20-2309

20-2309. Renewability

A. At least sixty days before the date of expiration of a health benefits plan, an
accountable health plan that provides a health benefits plan shall provide for written
notice to the employer of the terms for renewal of the plan. The notice shall include an
explanation of the extent to which any increase in premiums is due to actual or expected
claims experience of the individuals covered under the employer's health benefits plan
contract.

B. An accountable health plan may refuse to renew or may terminate a health
benefits plan only if:

1. The employer fails to pay premiums or contributions in accordance with the terms
of the health benefits plan of the accountable health plan or the accountable health plan
does not receive premium payments in a timely manner.

2. The employer committed an act or practice that constitutes fraud or made an
intentional misrepresentation of material fact under the terms of the health benefits
plan.

3. The employer has failed to comply with a material plan provision relating to
individual or employer participation rules as prescribed in subsection C of this section.

4. The accountable health plan has ceased to offer new coverage and has terminated
or ceased to renew all in-force coverage in the group market pursuant to this section.

5. In the case of an accountable health plan that offers a health benefits plan
through a network plan in this state, there is no longer any enrollee in connection with
the accountable health plan who lives, resides or works in the service area of the
accountable health plan or in the area served by the network plan for which the
accountable health plan is authorized to do business and the accountable health plan
would deny enrollment pursuant to section 20-2304, subsection G.

6. In the case of an accountable health plan that offers a health benefits plan in
the group market only through one or more bona fide associations, the membership of an
employer in the association has ceased but only if that coverage is terminated uniformly
without regard to any health status-related factor or any covered individual.

C. An accountable health plan may require that a minimum percentage of employees
who are not covered under a spouse's or parent's employer's health benefits plan be
enrolled in a plan if the percentage is applied uniformly to all plans that are offered
to employers of comparable size.

D. An accountable health plan is not required to renew a health benefits plan with
respect to an employer or individual if the accountable health plan:

1. Elects not to renew all of its health benefits plans that are issued to
employers or individuals in this state.

2. Provides notice to the director at least five business days before the
accountable health plan gives notice to each employer or individual covered under a
health benefits plan of the intention to discontinue offering any health benefits plans
in this state.

3. Provides notice of termination or nonrenewal to each employer or individual
covered under a plan at least one hundred eighty days before the renewal date of the
plan. If the accountable health plan terminates coverage, the accountable health plan
may not issue a health benefits plan to an employer in this state during the five year
period beginning on the termination date of the last plan that was not renewed.

E. If an accountable health plan decides to discontinue offering a particular
health benefits plan offered in the group market, the accountable health plan may
discontinue that coverage only if the accountable health plan:

1. Provides notice to the director at least five business days before the
accountable health plan gives notice to each employer or individual covered under that
health benefits plan of the intention to discontinue offering that health benefits plan
in this state.

2. Provides notice to each employer or individual covered under that health
benefits plan at least ninety days before the date of the discontinuation of that
coverage.

3. Offers to each employer whose coverage is discontinued pursuant to this
subsection the option to purchase all other health benefits plans currently offered by
the accountable health plan for employers in the group market uniformly without regard to
any health status-related factor of any employee or a spouse or a dependent of the
employee enrolled or individuals who may become eligible for that coverage.