§ 3221. Group or blanket accident and health insurance policies; Show
(1) (A) No statement made by the person insured shall avoid the (B) All statements contained in any such written instrument shall be (2) That no agent has authority to change the policy or waive any of (3) That all new employees or new members in the classes eligible for (4) That all premiums due under the policy shall be remitted by the (5) The
conditions under which the insurer may decline to renew the (6) That the insurer shall issue either to the employer or person in (7) The ages, to which the insurance provided therein shall be (8) That written notice of claim must be given to the insurer within (9) That in the case of claim for loss of time for disability, written (10) That the insurer will furnish to the person making claim or to (11) That the insurer shall have the right and opportunity to examine (12) That benefits payable under the policy other than benefits for (13) That indemnity for loss of life of the insured is payable in (14) That no action at law or in equity shall be
brought to recover on (15) Any policy and certificate, other than one issued in fulfillment "NOTICE - THIS POLICY OR CERTIFICATE DOES NOT MEET THE REQUIREMENTS OF (16) No
policy delivered or issued for delivery in this state which (b) No such policy shall be delivered or issued for delivery in this (c) Any portion of any such policy, which purports, by reason of the (d) (1) The superintendent may approve any form of certificate to be (2) The superintendent may approve any form of group insurance policy (3) The superintendent may also approve any form of group insurance (e) (1) A group policy providing hospital, medical or surgical expense (2) The insurer shall not be required to issue a converted policy (3) The converted policy shall, at the option of the employee or (4) If delivery of an individual converted policy is to be made (5) The conversion provision shall also be available upon
the death of (6) (A) Each certificate holder shall be given written notice of such (B) Written notice by the policyholder given to the certificate holder (C) A group contract issued by an insurer may contain a provision to (7) In addition to the right of conversion herein, the employee or (8) For purposes of this subsection, the term "dependent" shall (f) If the group insurance policy insures the employee or member for (g) For conversion purposes, an insurer shall offer to the employee or (h) Every small group policy or association group policy delivered or (1) "essential health benefits package" shall have the meaning set (2) "grandfathered health plan" means coverage provided by an insurer (3) "small group" means a group of one hundred or fewer employees or (4)
"association group" means a group defined in subparagraphs (B), (A) the group includes one or more individual members; or (B) the group includes one or more member employers or other member (i) An insurer shall not be required to offer the policyholder any (j) No policy of group or blanket accident and health insurance shall (k) (1) (A) Every group policy delivered or issued for delivery in (B) Such
coverage may be subject to an annual deductible of not more (C) Home care means the care and treatment of a covered person who is (D) Home care shall be provided by an agency possessing a valid (i) Part-time or
intermittent home nursing care by or under the (ii) Part-time or intermittent home health aide services which consist (iii) Physical, occupational or speech therapy if provided by the home (iv) Medical supplies, drugs and medications prescribed by a (E) For the purpose of determining the benefits for home care (2) (A) Every insurer issuing a group policy delivered or issued for (B) Such policy shall provide benefits for tests ordered by a (i) tests are necessary for and consistent with the diagnosis and (ii) reservations for a hospital bed and for an operating room were (iii) the surgery actually takes place within seven days of such (iv) the patient is physically present at the hospital for the tests. (3) Every group policy delivered or issued for delivery in this state (4) (A) Every group policy delivered or issued for delivery in this (i) without the need for any prior authorization determination; (ii) regardless of whether the health care provider furnishing such (iii) if the emergency services are provided by a non-participating (iv) if the emergency services are provided by a non-participating (B) Any requirements of section 2719A(b) of the Public
Health Service (C) In this paragraph, an "emergency condition" means a medical or (D) In this paragraph, "emergency services" means, with respect to an (E) In this paragraph, "to stabilize" means, with respect to an (5) (A) (i) Every group or blanket policy delivered or issued for (ii) Maternity care coverage shall also include, at minimum, parent (iii) The mother shall have the option to be discharged earlier than (B) Coverage provided under this
paragraph for care and treatment (6) (A) Every group policy issued or delivered in this state which (i) subject to the provisions of subparagraph (C) of this paragraph, (ii) provided, further however, that subject to the provisions of (iii) provided, further however, every such policy which provides (B) Every group policy issued or delivered in this state which (i) subject to the provisions of subparagraph (C) of this paragraph, (ii)
provided, further however, that subject to the provisions of (iii) provided, further however, every such policy which provides (C) Coverage of diagnostic
and treatment procedures, including (i) Diagnosis and treatment of infertility shall be prescribed as part (ii) Coverage may be subject to
