1. a. As a condition of transacting business in this state with small employers, every
small employer carrier shall actively offer small employers all health benefit plans
it actively markets to small employers in this state.
b.
(1)Subject to subdivision a of subsection 1, a small employer carrier shall issue
any health benefit plan to any eligible small employer that applies for the
plan and agrees to make the required premium payments and to satisfy the
other reasonable provisions of the health benefit plan not inconsistent with
this chapter and section 26.1-36-37.2. However, a carrier may not be
required to issue a health benefit plan to a self-employed individual who is
covered by, or is eligible for coverage under, a health benefit plan offered by
an employer.
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1. a. As a condition of transacting business in this state with small employers, every
small employer carrier shall actively offer small employers all health benefit plans
it actively markets to small employers in this state.
b. (1) Subject to subdivision a of subsection 1, a small employer carrier shall issue
any health benefit plan to any eligible small employer that applies for the
plan and agrees to make the required premium payments and to satisfy the
other reasonable provisions of the health benefit plan not inconsistent with
this chapter and section 26.1-36-37.2. However, a carrier may not be
required to issue a health benefit plan to a self-employed individual who is
covered by, or is eligible for coverage under, a health benefit plan offered by
an employer.
(2) In the case of a small employer carrier that establishes more than one class
of business pursuant to section 26.1-36.3-03, the small employer carrier
shall maintain and issue to eligible small employers all health benefit plans it
actively markets to small employers. A small employer carrier may apply
reasonable criteria in determining whether to accept a small employer into a
class of business if the criteria are not intended to discourage or prevent
acceptance of small employers applying for a health benefit plan, are not
related to a health status-related factor of the small employer, and are
applied consistently to all small employers applying for coverage in the class
of business. The small employer carrier shall provide for the acceptance of
all eligible small employers into one or more classes of business. This
paragraph does not apply to a class of business into which the small
employer carrier is no longer enrolling new small businesses.
2. Health benefit plans covering small employers must comply with the following:
a. A health benefit plan may impose a pre-existing condition exclusion only if:
(1) The exclusion relates to a condition, regardless of the cause of the
condition, for which medical advice, diagnosis, care, or treatment was
recommended or received within the six-month period immediately
preceding the effective date of coverage;
(2) The exclusion extends for a period of not more than twelve months after the
effective date of coverage;
(3) The exclusion does not relate to pregnancy as a pre-existing condition; and
(4) The exclusion does not treat genetic information as a pre-existing condition
in the absence of a diagnosis of a condition related to such information.
b. A small employer carrier shall reduce any time period applicable to a pre-existing
condition exclusion or limitation period by the aggregate of periods the individual
was covered by qualifying previous coverage, if any, if the qualifying previous
coverage was continuous until at least sixty-three days prior to the effective date
of the new coverage. Any waiting period applicable to an individual for coverage
under a group health benefit plan may not be taken into account in determining
the period of continuous coverage. This subdivision does not preclude application
of an employer waiting period applicable to all new enrollees under the health
benefit plan. Small employer carriers shall credit coverage by either a standard
method or an alternative method. The commissioner shall adopt rules for
crediting coverage under the standard and alternative method. These rules must
be consistent with the Health Insurance Portability and Accountability Act of 1996
[Pub. L. 104-191; 110 Stat. 1936; 29 U.S.C. 1181 et seq.] and any federal rules
adopted pursuant thereto.
c. A health benefit plan may exclude coverage for late enrollees for the greater of
eighteen months or for an eighteen-month pre-existing condition exclusion;
however, if both a period of exclusion from coverage and a pre-existing condition
exclusion are applicable to a late enrollee, the combined period may not exceed
eighteen months from the date the individual enrolls for coverage under the
health benefit plan.
d. (1) Except as provided in this subdivision, a small employer carrier shall apply
requirements used to determine whether to provide coverage to a small
employer, including requirements for minimum participation of eligible
employees and minimum employer contributions, uniformly among all small
employers with the same number of eligible employees who are applying for
coverage or receiving coverage from the small employer carrier.
(2) A small employer carrier may vary application of minimum participation
requirements and minimum employer contribution requirements only by the
size of the small employer group.
(3) (a) Except as provided in subparagraph b, a small employer carrier, in
applying minimum participation requirements with respect to a small
employer, may not consider employees or dependents who have
qualifying existing coverage in determining whether the applicable
percentage of participation is met. For purposes of determining the
applicable percentage of participation under this subparagraph only,
individual health benefit plans are not included in the definition of
"qualifying existing coverage" under section 26.1-36.3-01.
(b) With respect to a small employer, with ten or fewer eligible employees,
a small employer carrier may consider employees or dependents who
have coverage under another health benefit plan sponsored by the
small employer in applying minimum participation requirements.
(4) A small employer carrier may not increase any requirement for minimum
employee participation or any requirement for minimum employer
contribution applicable to a small employer at any time after the small
employer has been accepted for coverage.
e. (1) If a small employer carrier offers coverage to a small employer, the small
employer carrier shall offer coverage to all of the eligible employees of a
small employer and their dependents. A small employer carrier may not offer
coverage only to certain individuals in a small employer group or only to part
of the group, except in the case of late enrollees as provided in
subdivision c.
(2) Except as permitted under subsection 1 and this subsection, a small
employer carrier may not modify a health benefit plan with respect to a small
employer or any eligible employee or dependent through riders,
endorsements, or otherwise, to restrict or exclude coverage for certain
diseases or medical conditions otherwise covered by the health benefit plan.
3. a. A small employer carrier offering coverage through a network plan is not required
to offer coverage or accept applications under subsection 1 to a small employer
if:
(1) The small employer does not have eligible individuals who live, work, or
reside in the service area for such network plan; or
(2) The small employer does have eligible individuals who live, work, or reside
in the service area for the network plan, but the carrier has demonstrated, if
required, to the commissioner that it will not have the capacity to deliver
services adequately to enrollees of any additional groups because of its
obligations to existing group contractholders and enrollees, and that it is
applying this paragraph uniformly to all employers without regard to the
claims experience of those employers and their employees and their
dependents or any health status-related factor relating to such employees
and dependents.
b. A small employer carrier, upon denying health insurance coverage in any service
area in accordance with paragraph 2 of subdivision a, may not offer coverage in
the small employer market within the service area for a period of one hundred
eighty days after the date the coverage is denied.
4. A small employer carrier is not required to provide coverage to small employers
pursuant to subsection 1 for any period of time for which the commissioner determines
that the carrier does not have the financial reserves to underwrite additional coverage
and is applying this section uniformly without regard to the claims experience of small
employers or any health status-related factor relating to employees and their
dependents. A small employer carrier denying coverage in accordance with this
section may not offer coverage in connection with a group health benefit plan in the
small group market for a period of one hundred eighty days after the health coverage
is denied or until the carrier has demonstrated to the commissioner sufficient financial
reserves to underwrite financial coverage, whichever is later.
5. Subsection 1 does not apply to health benefit plans offered by a small employer carrier
if the carrier makes the health benefit plans available in the small employer market
only through one or more associations.