§ 27-18.6-4. Discrimination prohibited.
(a)(1) Notwithstanding any of the provisions of this title to the contrary, a group health
plan and a health insurance carrier offering group health insurance in connection
with a group health plan may not establish rules for eligibility (including continued
eligibility) of any individual to enroll under the terms of the plan based on health
status-related factors in relation to the individual or dependent of the individual.
(2) Rules for eligibility to enroll under a plan include rules defining any applicable
waiting periods for enrollment.
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§ 27-18.6-4. Discrimination prohibited.
(a)(1) Notwithstanding any of the provisions of this title to the contrary, a group health
plan and a health insurance carrier offering group health insurance in connection
with a group health plan may not establish rules for eligibility (including continued
eligibility) of any individual to enroll under the terms of the plan based on health
status-related factors in relation to the individual or dependent of the individual.
(2) Rules for eligibility to enroll under a plan include rules defining any applicable
waiting periods for enrollment.
(b) Subsection (a) of this section shall not be construed:
(1) To require a group health plan or group health insurance coverage to provide particular
benefits other than those provided under the terms of the plan or coverage; or
(2) To prevent a plan or coverage from establishing limitations on the amount, level,
extent, or nature of the benefits or coverage for similarly situated individuals enrolled
in the coverage.
(c)(1) A group health plan and a health insurance carrier offering health insurance coverage
in connection with a group health plan may not require any individual (as a condition
of enrollment or continued enrollment under the plan) to pay a premium or contribution
that is greater than the premium or contribution for a similarly situated individual
enrolled in the plan on the basis of any health status-related factor in relation
to the individual or to an individual enrolled under the plan as a dependent of the
individual.
(2) Nothing contained within this subsection shall be construed to:
(i) Restrict the amount that an employer may be charged for coverage under a group health
plan; or
(ii) Prevent a group health plan and a health insurance carrier offering group health insurance
coverage from establishing premium discounts or rebates or modifying applicable copayments
or deductibles in return for adherence to programs of health promotion and disease
prevention.