§ 26.1-36.3-02 — Applicability and scope

North Dakota § 26.1-36.3-02

• Jurisdiction: North Dakota
• Title 26.1: Insurance
• Ch. 26.1-36.3: Small Employer Employee Health Insurance

Text

1. This chapter and section 26.1-36-37.2 apply to any health benefit plan that provides
coverage to the employees of a small employer in this state if:
a. Any portion of the premium or benefits is paid by or on behalf of the small
employer;
b. An eligible employee or dependent is reimbursed, whether through wage
adjustments or otherwise, by or on behalf of the small employer for any portion of
the premium; or
c. The health benefit plan is treated by the employer or any of the eligible
employees or dependents as part of a plan or program for the purposes of
section 106, 125, or 162 of the United States Internal Revenue Code.
2. a. Except as provided in subdivision b, carriers that are affiliated companies or that
are eligible to file a consolidated tax return must be treated as one carrier and
any restrictions or limitations imposed by this chapter and section 26.1-36-37.2
apply as if all health benefit plans delivered or issued for delivery to small
employers in this state by the affiliated carriers were issued by one carrier.
b. An affiliated carrier that is a health maintenance organization having a certificate
of authority may be considered to be a separate carrier for the purposes of this
chapter and section 26.1-36-37.2.
c. Unless otherwise authorized by the commissioner, a small employer carrier may
not enter into one or more ceding arrangements with respect to health benefit
plans delivered or issued for delivery to small employers in this state if the
arrangements would result in less than fifty percent of the insurance obligation or
risk for the health benefit plans being retained by the ceding carrier.
3. a. A Taft Hartley trust, or a carrier with the written authorization of that trust, may
make a written request to the commissioner for a waiver from the application of
any of the provisions of subsection 1 of section 26.1-36.3-04 with respect to a
health benefit plan provided to the trust.
b. The commissioner may grant the waiver if the commissioner finds that application
of subsection 1 of section 26.1-36.3-04, with respect to the trust:
(1) Would have a substantial adverse effect on the participants and
beneficiaries of that trust; and
(2) Would require significant modifications to one or more collective bargaining
arrangements under which the trust is established or maintained.
c. A waiver granted under this section does not apply to a person who participates
in the trust as an associate member of an employee organization.