689C.470 - Renewal of contract; discontinuing issuance and renewal of form of product of health benefit plan or health benefit plan.
689C.470 Renewal of contract; discontinuing issuance and renewal of form of product of health benefit plan or health benefit plan.
1. Except as otherwise provided in NRS 689C.360 to 689C.600, inclusive, a carrier shall renew a contract as to all insured small employers that are members of a voluntary purchasing group and their employees and dependents at the request of the purchaser unless:
(a) Required premiums are not paid;
(b) The insured employer or other purchaser is guilty of fraud or misrepresentation;
(c) Provisions of the contract are breached;
(d) The number or percentage of employees covered under the contract is less than the number or percentage of eligible employees required by the contract;
(e) The employer or purchaser is no longer engaged in the business in which it was engaged on the effective date of the contract; or
(f) The Commissioner finds that the continuation of the coverage is not in the best interests of the persons insured under the contract or would impair the carrier’s ability to meet its contractual obligations. If nonrenewal occurs as a result of findings pursuant to this subsection, the Commissioner shall assist affected persons in replacing coverage.
2. A carrier may discontinue issuance and renewal of a form of a product of a health benefit plan offered to a small employer or purchasers pursuant to NRS 689C.360 to 689C.600, inclusive, if the Commissioner finds that the form of the product offered by the carrier is obsolete and is being replaced with comparable coverage. A form of a product of a health benefit plan may be discontinued by a carrier pursuant to this subsection only if:
(a) The carrier notifies the Commissioner and the chief regulatory officer for insurance in each state in which it is licensed of its decision pursuant to this subsection to discontinue offering and renewing the form of the product at least 60 days before the carrier notifies the affected small employers and purchasers pursuant to paragraph (b).
(b) The carrier notifies each affected small employer and purchaser, and the Commissioner and the chief regulatory officer for insurance in each state in which any affected small employer is located or employee resides, of the decision of the carrier to discontinue offering the form of the product. The notice must be made at least 180 days before the date on which the carrier will discontinue offering the form of the product.
(c) The carrier offers to each affected small employer and purchaser the option to purchase any other health benefit plan currently offered by the carrier to small employers in this state.
(d) In exercising the option to discontinue the particular form of the product and in offering the option to purchase other coverage pursuant to paragraph (c), the carrier acts uniformly without regard to the claim experience of the affected small employers and any health status-related factor relating to any participant or beneficiary covered by the discontinued product or any new participant or beneficiary who may become eligible for such coverage.
3. A carrier may discontinue the issuance and renewal of a health benefit plan offered to a voluntary purchasing group pursuant to this chapter only through a bona fide association if:
(a) The membership of the small employer who employs the members of the voluntary purchasing group or the purchaser in the association was the basis for the provision of coverage;
(b) The membership of that small employer or the purchaser in the association ceases; and
(c) The coverage is terminated pursuant to this subsection uniformly without regard to any health status-related factor relating to the small employer or the purchaser or his or her dependent.
(Added to NRS by 1995, 2679; A 1997, 2951)