§ 27-20.4-5 - Continuity of coverage for individual who changes groups, changes insurers within the same group, or changes benefit plans provided by the same insurer.
SECTION 27-20.4-5
§ 27-20.4-5 Continuity of coverage forindividual who changes groups, changes insurers within the same group, orchanges benefit plans provided by the same insurer. – (a) This section applies to all health benefit group contracts issued by aninsurer when a member of the group changes from one group to another group dueto a change in employment, or when due to the action of the employer or insureris: (1) forced to change from one benefit plan to another; or (2) forced tochange from one insurer to another.
(b) Except as provided in subsection (c) of this section,this section provides continuity of coverage for a person who seeks coverageunder a succeeding contract if coverage under the prior contract is terminatedwithin three (3) months before the date the person enrolls or is eligible toenroll in the succeeding contract. No period of ineligibility for any healthplan imposed by terms of employment may be considered in determining whetherthe coverage ended within three (3) months of the date the person enrolls orwould be eligible to enroll, and if:
(1) That person was covered under an individual or groupcontract or policy issued by any insurer and that person's health benefit planwas eliminated by the employer or the insurer; or
(2) That person was covered under an individual or groupcontract or policy issued by any insurer and that person has terminatedemployment and at, or following, termination of employment that person is noteligible or is no longer eligible for COBRA continuation coverage under grouphealth plans as provided for in 42 U.S.C. § 300bb-1 et seq., or forextended medical benefits as provided in Chapter 19.1 of this title.
(c) Notwithstanding subsection (b) of this section, thissection does not provide continuity of coverage for a late enrollee.
(d) Except as otherwise provided in this section, in a grouphealth benefit contract subject to this section, any insurer covering employeesof the employer must, for any person described in subsection (b) of thissection, waive any medical underwriting, but only to the extent that theunderwriting is used to exclude a specific condition or the person, or waivepreexisting conditions exclusion or limitations to the extent that benefitswould have been payable under the prior contract if that contract were still ineffect. The issuer of the succeeding contract is not required to duplicate anybenefits covered by the issuer of the prior contract.