§ 27-18.6-5. Continuation of coverage — Renewability.
(a) Notwithstanding any of the provisions of this title to the contrary, a health insurance
carrier that offers health insurance coverage in the large group market in this state
in connection with a group health plan shall renew or continue in force that coverage
at the option of the plan sponsor of the plan.
(b) A health insurance carrier may nonrenew or discontinue health insurance coverage offered
in connection with a group health plan in the large group market based only on one
or more of the following:
(1) The plan sponsor has failed to pay premiums or contributions in accordance with the
terms of the health insurance coverage or the carrier has not received timely premium
payments;
(2) The plan sponsor has performed an act or practice that constitutes fraud or made an
intentional misrepresentation of material fact under the terms of the coverage;
(3) The plan sponsor has failed to comply with a material plan provision relating to employer
contribution or group participation rules, as permitted by the director pursuant to
rule or regulation;
(4) The carrier is ceasing to offer coverage in accordance with subsections (c) and (d)
of this section;
(5) The director finds that the continuation of the coverage would:
(i) Not be in the best interests of the policyholders or certificate holders; or
(ii) Impair the carrier's ability to meet its contractual obligations;
(6) In the case of a health insurance carrier that offers health insurance coverage in
the large group market through a network plan, there is no longer any enrollee in
connection with that plan who resides, lives, or works in the service area of the
carrier (or in an area for which the carrier is authorized to do business); and
(7) In the case of health insurance coverage that is made available in the large group
market only through one or more bona fide 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 section uniformly without regard to any health
status-related factor relating to any covered individual.
(c) In any case in which a carrier decides to discontinue offering a particular type of
group health insurance coverage offered in the large group market, coverage of that
type may be discontinued by the carrier only if:
(1) The carrier provides notice of the decision to all affected plan sponsors, participants,
and beneficiaries at least ninety (90) days prior to the date of discontinuation of
coverage;
(2) The carrier offers to each plan sponsor provided coverage of this type in the large
group market the option to purchase any other health insurance coverage currently
being offered by the carrier to a group health plan in the market; and
(3) In exercising this option to discontinue coverage of this type and in offering the
option of coverage under subdivision (3) of this subsection, the carrier acts uniformly
without regard to the claims experience of those plan sponsors or any health status-related
factor relating to any participants or beneficiaries covered or new participants or
beneficiaries who may become eligible for coverage.
(d) In any case in which a carrier elects to discontinue offering and to nonrenew all
of its health insurance coverage in the large group market in this state, the carrier
shall:
(1) Provide advance notice to the director, to the insurance commissioner in each state
in which the carrier is licensed, and to each plan sponsor (and participants and beneficiaries
covered under that coverage and to the insurance commissioner in each state in which
an affected insured individual is known to reside) of the decision at least one hundred
eighty (180) days prior to the date of the discontinuation of coverage. Notice to
the insurance commissioner shall be provided at least three (3) working days prior
to the notice to the affected plan sponsors, participants, and beneficiaries; and
(2) Discontinue all health insurance issued or delivered for issuance in this state's
large group market and not renew coverage under any health insurance coverage issued
to a large employer.
(e) In the case of a discontinuation under subsection (d) of this section, the carrier
shall be prohibited from the issuance of any health insurance coverage in the large
group market in this state for a period of five (5) years from the date of notice
to the director.
(f) 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 in the large group
market.
(g) In applying this section in the case of health insurance coverage that is made available
by a carrier in the large group market to employers only through one or more associations,
a reference to a "plan sponsor� is deemed, with respect to coverage provided to an
employer member of the association, to include a reference to that employer.