This text of North Dakota § 26.1-18.1-14 (Enrollment period and replacement coverage in the event of insolvency) is published on Counsel Stack Legal Research, covering North Dakota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
1.Enrollment period.
a.In the event of an insolvency of a health maintenance organization, upon order of
the commissioner all other carriers that participated in the enrollment process
with the insolvent health maintenance organization at a group's last regular
enrollment period shall offer the group's enrollees of the insolvent health
maintenance organization a thirty-day enrollment period commencing upon the
date of insolvency. Each carrier shall offer the enrollees of the insolvent health
maintenance organization the same coverages and rates that it had offered to the
enrollees of the group at its last regular enrollment period.
b.If no other carrier had been offered to some groups enrolled in the insolvent
health maintenance organization, or if the commissioner determines that the
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1. Enrollment period.
a. In the event of an insolvency of a health maintenance organization, upon order of
the commissioner all other carriers that participated in the enrollment process
with the insolvent health maintenance organization at a group's last regular
enrollment period shall offer the group's enrollees of the insolvent health
maintenance organization a thirty-day enrollment period commencing upon the
date of insolvency. Each carrier shall offer the enrollees of the insolvent health
maintenance organization the same coverages and rates that it had offered to the
enrollees of the group at its last regular enrollment period.
b. If no other carrier had been offered to some groups enrolled in the insolvent
health maintenance organization, or if the commissioner determines that the
other health benefit plans lack sufficient health care delivery resources to assure
that health care services will be available and accessible to all of the group
enrollees of the insolvent health maintenance organization, then the
commissioner shall allocate equitably the insolvent health maintenance
organization's group contracts for the groups among all health maintenance
organizations which operate within a portion of the insolvent health maintenance
organization's service area, taking into consideration the health care delivery
resources of each health maintenance organization. Each health maintenance
organization to which a group or groups are so allocated shall offer the group or
groups the health maintenance organization's existing coverage which is most
similar to each group's coverage with the insolvent health maintenance
organization at rates determined in accordance with the successor health
maintenance organization's existing rating methodology.
c. The commissioner shall also allocate equitably the insolvent health maintenance
organization's nongroup enrollees which are unable to obtain other coverage
among all health maintenance organizations which operate within a portion of the
insolvent health maintenance organization's service area, taking into
consideration the health care delivery resources of each health maintenance
organization. Each health maintenance organization to which nongroup enrollees
are allocated shall offer nongroup enrollees the health maintenance
organization's existing coverage for individual or conversion coverage as
determined by the type of coverage in the insolvent health maintenance
organization at rates determined in accordance with the successor health
maintenance organization's existing rating methodology. Successor health
maintenance organizations which do not offer direct nongroup enrollment may
aggregate all of the allocated nongroup enrollees into one group for rating and
coverage purposes.
2. Replacement coverage.
a. "Discontinuance" means the termination of the contract between the group
contractholder and a health maintenance organization due to the insolvency of
the health maintenance organization, and does not refer to the termination of any
agreement between any individual enrollee and the health maintenance
organization.
b. Any carrier providing replacement coverage with respect to group hospital,
medical, or surgical expense or service benefits within a period of sixty days from
the date of discontinuance of a prior health maintenance organization contract or
policy providing hospital, medical, or surgical expense or service benefits shall
immediately cover all enrollees who were validly covered under the previous
health maintenance organization contract or policy at the date of discontinuance
and who would otherwise be eligible for coverage under the succeeding carrier's
contract, regardless of any provisions of the contract relating to active
employment or hospital confinement or pregnancy.
c. Except to the extent benefits for the condition would have been reduced or
excluded under the prior carrier's contract or policy, no provision in a succeeding
carrier's contract of replacement coverage which would operate to reduce or
exclude benefits on the basis that the condition giving rise to benefits pre-existed
the effective date of the succeeding carrier's contract may be applied with respect
to those enrollees validly covered under the prior carrier's contract or policy on
the date of discontinuance.