§ 27-18.5-4 - Continuation of coverage – Renewability.
SECTION 27-18.5-4
§ 27-18.5-4 Continuation of coverage– Renewability. – (a) A health insurance carrier that provides individual health insurancecoverage to an individual in this state shall renew or continue in force thatcoverage at the option of the individual.
(b) A health insurance carrier may nonrenew or discontinuehealth insurance coverage of an individual in the individual market based onlyon one or more of the following:
(1) The individual has failed to pay premiums orcontributions in accordance with the terms of the health insurance coverage orthe carrier has not received timely premium payments;
(2) The individual has performed an act or practice thatconstitutes fraud or made an intentional misrepresentation of material factunder the terms of the coverage;
(3) The carrier is ceasing to offer coverage in accordancewith subsections (c) and (d) of this section;
(4) In the case of a carrier that offers health insurancecoverage in the market through a network plan, the individual no longerresides, lives, or works in the service area (or in an area for which thecarrier is authorized to do business) but only if the coverage is terminateduniformly without regard to any health status-related factor of coveredindividuals; or
(5) In the case of health insurance coverage that is madeavailable in the individual market only through one or more bona fideassociations, the membership of the individual in the association (on the basisof which the coverage is provided) ceases but only if the coverage isterminated uniformly and without regard to any health status-related factor ofcovered individuals.
(c) In any case in which a carrier decides to discontinueoffering a particular type of health insurance coverage offered in theindividual market, coverage of that type may be discontinued only if:
(1) The carrier provides notice, to each covered individualprovided coverage of this type in the market, of the discontinuation at leastninety (90) days prior to the date of discontinuation of the coverage;
(2) The carrier offers to each individual in the individualmarket provided coverage of this type, the opportunity to purchase any otherindividual health insurance coverage currently being offered by the carrier forindividuals in the market; and
(3) In exercising this option to discontinue coverage of thistype and in offering the option of coverage under subdivision (2) of thissubsection, the carrier acts uniformly without regard to any healthstatus-related factor of enrolled individuals or individuals who may becomeeligible for the coverage.
(d) In any case in which a carrier elects to discontinueoffering all health insurance coverage in the individual market in this state,health insurance coverage may be discontinued only if:
(1) The carrier provides notice to the director and to eachindividual of the discontinuation at least one hundred eighty (180) days priorto the date of the expiration of the coverage; and
(2) All health insurance issued or delivered in this state inthe market is discontinued and coverage under this health insurance coverage inthe market is not renewed.
(e) In the case of a discontinuation under subsection (d) ofthis section, the carrier may not provide for the issuance of any healthinsurance coverage in the individual market in this state during the five (5)year period beginning on the date the carrier filed its notice with thedepartment to withdraw from the individual health insurance market in thisstate. This five (5) year period may be reduced to a minimum of three (3) yearsat the discretion of the health insurance commissioner, based on his/heranalysis of market conditions and other related factors.
(f) The provisions of subsections (d) and (e) of this sectiondo not apply if, at the time of coverage renewal, a health insurance carriermodifies the health insurance coverage for a policy form offered to individualsin the individual market so long as the modification is consistent with thischapter and other applicable law and effective on a uniform basis among allindividuals with that policy form.
(g) In applying this section in the case of health insurancecoverage made available by a carrier in the individual market to individualsonly through one or more associations, a reference to an "individual" includesa reference to the association (of which the individual is a member).