chapter. See South Carolina Code 38-71-190
  • Standard health insurance plan: means a health insurance plan developed pursuant to Section 38-71-1420. See South Carolina Code 38-71-1330
  • Terminate: means the cancellation of the relationship between an insurance producer and the insurer or the termination of a producer's authority to transact insurance. See South Carolina Code 31-3-580