(1)Each carrier offering
individual or small employer health benefit plans shall actively market health
benefit plan coverage to eligible individuals or small employers in the state, as
applicable.
(2)(a) Except as provided in paragraph (b) of this subsection (2), no carrier or
producer shall, directly or indirectly, engage in the following activities:
(I)Encouraging or directing individuals or small employers to refrain from
filing an application for coverage with the individual or small employer carrier
because of the health status, claims experience, industry, occupation, or
geographic location of the individual or small employer;
(II)Encouraging or directing individuals or small employers to seek coverage
from another carrier because of the health status, claims experien
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(1) Each carrier offering
individual or small employer health benefit plans shall actively market health
benefit plan coverage to eligible individuals or small employers in the state, as
applicable.
(2) (a) Except as provided in paragraph (b) of this subsection (2), no carrier or
producer shall, directly or indirectly, engage in the following activities:
(I) Encouraging or directing individuals or small employers to refrain from
filing an application for coverage with the individual or small employer carrier
because of the health status, claims experience, industry, occupation, or
geographic location of the individual or small employer;
(II) Encouraging or directing individuals or small employers to seek coverage
from another carrier because of the health status, claims experience, industry,
occupation, or geographic location of the individual or small employer.
(b) The provisions of paragraph (a) of this subsection (2) shall not apply with
respect to information provided by a carrier or producer to an individual or a small
employer regarding the established geographic service area or a restricted network
provision of a carrier.
(3) (a) Except as provided in paragraph (b) of this subsection (3), a carrier
shall not, directly or indirectly, enter into any contract, agreement, or arrangement
with a producer that provides for or results in the compensation paid to a producer
for the sale of a health benefit plan to be varied because of the health status,
claims experience, industry, occupation, or geographic location of the individual or
small employer.
(b) Paragraph (a) of this subsection (3) shall not apply to a compensation
arrangement with a producer on the basis of a percentage of premium if such
percentage does not vary because of the health status, claims experience, industry,
occupation, or geographic area of the individual or small employer.
(4) Repealed.
(5) A carrier shall not terminate, fail to renew, or limit its contract or
agreement of representation with a producer for any reason related to the health
status, claims experience, occupation, or geographic area of the individuals or small
employers placed by the producer with the carrier.
(6) No carrier shall induce or otherwise encourage a small employer to
exclude an employee from health coverage or benefits provided in connection with
the employee's employment.
(7) Any denial by a carrier of an application for coverage from an individual
or a small employer shall be in writing and shall state any reason for the denial.
(8) The commissioner may establish regulations setting forth additional
standards to provide for the fair marketing and broad availability of health benefit
plans to individuals and small employers in this state.
(9) A violation of this section by a carrier or a producer is an unfair or
deceptive act or practice pursuant to the provisions of part 11 of article 3 of this
title.
(10) If a small employer carrier enters into a contract, agreement, or other
arrangement with a third-party administrator to provide administrative marketing or
other service related to the offering of health benefit plans to small employers in
this state, the third-party administrator shall be subject to this section as if it were
a small employer carrier.
(11) (a) Effective January 1, 2014, all carriers offering or providing health
benefit plan coverage shall provide a summary of benefits and coverage form that
complies with the requirements of federal law. The commissioner shall adopt rules
specifying when carriers are required to provide the form.
(b) (I) To the extent consistent with the summary of benefits and coverage
form requirements in federal law, and in addition to the summary of benefits and
coverage form required by paragraph (a) of this subsection (11), the commissioner
may adopt and require carriers to provide any supplemental health benefit plan
description forms the commissioner deems appropriate. The commissioner, by rule,
may determine the format for and elements of the supplemental health benefit plan
description form.
(II) The commissioner shall design the supplemental health benefit plan
description form to facilitate the comparison of different health benefit plans. The
form must also include informational materials specifying the plan's cancer
screening coverages and their respective parameters.
(III) A carrier shall provide a completed supplemental health benefit plan
description form when the carrier provides the form described in paragraph (a) of
this subsection (11).