§ 26.1-36.3-05 — Renewability of coverage

North Dakota § 26.1-36.3-05

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

Text

1. A health benefit plan subject to this chapter and section 26.1-36-37.2 must be
renewable with respect to all eligible employees and dependents, at the option of the
small employer, except for any of the following:
a. The plan sponsor has failed to pay premiums or contributions in accordance with
the terms of the health benefit plan or the health carrier has not received timely
premium payments.
b. The plan sponsor or small employer has performed an act or practice that
constitutes fraud or made an intentional misrepresentation of a material fact
under the terms of the coverage.
c. Noncompliance with the carrier's minimum participation requirements.
d. Noncompliance with the carrier's employer contribution requirements.
e. A decision by the small employer carrier to discontinue offering a particular type
of group health benefit plan in the state's small employer market. A type of health
benefit plan may be discontinued by the carrier in that market only if the carrier:
(1) Provides advance notice of its decision under this paragraph to the
commissioner in each state in which it is licensed;
(2) Provides notice of the decision not to renew coverage to all affected small
employers, participants, and beneficiaries, and to the commissioner in each
state in which an affected insured individual is known to reside at least
ninety days prior to the nonrenewal of any health benefit plans by the
carrier. Notice to the commissioner under this subdivision must be provided
at least three working days prior to the notice to the affected small
employers and participants and beneficiaries;
(3) Offers to each plan sponsor provided the type of group health benefit plan
the option to purchase all other health benefit plans currently being offered
by the carrier to employers in the state; and
(4) In exercising the option to discontinue the particular type of group health
benefit plan and in offering the option of coverage under paragraph 3, the
carrier acts uniformly without regard to the claims experience of those
sponsors or any health status-related factor relating to any participants or

beneficiaries covered or new participants or beneficiaries who may become
eligible for such coverage.
f. A decision by the small employer carrier to discontinue offering and to nonrenew
all its health benefit plans delivered or issued for delivery to small employers in
this state. In such a case, the carrier shall:
(1) Provide advance notice of its decision under this paragraph to the
commissioner in each state in which it is licensed;
(2) Provide notice of the decision not to renew coverage to all affected small
employers, participants, and beneficiaries, and to the commissioner in each
state in which an affected insured individual is known to reside at least one
hundred eighty days prior to the nonrenewal of any health benefit plans by
the carrier. Notice to the commissioner under this subdivision shall be
provided at least three working days prior to the notice to the affected small
employers and participants and beneficiaries; and
(3) Discontinue all health insurance issued or delivered for issuance in the
state's small employer market and not renew coverage under any health
benefit plan issued to a small employer.
g. In the case of health benefit plans that are made available in the small employer
market only through one or more associations, the membership of an employer in
the association, on the basis of which the coverage is provided, ceases, but only
if the coverage is terminated under this subdivision uniformly without regard to
any health status-related factor relating to any covered individual.
h. The commissioner finds that the continuation of the coverage would not be in the
best interests of the policyholders or certificate holders or would impair the
carrier's ability to meet its contractual obligations. In this case the commissioner
shall assist affected small employers in finding replacement coverage.
2. A small employer carrier that elects not to renew a health benefit plan under
subdivision f of subsection 1 may not write new business in the small employer market
in this state for a period of five years from the date of notice to the commissioner.
3. In the case of a small employer carrier doing business in one established geographic
service area of the state, this section only applies to the carrier's operations in that
service area.
4. A small employer carrier offering through a network plan may not be required to offer
coverage or accept applications pursuant to subsection 1 or 2 in the case of the
following:
a. To an eligible person who no longer resides, lives, or works in the service area, or
in an area for which the carrier is authorized to do business, but only if coverage
is terminated under this subdivision uniformly without regard to any health
status-related factor; or
b. To a small employer that no longer has any enrollee in connection with the plan
who lives, resides, or works in the service area of the carrier, or the area for
which the carrier is authorized to do business.
5. At the time of coverage renewal, a health insurance carrier may modify the health
insurance coverage for a product offered to a group health plan if, for coverage that is
available in such market other than only through one or more bona fide associations,
the modification is reasonable, consistent with state law, and effective on a uniform
basis among group health plans with that product. If coverage is modified, the carrier
shall:
a. Provide advance notice of its decision under this subsection to the commissioner
at least three working days prior to mailing the notice to the affected small
employers and participants and beneficiaries.
b. Provide notice of the decision to modify health coverage to all affected small
employers, participants, and beneficiaries and the commissioner sixty days prior
to the modification of health coverage by the carrier.