§ 27-20.4-4 - Continuity on replacement of total group contract.
SECTION 27-20.4-4
§ 27-20.4-4 Continuity on replacement oftotal group contract. – (a) Notwithstanding any other provision of law, this section applies to allhealth plans providing coverage regulated by chapters 18, 19, 20, 20.1 and 41of this title and to all total group contracts, except group long term carepolicies issued by an insurer to contract holders who are obtaining coverage toreplace coverage under a different contract or policy issued by any insurer.
(b) This section provides continuity of coverage to eligiblepersons under the succeeding contract who were covered under a total groupcontract at any time during the ninety (90) days before the discontinuance ofthe total group contract, when that contract is replaced by another total groupcontract.
(c) In a replacement contract subject to this section, aninsurer may not, for any person described in subsection (b) of this section:
(1) Request that the person provide or seek to obtainevidence of insurability other than to:
(i) Determine whether the group as a whole is insurable;
(ii) Determine rates for the whole group; and
(iii) Make reinsurance decisions;
(2) Decline to enroll the person on the basis of evidence ofinsurability if the person is eligible for coverage; or
(3) Impose a period during which benefits are excluded orlimited with respect to preexisting conditions on that person, except asprovided in this section.
(d) Notwithstanding subsection (c) of this section, anyperson who was covered under the replaced total group contract for fewer thanninety (90) continuous days may be subject to a preexisting condition exclusionor waiting period in the replacement contract, provided the period is notlonger than ninety (90) days and credit is given for satisfaction or partialsatisfaction of any preexisting condition exclusions or limitations under thereplaced total group contract.
(e) The insurer that issued the replaced contract or policyis liable after the discontinuance of that contract or policy only to theextent of its accrued liability and any extensions of benefits provided in itscontract.