co-payments, coinsurance and (iii) Except as provided in items (vi) and (vii) of this subparagraph, (iv) The superintendent, in consultation with the commissioner of (I) The identification of experimental procedures and treatments not (II) The identification of the required training, experience and other (III) The determination of appropriate medical candidates by the (v)(I) For the purposes of this paragraph, "infertility" means a (II) For purposes of this paragraph, "iatrogenic infertility" means an (vi) Coverage shall also include standard fertility preservation (vii) Every large group policy delivered or issued for delivery in (viii) No insurer providing coverage under this paragraph shall (D) Every policy that provides coverage for prescription fertility (7)(A) Every group or blanket accident and health insurance policy (B) Such coverage may be subject to annual deductibles and coinsurance (C) This paragraph shall not apply to
a policy which covers persons (8) (A) Every group or blanket policy delivered or issued for delivery (B) An insurer providing coverage under this paragraph and any (i) deny to a covered person eligibility, or continued eligibility, to (ii) provide incentives (monetary or otherwise) to encourage a covered (iii) penalize in any way or reduce or limit the compensation of a (iv)
provide incentives (monetary or otherwise) to a health care (v) restrict coverage for any portion of a period within a hospital (C) The prohibitions in subparagraph (B) of this paragraph shall be in (9)(A) Every policy which provides medical, major medical, or similar (i) In the case of a policy that requires, or provides financial (ii) In the case of a policy that does not provide financial (iii) Such coverage may be subject to annual deductibles and Nothing in
this paragraph shall eliminate or diminish an insurer's (B) An insurer providing coverage under this paragraph and any (i) deny to a covered person eligibility, or continued eligibility, to (ii) provide incentives (monetary or otherwise) to encourage a covered (iii) penalize in any way or reduce or limit the compensation of a (iv) provide incentives (monetary or otherwise) to a health care (C) The prohibitions in subparagraph (B) of this paragraph shall be
in (10)(A) Every group or blanket policy delivered or issued for delivery (i) all stages of reconstruction of the breast on which the mastectomy (ii) surgery and reconstruction of the other breast to produce a (B) An insurer providing coverage under this paragraph and any (i) deny to a covered person eligibility, or continued eligibility,
to (ii) provide incentives (monetary or otherwise) to encourage a covered (iii) penalize in any way or reduce or limit the compensation of a (iv) provide incentives (monetary or otherwise) to a health care (v) restrict coverage for any portion of a period within a hospital (C) The prohibitions in this paragraph shall be in addition to the * (11) Every policy that provides coverage for prescription drugs * NB There are 2 par (11)'s * (11)(A) Every policy which is a "managed care product" as defined in (C) Every policy which includes coverage for physician services in a (D) For purposes of this paragraph, a "managed care product" shall (E) The coverage required by this paragraph shall not be abridged by * NB There are 2 par (11)'s (12) No policy of group or blanket accident and health insurance (13) Every group or blanket policy delivered or issued for delivery in (A) for purposes of subparagraphs (B) and (C) of this paragraph, bone (B) for purposes of subparagraphs (A) and (C) of this paragraph, bone (i) previously
diagnosed as having osteoporosis or having a family (ii) with symptoms or conditions indicative of the presence, or the (iii) on a prescribed drug regimen posing a significant risk of (iv) with lifestyle factors to such a degree as posing a significant (v) with such age, gender and/or other physiological characteristics (C) Such coverage required pursuant to subparagraph (A) or (B) of this (D) In addition to subparagraph (A), (B) or (C) of this paragraph, (i) evidence-based items or services for bone mineral density that (ii) with respect to women, such additional preventive care
and (E) For purposes of this paragraph, "grandfathered health plan" means (14) No group or blanket policy delivered or issued for delivery in (15)(A) No group or blanket managed care health insurance policy that (B) No group or blanket managed care health insurance policy that (C) For purposes of this paragraph, a "health care provider" is a (D) For purposes of this paragraph, a "managed care health insurance (16)(A) Every group or blanket policy that includes coverage for (i) The
out-of-network provider is duly licensed to practice and (ii) The out-of-network provider is located outside the service area (iii) The in-network healthcare provider treating the insured for the (iv) The insured has notified, in writing, the insurer at least thirty (v) The insurer shall have the right to pre-approve the dialysis (vi) Such coverage is limited to no greater than ten out-of-network (B) Where coverage for out-of-network dialysis treatment is provided (C) Such coverage of out-of-network dialysis services required by (17) Notwithstanding title eleven of article five of the social (18) Every group or blanket policy which provides medical, major (19) Every group or blanket accident and health insurance policy (20) No group or blanket policy delivered or issued for delivery in (21) Every group or blanket policy delivered or issued for delivery in * (22) (A) Every policy which provides hospital,
