§ 23-86-306 — Prohibiting discrimination against individual participants and beneficiaries based on health status

(a) Ineligibility to Enroll. (1) In General. Subject to subdivision (a)(2) of this section, a group health plan and a health insurance issuer offering group health insurance coverage in connection with a group health plan may not establish rules for eligibility including continued eligibility of any individual to enroll under the terms of the group health plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual: (A) Health status; (B) Medical condition, including both physical and mental illnesses; (C) Claims experience; (D) Receipt of health care; (E) Medical history; (F) Genetic information; (G) Evidence of insurability including conditions arising out of acts of domestic violence; or (H) Disability. (2) No Application to Benefits or Exclusions. To the extent consistent with § 23-86-304, subdivision (a)(1) of this section shall not be construed: (A) To require a group health plan or group health insurance coverage to provide particular benefits other than those provided under the terms of such a group health plan or group health insurance coverage; or (B) To prevent such a group health plan or group health insurance coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the group health plan or group health insurance coverage. (3) Construction. For purposes of subdivision (a)(1) of this section, rules for eligibility to enroll under a group health plan include rules defining any applicable waiting periods for such enrollment. (b) In Premium Contributions. (1) In General. A group health plan and a health insurance issuer offering health insurance coverage in connection with a group health plan may not require any individual as a condition of enrollment or continued enrollment under the group health plan to pay a premium or contribution which is greater than the premium or contribution for a similarly situated individual enrolled in the group health plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the group health plan as a dependent of the individual. (2) Construction. Nothing in subdivision (b)(1) of this section shall be construed to: (A) Restrict the amount that an employer may be charged for coverage under a group health plan; or (B) Prevent a group health plan and a health insurance issuer offering group health insurance coverage from establishing otherwise lawful premium discounts, rebates, or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.

Legislative History

Acts 1997, No. 997, § 1.