§ 27-18.6-5 - Continuation of coverage – Renewability.
SECTION 27-18.6-5
§ 27-18.6-5 Continuation of coverage– Renewability. – (a) Notwithstanding any of the provisions of this title to the contrary, ahealth insurance carrier that offers health insurance coverage in the largegroup market in this state in connection with a group health plan shall renewor continue in force that coverage at the option of the plan sponsor of theplan.
(b) A health insurance carrier may nonrenew or discontinuehealth insurance coverage offered in connection with a group health plan in thelarge group market based only on one or more of the following:
(1) The plan sponsor 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 plan sponsor has performed an act or practice thatconstitutes fraud or made an intentional misrepresentation of material factunder the terms of the coverage;
(3) The plan sponsor has failed to comply with a materialplan provision relating to employer contribution or group participation rules,as permitted by the director pursuant to rule or regulation;
(4) The carrier is ceasing to offer coverage in accordancewith subsections (c) and (d) of this section;
(5) The director finds that the continuation of the coveragewould:
(i) Not be in the best interests of the policyholders orcertificate holders; or
(ii) Impair the carrier's ability to meet its contractualobligations;
(6) In the case of a health insurance carrier that offershealth insurance coverage in the large group market through a network plan,there is no longer any enrollee in connection with that plan who resides,lives, or works in the service area of the carrier (or in an area for which thecarrier is authorized to do business); and
(7) In the case of health insurance coverage that is madeavailable in the large group market only through one or more bona fideassociations, the membership of an employer in the association (on the basis ofwhich the coverage is provided) ceases, but only if the coverage is terminatedunder this section uniformly without regard to any health status-related factorrelating to any covered individual.
(c) In any case in which a carrier decides to discontinueoffering a particular type of group health insurance coverage offered in thelarge group market, coverage of that type may be discontinued by the carrieronly if:
(1) The carrier provides notice of the decision to allaffected plan sponsors, participants, and beneficiaries at least ninety (90)days prior to the date of discontinuation of coverage;
(2) The carrier offers to each plan sponsor provided coverageof this type in the large group market the option to purchase any other healthinsurance coverage currently being offered by the carrier to a group healthplan in the market; and
(3) In exercising this option to discontinue coverage of thistype and in offering the option of coverage under subdivision (3) of thissubsection, the carrier acts uniformly without regard to the claims experienceof those plan sponsors or any health status-related factor relating to anyparticipants or beneficiaries covered or new participants or beneficiaries whomay become eligible for coverage.
(d) In any case in which a carrier elects to discontinueoffering and to nonrenew all of its health insurance coverage in the largegroup market in this state, the carrier shall:
(1) Provide advance notice to the director, to the insurancecommissioner in each state in which the carrier is licensed, and to each plansponsor (and participants and beneficiaries covered under that coverage and tothe insurance commissioner in each state in which an affected insuredindividual is known to reside) of the decision at least one hundred eighty(180) days prior to the date of the discontinuation of coverage. Notice to theinsurance commissioner shall be provided at least three (3) working days priorto the notice to the affected plan sponsors, participants, and beneficiaries;and
(2) Discontinue all health insurance issued or delivered forissuance in this state's large group market and not renew coverage under anyhealth insurance coverage issued to a large employer.
(e) In the case of a discontinuation under subsection (d) ofthis section, the carrier shall be prohibited from the issuance of any healthinsurance coverage in the large group market in this state for a period of five(5) years from the date of notice to the director.
(f) At the time of coverage renewal, a health insurancecarrier may modify the health insurance coverage for a product offered to agroup health plan in the large group market.
(g) In applying this section in the case of health insurancecoverage that is made available by a carrier in the large group market toemployers only through one or more associations, a reference to a "plansponsor" is deemed, with respect to coverage provided to an employer member ofthe association, to include a reference to that employer.