North Dakota Administrative Code
Title 45 - Insurance, Commissioner of
Article 45-06 - Accident and Health Insurance
Chapter 45-06-06.1 - Regulation to Implement The Small Employer Health Insurance Availability Act
Section 45-06-06.1-04 - Transition for assumptions of business from another carrier
Universal Citation: ND Admin Code ยง 45-06-06.1-04
Current through Supplement No. 394, October, 2024
1.
a. A
small employer carrier shall not transfer or assume the entire insurance
obligation or risk of a health benefit plan covering a small employer in this
state unless:
(1) The transaction has been
approved, to the extent required by law, by the insurance supervisory official
of the state of domicile of the assuming carrier;
(2) The transaction has been approved to the
extent required by law by the insurance supervisory official of the state of
domicile of the ceding carrier; and
(3) The transaction otherwise meets the
requirements of this section.
b. A carrier domiciled in this state that
proposes to assume or cede the entire insurance obligation or risk of one or
more small employer health benefit plans from another carrier shall make a
filing for approval with the commissioner at least sixty days prior to the date
of the proposed assumption. The commissioner may approve the transaction if the
commissioner finds that the transaction is in the best interests of the
individuals insured under the health benefit plans to be transferred and is
consistent with the purposes of the Act and this chapter. The commissioner
shall not approve the transaction until at least thirty days after the date of
the filing; except that, if the ceding carrier is in hazardous financial
condition, the commissioner may approve the transaction as soon as the
commissioner deems reasonable after the filing.
c.
(1) The
filing required under subdivision b shall:
(a) Describe the class of business, including
any eligibility requirements, of the ceding carrier from which the health
benefit plans will be ceded;
(b)
Describe whether the assuming carrier will maintain the assumed health benefit
plans as a separate class of business pursuant to subsection 3 or will
incorporate them into an existing class of business pursuant to subsection 4.
If the assumed health benefit plans will be incorporated into an existing class
of business, the filing shall describe the class of business of the assuming
carrier into which the health benefit plans will be incorporated;
(c) Describe whether the health benefit plans
being assumed are currently available for purchase by small employers;
(d) Describe the potential effect
of the assumption, if any, on the benefits provided by the health benefit plans
to be assumed;
(e) Describe the
potential effect of the assumption, if any, on the premiums for the health
benefit plans to be assumed;
(f)
Describe any other potential material effects of the assumption on the coverage
provided to the small employers covered by the health benefit plans to be
assumed; and
(g) Include any other
information required by the commissioner.
(2) A domestic small employer carrier
required to make a filing under subdivision b shall also make an informational
filing with the commissioner of each state in which there are small employer
health benefit plans that would be included in the transaction. The
informational filing to each state shall be made concurrently with the filing
made under subdivision b and shall include at least the information specified
in paragraph 1 for the small employer health benefit plans in that state.
d. A small employer
carrier shall not transfer or assume the entire insurance obligation or risk of
a health benefit plan covering a small employer in this state unless it
complies with the following provisions:
(1)
The carrier has provided notice to the commissioner at least sixty days prior
to the date of the proposed assumption. The notice shall contain the
information specified in subdivision c for the health benefit plans covering
small employers in this state.
(2)
If the assumption of a class of business would result in the assuming small
employer carrier being out of compliance with the limitations related to
premium rates contained in subdivision a of subsection 1 of North Dakota
Century Code section 26.1-36.3-04, the assuming carrier shall make a filing
with the commissioner pursuant to subsection 3 of North Dakota Century Code
section 26.1-36.3-04 seeking suspension of the application of subdivision a of
subsection 1 of section 26.1-36.3-04.
(3) An assuming carrier seeking suspension of
the application of subdivision a of subsection 1 of North Dakota Century Code
section 26.1-36.3-04 shall not complete the assumption of health benefit plans
covering small employers in this state unless the commissioner grants the
suspension requested pursuant to paragraph 2.
(4) Unless a different period is approved by
the commissioner, a suspension of the application of subdivision a of
subsection 1 of North Dakota Century Code section 26.1-36.3-04, with respect to
an assumed class of business, shall be for no more than fifteen months and,
with respect to each individual small employer, shall last only until the
anniversary date of such employer's coverage, except that the period with
respect to an individual small employer may be extended beyond its first
anniversary date for a period of up to twelve months if the anniversary date
occurs within three months of the date of assumption of the class of business.
