after termination of employment or membership.
A group policy or certificate of insurance or certificate on a master policy of a group as
defined by subsection 6 of section 26.1-02-05 delivered or issued for delivery in this state issued
by any insurance company, nonprofit health service corporation, health maintenance
organization, or any other insurer that provides hospital, surgical, or major medical expense
insurance or any accommodation of these coverages on an expense-incurred basis, but not a
policy that provides benefits for specific diseases or for accidental injuries only, must provide
that employees or members whose insurance under the group policy would otherwise terminate
because of termination of employment or membership are entitled to continue their hospital,
surgical, and
Free access — add to your briefcase to read the full text and ask questions with AI
after termination of employment or membership.
A group policy or certificate of insurance or certificate on a master policy of a group as
defined by subsection 6 of section 26.1-02-05 delivered or issued for delivery in this state issued
by any insurance company, nonprofit health service corporation, health maintenance
organization, or any other insurer that provides hospital, surgical, or major medical expense
insurance or any accommodation of these coverages on an expense-incurred basis, but not a
policy that provides benefits for specific diseases or for accidental injuries only, must provide
that employees or members whose insurance under the group policy would otherwise terminate
because of termination of employment or membership are entitled to continue their hospital,
surgical, and major medical insurance under that group policy, for themselves and their eligible
dependents, subject to all of the group policy's terms and conditions applicable to those forms of
insurance and to the following conditions:
1. Continuation is only available to an employee or member who has been continuously
insured under the group policy, and for similar benefits under any group policy which it
replaced, during the entire three-month period ending with the termination.
2. Continuation is not available for any person who is covered by Medicare. Neither is
continuation available for any person who is covered by any other insured or
uninsured arrangement which provides hospital, surgical, or medical coverages for
individuals in a group and under which the person was not covered immediately prior
to the termination.
3. Continuation need not include dental, vision care, or prescription drug benefits or any
other benefits provided under the group policy in addition to its hospital, surgical, or
major medical benefits.
4. An employee or member who wishes continuation of coverage must request the
continuation in writing within the ten-day period following the later of the date of
termination, or the day the employee is given notice of the right of continuation by
either the employer or the group policyholder. The employee or member may not elect
continuation more than thirty-one days after the date of termination.
5. An employee or member electing continuation shall pay to the group policyholder or
the employer, on a monthly basis in advance, the amount of contribution required by
the policyholder or employer, but not more than the group rate for the insurance being
continued under the group policy on the due date of each payment. The employee's or
member's written election of continuation, together with the first contribution required
to establish contributions on a monthly basis in advance, must be given to the
policyholder or employer within thirty-one days of the date the employee's or member's
insurance would otherwise terminate.
6. Continuation of insurance under the group policy for any person terminates when the
person fails to satisfy subsection 2 or, if earlier, at the first to occur of the following:
a. The date thirty-nine weeks after the date the employee's or member's insurance
under the policy would otherwise have terminated because of termination of
employment or membership.
b. If the employee or member fails to make timely payment of a required
contribution, the end of the period for which contributions were made.
c. The date on which the group policy is terminated or, in the case of an employee,
the date the employer terminates participation under the group policy. However, if
this subdivision applies and the coverage ceasing by reason of such termination
is replaced by similar coverage under another group policy, the following apply:
(1) The employee or member may become covered under that other group
policy for the balance of the period that the employee or member would
have remained covered under the prior group policy in accordance with this
subsection had a termination described in this subdivision not occurred.
(2) The minimum level of benefits to be provided by the other group policy is the
applicable level of benefits of the prior group policy reduced by any benefits
payable under that prior group policy.
(3) The prior group policy must continue to provide benefits to the extent of its
accrued liabilities and extensions of benefits as if the replacement had not
occurred.
7. A notification of the continuation privilege must be included in each certificate of
coverage.
8. Upon termination of the continuation period, the member, surviving spouse, or
dependent is entitled to exercise any option which is provided in the group plan to
elect a conversion policy. The member electing a conversion policy shall notify the
carrier of the election and pay the required premium within thirty-one days of the
termination of the continued coverage under the group contract.
9. a. Notwithstanding any other provision of this section, an employee or member who
does not have an election of continuation coverage as described in this section in
effect on the effective date of the American Recovery and Reinvestment Act of
2009 [Pub. L. 111-5], but who would be an assistance-eligible individual under
title III of division B of the Act if the election were in effect, may elect continuation
coverage. The employer or the group policyholder shall provide employees or
members with additional written notice of the right to elect coverage under this
subsection within sixty days of the date of enactment of the American Recovery
and Reinvestment Act of 2009 or May 19, 2009, whichever is later. The employee
or member may make the election in writing no later than sixty days after the date
the employer or the group policyholder provides the notice to the employee or
member.
b. Continuation coverage elected under this subsection commences with the first
period of coverage beginning after February 16, 2009, and may not extend
beyond the period of continuation coverage that would have been required if the
coverage had instead been elected under subsection 4.
c. The period beginning on the date that the employee or member was involuntarily
terminated and ending when the continuation coverage starts must be
disregarded for the purpose of determining whether a pre-existing condition
exclusion period applies.
d. An employee or member electing continuation under this subsection shall pay to
the group policyholder or the employer, on a monthly basis in advance, the
amount of contribution required by the policyholder or employer, but not more
than the group rate for the insurance being continued under the group policy on
the due date of each payment. The employee's or member's written election of
continuation, together with the contribution required to establish contributions on
a monthly basis in advance, must be given to the policyholder or employer within
thirty-one days of the date the employee's or member's election of continuation
coverage.
e. Continuation of insurance under this subsection terminates at the earlier of the
date when the person fails to satisfy subsection 2 or when the person fails to
satisfy any requirement of subsection 6.
f. The notification described in subsection 7 is not required for continuation
coverage elected under this subsection.
g. Except as otherwise provided in this subsection, the provisions of this section
apply to an employee or member electing continuation coverage.