58-18-46 Renewability of health benefit plans--Employer's election--Exceptions.
Renewability of health benefit plans--Employer's election--Exceptions.
provided in §§ 58-18-42 to 58-18-49, inclusive, a health benefit plan subject to this chapter is
renewable to all eligible employees and dependents at the option of the employer, except for the
The employer has failed to pay premiums or contributions in accordance with the terms
of the health insurance coverage or the insurer has not received timely premium
Fraud or intentional misrepresentation of material fact by the employer;
Noncompliance with the carrier's employer contribution or participation requirements;
The number of individuals covered under the plan is less than the number or percentage
of eligible individuals required under the plan;
In the case of a health insurance issuer that offers health insurance coverage in the market
through a network plan, there is no longer any enrollees in connection with the plan who
live, reside, or work in the service area of the issuer or in the area for which the issuer is
authorized to do business and the issuer would deny enrollment with respect to the plan
as provided for in § 58-18B-37;
The employer carrier elects to nonrenew all of its health benefit plans delivered or issued
for delivery to employers in this state;
In the case of health insurance coverage that is made available only through one or more
bona fide associations, the membership of an employer in the association (on the basis of
which the coverage is provided) ceases but only if the coverage is terminated uniformly
without regard to any health status-related factor relating to any covered individual; or
If the issuer decides to discontinue offering a particular type of group health insurance
offered in the group market, coverage of such type may be discontinued if:
The issuer provides notice to each employer provided coverage of this type in such
market (and any participant and beneficiary covered under such coverage) of the
discontinuation at least ninety days prior to the date of the discontinuation of the
The issuer offers to each employer provided coverage of this type in such market,
the option to purchase all other health insurance coverage currently being offered
by the issuer to a group health plan in such market;
In exercising the option to discontinue coverage of this type and in offering the
option of coverage under subsection (b), the issuer acts uniformly without regard
to the claims experience of those employers or any health status-related factor
relating to any participant or beneficiary covered or any new participant or
beneficiary who may become eligible for such coverage.
If a carrier nonrenews a health benefit plan pursuant to this section, the director shall assist
affected employers in finding replacement coverage.
Source: SL 1994, ch 383, § 5; SL 1997, ch 289, § 10; SL 2001, ch 275, § 5.