Chapter
05-068
2005 -- S 0421 SUBSTITUTE A
Enacted 06/22/05
A N A C T
RELATING TO INSURANCE
- INDIVIDUAL HEALTH INSURANCE COVERAGE
Introduced By: Senators Cote, Paiva-Weed, Felag, J Montalbano, and Perry
Date Introduced: February
10, 2005
It is enacted by the General
Assembly as follows:
SECTION
1. Section 27-18.5-4 of the General Laws in Chapter 27-18.5 entitled
"Individual
Health Insurance Coverage" is hereby amended to read as follows:
27-18.5-4.
Continuation of coverage -- Renewability. -- (a) A health insurance
carrier
that
provides individual health insurance coverage to an individual in this state
shall renew or
continue
in force that coverage at the option of the individual.
(b) A health insurance carrier may nonrenew or discontinue health insurance
coverage of
an
individual in the individual market based only on one or more of the following:
(1) The individual 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 individual 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 carrier is ceasing to offer coverage in accordance with subsections (c)
and (d) of
this
section;
(4) In the case of a carrier that offers health insurance coverage in the
market through a
network
plan, the individual no longer resides, lives, or works in the service area (or
in an area for
which
the carrier is authorized to do business) but only if the coverage is
terminated uniformly
without
regard to any health status-related factor of covered individuals; or
(5) In the case of health insurance coverage that is made available in the
individual
market
only through one or more bona fide associations, the membership of the
individual in the
association
(on the basis of which the coverage is provided) ceases but only if the
coverage is
terminated
uniformly and without regard to any health status-related factor of covered
individuals.
(c) In any case in which a carrier decides to discontinue offering a particular
type of
health
insurance coverage offered in the individual market, coverage of that type may
be
discontinued
only if:
(1) The carrier provides notice, to each covered individual provided coverage
of this type
in the
market, of the discontinuation at least ninety (90) days prior to the date of
discontinuation
of the
coverage;
(2) The carrier offers to each individual in the individual market provided
coverage of
this
type, the opportunity to purchase any other individual health insurance
coverage currently
being
offered by the carrier for individuals in the market; and
(3) In exercising this option to discontinue coverage of this type and in
offering the
option
of coverage under subdivision (2) of this subsection, the carrier acts
uniformly without
regard
to any health status-related factor of enrolled individuals or individuals who
may become
eligible
for the coverage.
(d) In any case in which a carrier elects to discontinue offering all health
insurance
coverage
in the individual market in this state, health insurance coverage may be
discontinued
only if:
(1) The carrier provides notice to the director and to each individual of the
discontinuation
at least one hundred eighty (180) days prior to the date of the expiration of
the
coverage;
and
(2) All health insurance issued or delivered in this state in the market is
discontinued and
coverage
under this health insurance coverage in the market is not renewed.
(e) In the case of a discontinuation under subsection (d) of this section, the
carrier may
not
provide for the issuance of any health insurance coverage in the individual
market in this state
during
the five (5) year period beginning on the date of the discontinuation
of the last health
insurance
coverage not renewed carrier filed
its notice with the department to withdraw from the
individual
health insurance market in this state. This five (5) year period may be reduced
to a
minimum
of three (3) years at the discretion of the health insurance commissioner,
based on
his/her
analysis of market conditions and other related factors.
(f) The provisions of subsections (d) and (e) of this section do not apply if,
at the time of
coverage
renewal, a health insurance carrier modifies the health insurance coverage for
a policy
form
offered to individuals in the individual market so long as the modification is
consistent with
this
chapter and other applicable law and effective on a uniform basis among all
individuals with
that
policy form.
(g) In applying this section in the case of health insurance coverage made
available by a
carrier
in the individual market to individuals only through one or more associations,
a reference
to an
"individual" includes a reference to the association (of which the
individual is a member).
SECTION 2. This act shall take effect upon passage.
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LC00375/SUB A
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