20-1381

20-1381. Suspension of health care insurer
obligation to issue coverage on a guaranteed issuance basis to
eligible individuals

A. A health care insurer may apply to the director to suspend its obligation to
issue coverage to eligible individuals pursuant to section 20-1379 for a specified period
if all of the following conditions are met:

1. The health care insurer can demonstrate to the director that its financial or
administrative capacity to serve eligible individuals would impair the ability of the
health care insurer to serve previously enrolled individuals in the individual market.

2. The health care insurer requests that its obligation to issue coverage to
eligible individuals pursuant to section 20-1379 be suspended for a specified period, of
not more than one year, and provides a rationale for suspending its obligation to issue
coverage to eligible individuals for that period of time.

3. The health care insurer provides sufficient information for the director to
determine that the health care insurer has met the requirements of this subsection.

B. A health care insurer that refuses to enroll an eligible individual shall not
enroll any eligible individuals until the earlier of:

1. The date on which the director determines that the health care insurer has the
capacity to enroll eligible individuals.

2. The date on which the health care insurer enrolls an eligible individual. The
health care insurer shall notify the director within ten days after that enrollment.

C. The director shall approve or disapprove an application submitted by a health
care insurer within sixty days after the filing. The director may extend the period for
good cause for up to an additional sixty days. The director may suspend a health care
insurer's obligation to issue coverage to eligible individuals for a period of less time
than requested in the application.

D. In calculating the period of creditable coverage to determine if a person is an
eligible individual, if the person was an eligible individual when the person submitted
an application for coverage to a health care insurer and the health care insurer has
received an order pursuant to this section, the person continues to be an eligible
individual until the later of the expiration of the original sixty-three day period or an
additional thirty days after the individual receives a written notice from the health
care insurer pursuant to an order of the director that the health care insurer will not
issue coverage to the individual pursuant to section 20-1379.