Current through Reg. 50, No. 13; March 28, 2025
(a) Except as provided by subsection (d) of
this section, a health carrier shall renew a health benefit plan issued to an
association, or a bona fide association, at the option of the association or
bona fide association, unless:
(1) the
association or bona fide association has failed to pay premiums or
contributions in accordance with the terms of the health benefit plan,
including any timeliness requirements;
(2) the association or bona fide association
has performed an act or practice that constitutes fraud, or has made an
intentional misrepresentation of material fact, relating in any way to the
health benefit plan, including claims for benefits under the health benefit
plan;
(3) in regards only to a
health benefit plan offered by an HMO or a group hospital service plan issued
under the Insurance Code Chapter 20, the association or bona fide association
ceases to have any covered members who reside, live, or work in the service
area of the HMO or group hospital service plan, but only if coverage is
terminated uniformly without regard to any health status-related factor of
covered members or dependents of covered members, if dependent coverage is
offered; or
(4) the health carrier
is ceasing to offer health benefit plan coverage in the association market in
accordance with subsection (d) of this section.
(b) A health carrier may refuse to renew the
coverage of a covered member or dependent if:
(1) the member fails to pay premiums or
contributions in accordance with the terms of the health benefit plan,
including any timeliness requirements;
(2) the covered member or dependent has
performed an act or practice that constitutes fraud, or has made an intentional
misrepresentation of material fact, relating in any way to the health benefit
plan, including claims for benefits under the health benefit plan;
(3) in regards only to coverage offered by an
HMO or a group hospital service plan issued under the Insurance Code Chapter
20, the covered member no longer resides, lives, or works in the service area
of the HMO or group hospital service plan, but only if coverage is terminated
uniformly without regard to any health status-related factor of the covered
member or dependent;
(4) the health
carrier is ceasing to offer health benefit plan coverage in the association
market in accordance with subsection (d) of this section; or
(5) the covered member or dependent ceases to
be a member of the association or bona fide association to which the coverage
is offered, but only if such coverage is terminated under this paragraph
uniformly without regard to any health status-related factor of the covered
member or dependent.
(c)
Medicare eligibility or entitlement is not a basis for non-renewal or
termination of a health benefit plan issued to an association or bona fide
association or members of an association or bona fide association. However,
health benefit plan coverage sold to association and bona fide association
members before the members attain Medicare eligibility may contain coordination
of benefit provisions that comply with Chapter 3, Subchapter V of this title
(relating to Group Coordination of Benefits) and §
11.511 of this title (relating to
Optional Provisions).
(d) A health
carrier may discontinue a particular health benefit plan pursuant to paragraph
(1) of this subsection. A health carrier may discontinue all health benefit
plans pursuant to paragraph (2) of this subsection.
(1) A health carrier may discontinue offering
a particular type of health benefit plan offered to associations or bona fide
associations only if, at least 90 days before the date coverage will be
discontinued, the health carrier:
(A)
provides notice in writing to each association or bona fide association and
each member covered under the health benefit plan being discontinued;
(B) offers to the association or bona fide
association the option to purchase any other health benefit plan currently
being offered by the carrier to associations or bona fide associations;
and
(C) acts uniformly without
regard to any health status-related factor of covered members or dependents, or
new members or dependents who may become eligible for the coverage.
(2) A health carrier may
discontinue offering all health benefit plans offered to associations or bona
fide associations only if, at least 180 days before the date coverage will
expire, the health carrier:
(A) provides
notice in writing to the commissioner of insurance, each association or bona
fide association, and each covered member;
(B) discontinues and does not renew all
health benefit plans issued in this state or an approved geographic service
area of an HMO or group hospital service corporation to associations or bona
fide associations; and
(C) acts
uniformly without regard to any health status-related factor of covered members
or dependents of covered members, if dependent coverage is offered, or new
members or dependents who may become eligible for coverage.
(e) A health carrier
that elects not to renew all health benefit plans to associations or bona fide
associations in accordance with subsection (d)(2) of this section may not issue
any association or bona fide association coverage in this state, or in an
approved geographic service area of an HMO or group hospital service
corporation, during the five year period beginning on the date of
discontinuation of the last such coverage not renewed.
(f) Nothing in this section prohibits or
restricts a health carrier's ability to make changes in premium rates by
classes in accordance with applicable laws and regulations.
(g) Nothing in this section shall be
interpreted as prohibiting a health carrier from making modifications to a
health benefit plan mandated by state or federal law.
