Current through Supplement No. 394, October, 2024
1. Except as
provided in section
45-06-06.1-13, this chapter
applies to any health benefit plan, whether provided on a group or individual
basis, which:
a. Meets one or more of the
conditions set forth in subdivisions a, b, and c of subsection 1 of North
Dakota Century Code section 26.1-36.3-02; and
b. Provides coverage to one or more employees
of a small employer located in this state, without regard to whether the policy
or certificate was issued in this state.
2.
a. A
carrier that provides individual health insurance policies to one or more of
the employees of a small employer shall be considered a small employer carrier
and is subject to the provisions of the Act and this chapter with respect to
such policies if the small employer contributes directly or indirectly to the
premiums for the policies and the carrier is aware or should have been aware of
such contribution.
b. In the case
of a carrier that provides individual health insurance policies to one or more
employees of a small employer, the small employer carrier is subject to
subdivision b of subsection 1 of North Dakota Century Code section
26.1-36.3-06, relating to guaranteed issue of coverage, if:
(1) The small employer has at least two
employees;
(2) The small employer
contributes directly or indirectly to the premiums charged by the carrier; and
(3) The carrier is aware or should
have been aware of the contribution by the employer.
3. The provisions of the
Act and this chapter apply to a health benefit plan provided to a small
employer or to the employees of a small employer without regard to whether the
health benefit plan is offered under or provided through a group policy or
trust arrangement of any size sponsored by an association or discretionary
group.
4. An individual health
insurance policy is not subject to the provisions of the Act and this chapter
solely because the policyholder elects a deduction under section 162(1) of the
Internal Revenue Code.
5.
a.If a small employer is issued a health
benefit plan under the terms of the Act, the provisions of the Act and this
chapter continue to apply to the health benefit plan in the case that the small
employer subsequently employs less than two or more than fifty eligible
employees. Within sixty days of becoming aware that the employer has less than
two or more than fifty eligible employees but no later than the anniversary
date of the employer's health benefit plan, a carrier providing coverage to
such an employer shall notify the employer that the protections provided under
the Act and this chapter shall cease to apply to the employer if such employer
fails to renew its current health benefit plan or elects to enroll in a
different health benefit plan.
b.
(1) If a health benefit plan is issued to an
employer that is not a small employer as defined in the Act, but subsequently
the employer becomes a small employer, due to the loss or change of work status
of one or more employees, the terms of the Act shall not apply to the health
benefit plan. The carrier providing a health benefit plan to such an employer
shall not become a small employer carrier under the terms of the Act solely
because the carrier continues to provide coverage under the health benefit plan
to the employer.
(2) Within sixty
days of becoming aware that the employer is a "small employer" as that term is
defined in subsection 35 of North Dakota Century Code section 26.1-36.1-01, a
carrier providing coverage to an employer described in paragraph 1 shall notify
the employer of the options and protections available to the employer under the
Act, including the employer's option to purchase a small employer health
benefit plan from any small employer carrier.
6.
a.
(1) If a small employer has employees in more
than one state, the provisions of the Act and this chapter shall apply to a
health benefit plan issued to the small employer if:
(a) The majority of eligible employees of
such small employer are employed in this state; or
(b) If no state contains a majority of the
eligible employees of the small employer, the primary business location of the
small employer is in this state.
(2) In determining whether the laws of this
state or another state apply to a health benefit plan issued to a small
employer described in paragraph 1, the provisions of the subdivision shall be
applied as of the date the health benefit plan was issued to the small employer
for the period that the health benefit plan remains in effect.
b. If a health benefit plan is
subject to the Act and this chapter, the provisions of the Act and this chapter
shall apply to all individuals covered under the health benefit plan, whether
they reside in this state or in another state.
7. A carrier that is not operating as a small
employer carrier in this state shall not become subject to the provisions of
the Act and this chapter solely because a small employer that was issued a
health benefit plan in another state by that carrier moves to this state.
General Authority: NDCC 26.1-01-08
Law Implemented: NDCC
26.1-36.3
