26.1-36.3-05. Renewability of coverage

26.1-36.3-05. Renewability of coverage

1. A health benefit plan subject to this chapter and section 26.1-36-37.2 must be

renewable with respect to all eligible employees and dependents, at the option of the

small employer, except for any of the following:

a. The plan sponsor has failed to pay premiums or contributions in accordance with

the terms of the health benefit plan or the health carrier has not received timely

premium payments.

b. The plan sponsor or small employer has performed an act or practice that

constitutes fraud or made an intentional misrepresentation of a material fact

under the terms of the coverage.

c. Noncompliance with the carrier's minimum participation requirements.

d. Noncompliance with the carrier's employer contribution requirements.

e. A decision by the small employer carrier to discontinue offering a particular type

of group health benefit plan in the state's small employer market. A type of health

benefit plan may be discontinued by the carrier in that market only if the carrier:

(1) Provides advance notice of its decision under this paragraph to the

commissioner in each state in which it is licensed;

(2) Provides notice of the decision not to renew coverage to all affected small

employers, participants, and beneficiaries, and to the commissioner in each

state in which an affected insured individual is known to reside at least

ninety days prior to the nonrenewal of any health benefit plans by the

carrier. Notice to the commissioner under this subdivision must be provided

at least three working days prior to the notice to the affected small

employers and participants and beneficiaries;

(3) Offers to each plan sponsor provided the type of group health benefit plan

the option to purchase all other health benefit plans currently being offered

by the carrier to employers in the state; and

(4) In exercising the option to discontinue the particular type of group health

benefit plan and in offering the option of coverage under paragraph 3, the

carrier acts uniformly without regard to the claims experience of those

sponsors or any health status-related factor relating to any participants or

beneficiaries covered or new participants or beneficiaries who may become

eligible for such coverage.

f. A decision by the small employer carrier to discontinue offering and to nonrenew

all its health benefit plans delivered or issued for delivery to small employers in

this state. In such a case, the carrier shall:

(1) Provide advance notice of its decision under this paragraph to the

commissioner in each state in which it is licensed;

(2) Provide notice of the decision not to renew coverage to all affected small

employers, participants, and beneficiaries, and to the commissioner in each

state in which an affected insured individual is known to reside at least one

hundred eighty days prior to the nonrenewal of any health benefit plans by

the carrier. Notice to the commissioner under this subdivision shall be

provided at least three working days prior to the notice to the affected small

employers and participants and beneficiaries; and

iciaries, and to the commissioner in each

state in which an affected insured individual is known to reside at least one

hundred eighty days prior to the nonrenewal of any health benefit plans by

the carrier. Notice to the commissioner under this subdivision shall be

provided at least three working days prior to the notice to the affected small

employers and participants and beneficiaries; and

(3) Discontinue all health insurance issued or delivered for issuance in the

state's small employer market and not renew coverage under any health

benefit plan issued to a small employer.

g. In the case of health benefit plans that are made available in the small employer

market only through one or more associations, the membership of an employer in

the association, on the basis of which the coverage is provided, ceases, but only

if the coverage is terminated under this subdivision uniformly without regard to

any health status-related factor relating to any covered individual.

h. The commissioner finds that the continuation of the coverage would not be in the

best interests of the policyholders or certificate holders or would impair the

carrier's ability to meet its contractual obligations. In this case the commissioner

shall assist affected small employers in finding replacement coverage.

2. A small employer carrier that elects not to renew a health benefit plan under

subdivision f of subsection 1 may not write new business in the small employer market

in this state for a period of five years from the date of notice to the commissioner.

3. In the case of a small employer carrier doing business in one established geographic

service area of the state, this section only applies to the carrier's operations in that

service area.

4. A small employer carrier offering through a network plan may not be required to offer

coverage or accept applications pursuant to subsection 1 or 2 in the case of the

following:

a. To an eligible person who no longer resides, lives, or works in the service area, or

in an area for which the carrier is authorized to do business, but only if coverage

is terminated under this subdivision uniformly without regard to any health

status-related factor; or

b. To a small employer that no longer has any enrollee in connection with the plan

who lives, resides, or works in the service area of the carrier, or the area for

which the carrier is authorized to do business.

5. At the time of coverage renewal, a health insurance carrier may modify the health

insurance coverage for a product offered to a group health plan if, for coverage that is

available in such market other than only through one or more bona fide associations,

the modification is reasonable, consistent with state law, and effective on a uniform

basis among group health plans with that product. If coverage is modified, the carrier

shall:

a. Provide advance notice of its decision under this subsection to the commissioner

at least three working days prior to mailing the notice to the affected small

employers and participants and beneficiaries.

b. Provide notice of the decision to modify health coverage to all affected small

employers, participants, and beneficiaries and the commissioner sixty days prior

to the modification of health coverage by the carrier.