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58-18-46 Renewability of health benefit plans--Employer's election--Exceptions.
     58-18-46.   Renewability of health benefit plans--Employer's election--Exceptions. Except as 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 following reasons:
             (1)      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 payments;
             (2)      Fraud or intentional misrepresentation of material fact by the employer;
             (3)      Noncompliance with the carrier's employer contribution or participation requirements;
             (4)      The number of individuals covered under the plan is less than the number or percentage of eligible individuals required under the plan;
             (5)      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;
             (6)      The employer carrier elects to nonrenew all of its health benefit plans delivered or issued for delivery to employers in this state;
             (7)      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
             (8)      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:
             (a)      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 coverage;
             (b)      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;
             (c)      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.


Chapter 58-18

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