§ 42-157-3. General requirements.
(a) The exchange shall make qualified health plans available to qualified individuals
and qualified employers. The exchange shall not make available any health benefit
plan that has not been certified by the exchange as a qualified health plan in accordance
with federal law.
(b) The exchange shall allow an insurer to offer a plan that provides limited scope dental
benefits meeting the requirements of section 9832(c)(2)(A) of the Internal Revenue Code of 1986 through the exchange, either separately or in conjunction with a qualified health
plan, if the plan provides pediatri
Free access — add to your briefcase to read the full text and ask questions with AI
§ 42-157-3. General requirements.
(a) The exchange shall make qualified health plans available to qualified individuals
and qualified employers. The exchange shall not make available any health benefit
plan that has not been certified by the exchange as a qualified health plan in accordance
with federal law.
(b) The exchange shall allow an insurer to offer a plan that provides limited scope dental
benefits meeting the requirements of section 9832(c)(2)(A) of the Internal Revenue Code of 1986 through the exchange, either separately or in conjunction with a qualified health
plan, if the plan provides pediatric dental benefits meeting the requirements of section
1302(b)(1)(J) of the federal act [42 U.S.C. § 18022].
(c) Any health plan that delivers a benefit plan on the exchange that covers abortion
services, as defined in 45 C.F.R. § 156.280(d)(1), shall comply with segregation of funding requirements, as well as an annual assurance
statement to the Office of the Health Insurance Commissioner, in accordance with 45 C.F.R. § 156.280(e)(3) and (5).
(d) At least one plan variation for individual market plan designs offered on the exchange
at each level of coverage, as defined by section 1302(d)(1) of the federal act [42 U.S.C. § 18022], at which the carrier is offering a plan or plans, shall exclude coverage for abortion
services as defined in 45 C.F.R. § 156.280(d)(1). If the health plan proposes different rates for such plan variations, each listed
plan design shall include the associated rate. Except for religious employers (as
defined in section 6033(a)(3)(A)(i) of the Internal Revenue Code), employers selecting a plan under this religious exemption subsection may not designate
it as the single plan for employees, but shall offer their employees full-choice of
small employer plans on the exchange, using the employer-selected plan as the base
plan for coverage. The employer is not responsible for payment that exceeds that designated
for the employer-selected plan.
(e) Health plans that offer a plan variation that excludes coverage for abortion services
as defined in 45 C.F.R. § 156.280(d)(1) for a religious exemption variation in the small group market shall treat such a
plan as a separate plan offering with a corresponding rate.
(f) An employer who elects a religious exemption variation shall provide written notice
to prospective enrollees prior to enrollment that the plan excludes coverage for abortion
services as defined in 45 C.F.R. § 156.280(d)(1). The carrier must include notice that the plan excludes coverage for abortion services
as part of the Summary of Benefits and Coverage required by 42 U.S.C. § 300gg-15.