§431:2-201.5  Conformity to federal law. [Repeal and reenactment on July 1, 2013.  L 2009, c 11, §14.]  (a)  Theprovisions of Title 42 United States Code section 300gg, et seq., as theyrelate to group and individual health insurance shall apply to title 24,except:

(1)  Where state law provides greater health benefitsor coverage than Title 42 United States Code section 300gg, et seq., state lawshall be applicable; and

(2)  This section shall not apply to or affect lifeinsurance, endowment, or annuity contracts, or any supplemental contractthereto, described in section 431:10A-101(4).

(b)  The following definitions shall be usedwhen applying Title 42 United States Code section 300gg, et seq.:

"Employee" means an employee whoworks on a full-time basis with a normal workweek of twenty hours or more.

"Group health issuer" means allpersons offering health insurance coverage to any group or association, butshall not include those persons offering benefits exempted from Title I of theHealth Insurance Portability and Accountability Act of 1996, P.L. 104-191 undersections 732(c) and 733(c) of Title I of the Employee Retirement IncomeSecurity Act of 1974 and sections 2747 and 2791(c) of the Public Health ServiceAct.

"Qualifying event" means the date ofissuance of a general excise tax license, the loss of a job, a reduction inhours of work, or the exhaustion of the federal Consolidated Omnibus BudgetReconstruction Act continuation coverage that results in a loss of health carecoverage.

"Self-employed individual" means aperson operating the person's own business, whether as a sole proprietorship orin any other legally recognized manner in which a person may operate theperson's own business, who has a general excise tax license for that business, andwho is registered or licensed by the department of commerce and consumeraffairs for that business.

"Small employer" means an employerwho employs between one and no more than fifty employees.

(c)  All group health issuers shall offer allsmall group health plans to all small employers whose employees live, work, orreside in the group health issuer's service areas; provided that:

(1)  The commissioner may exempt a group health issuerif the commissioner determines that the group health issuer does not have thecapacity to deliver services adequately to enrollees of additional groups givenits obligation to existing employer groups; and

(2)  The commissioner may exempt from this subsectiongroup health plans offered to small employers that employ only one employee, ifthe group health issuer offers the small employer groups at least one smallgroup health plan that meets the requirements of chapter 393, and upon thedetermination by the commissioner that the group health issuer has the capacityto adequately deliver services to enrollees of the additional groups, subjectto its obligations to existing employer groups.

(d)  Subject to subsection (e)(1), beginningSeptember 1, 2008, and annually thereafter, all group health issuers shalloffer small group health plans to self-employed individuals who live, work, orreside in the group health issuer's service areas; provided that thecommissioner may exempt a group health issuer if the commissioner determinesthat the group health issuer does not have the capacity to deliver servicesadequately to enrollees of additional groups given its obligation to existingemployer groups.

(e)  Group health issuers may limit periods ofenrollment for self-employed individuals to a minimum of thirty calendar days;provided that:

(1)  Self-employed individuals who experience aqualifying event shall enroll with a group health issuer within thirty days ofthe qualifying event; and

(2)  Group health issuers shall be allowed to impose aone-year waiting period against self-employed individuals who terminatecoverage for any reason.  If a self-employed individual terminates coverage anda one-year waiting period is imposed against the individual, a group healthissuer need not reenroll the individual until the period of enrollmentfollowing the one-year waiting period.

(f)  A group health issuer shall be prohibitedfrom imposing any preexisting condition exclusion.

(g)  The commissioner may adopt rules toimplement, clarify, or conform title 24 to Title 42 United States Code section300gg, et seq.

(h)  The adoption of the Health InsurancePortability and Accountability Act of 1996, P.L. 104-191, for the purposes oftitle 24 is not an adoption for any purposes for income taxes under chapter235.

(i)  The State shall have jurisdiction over anymatter that Title 42 United States Code section 300gg, et seq., permits,including jurisdiction over enforcement.

(j)  As used in this section, "small grouphealth plans" means the medical plans currently offered, advertised, ormarketed by a group health issuer for small employers. [L 1997, c 291, §2; am L1999, c 93, §5; am L 2000, c 151, §1; am L 2001, c 55, §19; am L 2004, c 122,§2; am L 2007, c 247, §1; am L 2008, c 120, §§1, 3]