58-18-7.11 Continuation or conversion policy not required under certain circumstances.
Continuation or conversion policy not required under certain circumstances.
insurer may be required to offer or renew a continuation or conversion policy covering any person
The person is covered for similar benefits by another individual or group policy;
Similar benefits are provided for or available to such person, by reason of any state or
federal law, except any person who becomes entitled to Medicare on or before
continuation is elected or who is covered under another group plan on or before
continuation is elected;
The benefits under sources of the kind referred to in subdivision (1) for such person or
benefits provided or available under sources of the kind referred to in subdivision (2) for
such person, together with the continued or converted policy's benefits, would result in
overinsurance according to the insurer's standards for overinsurance;
There has been fraud or material misrepresentation in applying for any benefits under
continued or converted policy;
The person failed to pay any required contribution;
There has been cancellation of all similar insurance policies in the entire state;
For cause on the same basis, the plan could terminate the coverage of a similarly situated
The person was terminated from employment for gross misconduct; or
The group health insurance policy is terminated by an insurer as a result of the group not
meeting an insurer's participation or eligibility requirements. A person covered under a
group health insurance policy that is terminated for not meeting the insurer's participation
or eligibility requirements is not required to meet the twelve-month requirement for prior
creditable coverage pursuant to § 58-17-85 in order to become eligible for the risk pool.
SL 1984, ch 326, § 7; SL 1989, ch 433, § 9; SL 2001, ch 280, § 12; SL 2009, ch 265, § 1.