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 45-06-06.1-11 - Rules related to fair marketing
Universal Citation: ND Admin Code ยง 45-06-06.1-11
Current through Supplement No. 394, October, 2024
1.
a. A small employer carrier shall actively
market each of its health benefit plans to small employers in this state. A
small employer carrier may not suspend the marketing or issuance of a health
benefit plan unless the carrier has good cause and has received the prior
approval of the commissioner.
b. In
marketing the basic and standard health benefit plans to small employers, a
small employer carrier shall use at least the same sources and methods of
distribution that it uses to market other health benefit plans to small
employers. Any producer authorized by a small employer carrier to market health
benefit plans to small employers in the state shall also be authorized to
market the basic and standard health benefit plans.
2.
a. A
small employer carrier shall offer to any small employer that applies for or
makes an inquiry regarding health insurance coverage from the small employer
carrier all health benefit plans it actively markets to small employers. The
offer shall be in writing and shall include at least the following information:
(1) A general description of the benefits
contained in the health benefit plans being offered to small employers in this
state; and
(2) Information
describing how the small employer may enroll in the plans. The offer may be
provided directly to the small employer or delivered through a
producer.
b. In
connection with the offering of any health insurance coverage to a small
employer, a health insurance issuer is required to make reasonable disclosure
to the employer, as a part of its solicitation and sales materials, of the
availability of information described in this subsection; and upon request
provide that information to the employer.
Subject to the above, the information that must be provided is the provisions of coverage relating to the following:
(1) The issuer's right to change premium
rates and the factors that may affect changes in premium rates.
(2) Renewability of coverage.
(3) Any preexisting condition exclusion,
including use of the alternative method of counting creditable
coverage.
(4) The geographic areas
served by HMOs.
c.
(1) A small employer carrier shall provide a
price quote to a small employer, directly or through an authorized producer,
within ten working days of receiving a request for a quote and such information
as is necessary to provide the quote. A small employer carrier shall notify a
small employer, directly or through an authorized producer, within five working
days of receiving a request for a price quote of any additional information
needed by the small employer carrier to provide the quote.
(2) A small employer carrier may not apply
more stringent or detailed requirements related to the application process for
the basic and standard health benefit plans than are applied for other health
benefit plans offered by the carrier.
3. The small group carrier shall not require a small employer to join or contribute to any association or group as a condition of being accepted for coverage by the small employer carrier, except that, if membership in an association or other group is a requirement for accepting a small employer into a particular health benefit plan, a small employer carrier may apply such requirement, subject to the requirements of paragraph 2 of subdivision b of subsection 1 of North Dakota Century Code section 26.1-36.3-06.
4. A small employer carrier may not require, as a condition to the offer or sale of a health benefit plan to a small employer, that the small employer purchase or qualify for any other insurance product or service.
5.
a.
Carriers offering individual and group health benefit plans in this state shall
be responsible for determining whether the plans are subject to the
requirements of the Act and this chapter. Carriers shall elicit the following
information from applicants for such plans at the time of application:
(1) Whether or not any portion of the premium
will be paid by or on behalf of a small employer, either directly or through
wage adjustments or other means of reimbursement; and
(2) Whether or not the prospective
policyholder, certificate holder, or any prospective insured individual intends
to treat the health benefit plan as part of plan or program under section 162
(other than section 162(1)), section 125, or section 106 of the United States
Internal Revenue Code.
b. If a small employer carrier fails to
comply with subdivision a, the small employer carrier shall be deemed to be on
notice of any information that could reasonably have been attained if the small
employer carrier had complied with subdivision a.
General Authority: NDCC 26.1-01-08
Law Implemented: NDCC 26.1-36.3-11
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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