§ 26.1-36.4-05 — Renewability of health insurance coverage - Discrimination prohibited

North Dakota § 26.1-36.4-05

• Jurisdiction: North Dakota
• Title 26.1: Insurance
• Ch. 26.1-36.4: Hospital and Medical Insurance

Text

1. An insurer issuing policies or certificates under this chapter shall provide for the
renewability or continuability of coverage unless:
a. The individual or group has failed to pay premiums or contributions in accordance
with the terms of the health benefit plan or the insurer has not received timely
premium payments.
b. The individual or group 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 insurer's minimum group participation requirements.
d. Noncompliance with the insurer's employer group contribution requirements.

e. A decision by the insurer to discontinue offering a particular type of health
insurance coverage in the group or individual market. A type of group health
benefit plan or individual policy may be discontinued by the insurer in that market
only if the insurer:
(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
individuals, employers, participants, beneficiaries, and to the commissioner
in each state in which an affected insured is known to reside at least ninety
days prior to the nonrenewal of any health benefit plans by the insurer.
Notice to the commissioner under this subdivision must be provided at least
three working days prior to the notice to the affected individuals, employers,
participants, and beneficiaries;
(3) Offers to each affected group or individual the option to purchase all other
health benefit plans or individual coverage currently being offered by the
insurer in that market; and
(4) In exercising the option to discontinue the particular type of group health
benefit plan or individual coverage and in offering the option of coverage
under paragraph 3, the insurer acts uniformly without regard to claims
experience or any health status-related factor relating to any affected
individuals, participants, or beneficiaries covered or new individuals,
participants, or beneficiaries who may become eligible for such coverage.
f. A decision by the insurer to discontinue offering and to nonrenew all its health
benefit plans or individual coverage delivered or issued for delivery to employers
or individuals in this state. In such a case, the insurer shall:
(1) Provide 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
individuals, employers, participants, and beneficiaries, and to the
commissioner in each state in which an affected insured is known to reside
at least one hundred eighty days prior to the nonrenewal of any health
benefit plans by the insurer. Notice to the commissioner under this
subdivision must be provided at least three working days prior to the notice
to the affected individuals, employers, participants, and beneficiaries; and
(3) Discontinue all health insurance issued or delivered for issuance in the
state's group or individual market and not renew such health coverage in
that market.
g. In the case of health benefit plans that are made available in the group or
individual market only through one or more associations, the membership of an
employer or individual in the association, on the basis of which the coverage is
provided, ceases, but only if the coverage is terminated under this paragraph
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
insurer's ability to meet its contractual obligations. In this case the commissioner
shall assist affected insureds in finding replacement coverage.
2. An insurer that elects not to renew a health benefit plan under subdivision f of
subsection 1 may not write new business in the applicable market in this state for a
period of five years from the date of notice to the commissioner.
3. In the case of an insurer doing business in one established geographic service area of
the state, this section only applies to the insurer's operations in that service area.
4. An insurer offering coverage 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 insurer 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 an insurer that no longer has any enrollee in connection with the plan who
lives, resides, or works in the service area of the insurer, or the area for which the
insurer is authorized to do business.
5. At the time of coverage renewal, an insurer may modify the health insurance coverage
for a product offered to a group or individual, if the modification is reasonable,
consistent with state law, and effective on a uniform basis. 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 employers
and participants and beneficiaries.
b. Provide notice of the decision to modify health coverage to all affected
employers, participants, and beneficiaries and the commissioner sixty days prior
to the modification of health coverage by the carrier.