Current through Register Vol. 43, No. 02, November 27, 2024
(a) A
health benefit plan subject to this Regulation shall be renewable with respect
to all eligible employees or dependents, at the option of the small employer,
except in any of the following cases:
(1)
Nonpayment of the required premiums.
(2) Fraud or intentional misrepresentation of
a material fact by the small employer or, with respect to coverage of
individual insureds, the insureds or their representatives.
(3) Noncompliance with the carrier's minimum
participation requirements.
(4)
Noncompliance with the carrier's employer contribution requirements.
(5) The small employer carrier elects to
nonrenew all of its health benefit plans delivered or issued for delivery to
small employers in this state. In such a case the carrier shall:
a. Provide advance notice of its decision
under this Subdivision to the commissioner in each state in which it is
licensed; and
b. Provide notice of
the decision not to renew coverage to all affected small employers, insureds
and to the commissioner in each state in which an affected insured individual
is known to reside at least 180 days prior to the nonrenewal of any health
benefit plans by the carrier. Notice to the commissioner under this Paragraph
shall be provided at least three (3) working days prior to the notice to the
affected small employers.
(6) 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 such instance, the commissioner shall
assist affected small employers in finding replacement coverage. In the case of
a health maintenance organization, the decision by the Commissioner shall have
been made in consultation with, and with the approval of, the State Health
Officer.
(7) The small employer
carrier elects to discontinue the sale of the health benefit plan to small
employers in this state. In such a case, the carrier shall:
a. Provide 90 days advance notice of its
decision to the small employers covered by the discontinued health benefit plan
in this state; and
b. Offer each
affected small employer an option to purchase any other small group health
benefit plan offered by the carrier in this state.
c. The offer in Paragraph b. must be made
uniformly to all affected small employers in this state without regard to
health status related factors.
(8) Association membership ceases, provided
that the rules for cessation are applied uniformly without regard to health
status related factors.
(b) A small employer carrier that elects not
to renew a health benefit plan under Subdivision (5) of Subsection (a) shall be
prohibited from writing new business in the small employer market in this state
for a period of five (5) years from the date of notice to the
commissioner.
(c) In the case of a
small employer carrier doing business in one established geographic service
area of the state, the rules set forth in this subsection shall apply only to
the carrier's operations in that service area.
Author: Reyn Norman, Associate
Counsel