2.
a. Except as provided in subdivision b, a
small employer carrier shall not cede or assume the entire insurance obligation
or risk for a small employer health benefit plan unless the transaction
includes the ceding to the assuming carrier of the entire class of business
which includes such health benefit plan.
b. A small employer carrier may cede less
than an entire class of business to an assuming carrier if:
(1) One or more small employers in the class
have exercised their right under contract or state law to reject, either
directly or by implication, the ceding of their health benefit plans to another
carrier. In that instance, the transaction shall include each health benefit
plan in the class of business except those health benefit plans for which a
small employer has rejected the proposed cession; or
(2) After a written request from the
transferring carrier, the commissioner determines that the transfer of less
than the entire class of business is in the best interest of the small
employers insured in that class of business.
3. Except as provided in subsection 4, a small employer carrier that assumes one or more health benefit plans from another carrier shall maintain such health benefit plans as a separate class of business.
4. A small employer carrier that assumes one or more health benefit plans from another carrier may exceed the limitation contained in subsection 2 of North Dakota Century Code section 26.1-36.3-03, relating to the maximum number of classes of business a carrier may establish, due solely to such assumption for a period of up to fifteen months after the date of the assumption, provided that the carrier complies with the following provisions:
a.
Upon assumption of the health benefit plans, such health benefit plans shall be
maintained as a separate class of business. During the fifteen-month period
following the assumption, each of the assumed small employer health benefit
plans shall be transferred by the assuming small employer carrier into a single
class of business operated by the assuming small employer carrier. The assuming
small employer carrier shall select the class of business into which the
assumed health benefit plans will be transferred in a manner such that the
transfer results in the least possible change to the benefits and rating method
of the assumed health benefit plans.
b. The transfers authorized in subdivision a
shall occur with respect to each small employer on the anniversary date of the
small employer's coverage, except that the period with respect to an individual
small employer may be extended beyond its first anniversary date for a period
of up to twelve months if the anniversary date occurs within three months of
the date of assumption of the class of business.
c. A small employer carrier making a transfer
pursuant to subdivision a may alter the benefits of the assumed health benefit
plans to conform to the benefits currently offered by the carrier in the class
of business into which the health benefit plans have been transferred.
d. The premium rate for an assumed
small employer health benefit plan shall not be modified by the assuming small
employer carrier until the health benefit plan is transferred pursuant to
subdivision a. Upon transfer, the assuming small employer carrier shall
calculate a new premium rate for the health benefit plan from the rate manual
established for the class of business into which the health benefit plan is
transferred. In making such calculation, the risk load applied to the health
benefit plan shall be no higher than the risk load applicable to such health
benefit plan prior to the assumption.
e. During the fifteen-month period provided
in this subsection, the transfer of small employer health benefit plans from
the assumed class of business in accordance with this subsection shall not be
considered a violation of the first sentence of subsection 2 of North Dakota
Century Code section 26.1-36.3-04.
5. An assuming carrier may not apply eligibility requirements, including minimum participation and contribution requirements, with respect to an assumed health benefit plan or with respect to any health benefit plan subsequently offered to a small employer covered by such an assumed health benefit plan that are more stringent than the requirements applicable to such health benefit plan prior to the assumption.
6. The commissioner may approve a longer period of transition upon application of a small employer carrier. The application shall be made within sixty days after the date of assumption of the class of business and shall clearly state the justification for a longer transition period.
7. Nothing in this section or in the Act is intended to:
a.
Reduce or diminish any legal or contractual obligation or requirement,
including any obligation provided by law, of the ceding or assuming carrier
related to the transaction;
b.
Authorize a carrier that is not admitted to transact the business of insurance
in this state to offer or insure health benefit plans in this state; or
c. Reduce or diminish the
protections related to an assumption reinsurance transaction provided by law.
General Authority: NDCC 26.1-01-08, 26.1-36.3-03
Law Implemented: NDCC 26.1-36.3-03
Disclaimer: These regulations may not be the most recent version. North Dakota may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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