20-1411. Eligibility; prohibiting cancellation
because of eligibility for certain benefits
A. An insurer issuing group disability or blanket disability insurance contracts
shall not consider the availability of or a person's eligibility for medical assistance
pursuant to title XIX of the social security act (P.L. 89-97; 79 Stat. 344; 42 United
States Code section 1396a (1980)) when considering eligibility for coverage or
calculating payments under its plans for eligible policyholders.
B. To the extent that payment for covered expenses has been made under the state
program pursuant to title XIX of the social security act for health care items or
services furnished to an individual, the state is considered to have acquired the rights
of the individual to payment by any other party for those health care items or
services. On presentation of proof that the state program pursuant to title XIX of the
social security act has paid for covered items or services, the insurer shall make
payments to the state program pursuant to title XIX of the social security act according
to the coverage provided in the policy or certificate.
C. An insurer issuing group disability or blanket disability insurance contracts
may not impose on a state agency that has been assigned the rights of an individual who
is eligible for medical assistance and who is covered for health benefits from the
insurer any requirements that are different from the requirements applicable to an agent
or assignee of any other covered individual.
D. An insurer issuing group disability or blanket disability insurance contracts
shall not cancel or fail to renew the contract of any person based on that person's
eligibility for or enrollment in a program funded under title XIX of the social security
act or title 36, chapter 29 or 34. Nothing in this section prohibits cancellation or
failure to renew for nonpayment of monies due under the contract.
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