surgical, or medical (B) Coverage for abortion shall not be subject to annual deductibles (C) Notwithstanding any other provision, a group policy that provides (i) obtains an annual certification from the group policyholder that (ii) issues a rider to each certificate holder at no premium to be (iii) provides notice of the issuance of the policy and rider to the * NB Effective January 1, 2023 (l) (1) Every insurer delivering a group policy or issuing a group (2) (A) Every insurer delivering a group policy or issuing a group (B) Such coverage shall be made available at the inception of all new (C) In this paragraph, care in a nursing home means the continued care (i) the care is provided in a nursing home as
defined in section (ii) the covered person has been in a hospital for at least three days (iii) further hospitalization would otherwise be necessary. (D) In determining the total days of coverage for
nursing home care (E) The level of benefits to be provided for nursing home care must be (3)
(A) Every insurer delivering a group policy or issuing a group (B) In this paragraph: (i) "Ambulatory care in hospital
out-patient facilities" means (ii) "Ambulatory care in physicians' offices" means services for (C) Such coverage shall be made available
at the inception of all new (4) (A) Every insurer delivering a group policy or issuing a group (B) The state board for social work shall maintain a list of all (C) Such coverage shall be made available at the inception of all new (D) In addition to the requirements of subparagraph (A) of this (E) The state board for social work shall maintain a list of all (5) (A) Every insurer delivering a group or school blanket policy or (i) where the policy provides coverage for inpatient hospital care, (ii) where the policy provides coverage for physician services, it (B) Coverage required by this paragraph may be subject to annual (C) Coverage under this paragraph shall not apply financial (D) The criteria for medical necessity determinations under the policy (E) For purposes of this paragraph: (i) "financial requirement" means deductible, copayments, coinsurance (ii)
"predominant" means that a financial requirement or treatment (iii) "treatment limitation" means limits on the frequency of (iv) "mental health condition" means any mental health disorder as (F) An insurer shall provide coverage under
this paragraph, at a (G) This subparagraph shall apply to hospitals in this state that are (H) This subparagraph shall apply to crisis stabilization centers in (6) (A) Every policy that provides hospital, major medical or similar (B) Coverage provided under this paragraph may be limited to (C) Coverage provided under this paragraph may be subject to annual (D) This subparagraph shall apply to facilities in this state that are (E) The criteria for medical necessity determinations under the policy (F) For purposes of this paragraph: (i) "financial requirement" means deductible, copayments, coinsurance (ii) "predominant" means that a financial requirement or
treatment (iii) "treatment limitation" means limits on the frequency of (iv) "substance use disorder" shall have the meaning set forth in the (G) An insurer shall provide coverage under this paragraph, at a (7) (A) Every policy that provides medical, major medical or similar (B) Coverage under this paragraph may be limited to facilities in this (C) Coverage provided under this paragraph may be subject to annual (C-1) A large group policy that provides coverage under this paragraph (D) A policy providing coverage for substance use disorder services (i) does not exceed the allowable number of family visits provided by (ii) is otherwise entitled to coverage pursuant to this paragraph and (E) This subparagraph shall apply to facilities in this state that
are (F) The criteria for medical necessity determinations under the policy (G) For purposes of this paragraph: (i) "financial requirement" means deductible, copayments, coinsurance (ii) "predominant" means that a financial requirement or treatment (iii) "treatment limitation" means limits on the frequency of (iv) "substance use disorder" shall have the meaning set forth in the (H) An insurer shall provide coverage under this paragraph, at a (I) This subparagraph shall apply to crisis stabilization centers in (7-a) (A) Every policy that provides
medical, major medical or similar (B) Coverage provided under this paragraph may be subject to (8) (A) Every insurer issuing a group policy for delivery in this (B) In subparagraphs (A), (C) and (D) of this paragraph, preventive (i)
an initial hospital check-up and well-child visits scheduled in (ii) at each visit, services in accordance with the prevailing (iii) necessary immunizations, as determined by the superintendent in (C) Such coverage required pursuant to subparagraph (A) or (B) of this (D) Such coverage required pursuant to subparagraph (A) or (B) of this (E) In addition to subparagraph (A), (B), (C) or (D) of this (i) evidence-based items or services for preventive care and (ii) immunizations that have in effect a
recommendation from the (iii) with respect to children, including infants and adolescents, (iv) with respect to women, such additional preventive care and (F) The requirements of this paragraph shall also be applicable to a (G) For purposes of this
paragraph, "grandfathered health plan" means (9) Every insurer issuing a group policy for delivery in this state (10) (A) Every insurer issuing a group policy for delivery in this (B) For the purposes of this paragraph, hospice care shall mean the (C) Hospice care coverage shall be at least equal to: (i) a total of (D) Such coverage shall be made available at the inception of all new (E) Such coverage may be subject to annual deductibles and coinsurance (11) (A) Every insurer delivering a group or blanket policy or issuing (i) upon the recommendation of a physician, a mammogram, which may be (ii) a single
baseline mammogram, which may be provided by breast (iii) an annual mammogram, which may be provided by breast (iv) for large group policies that provide coverage for hospital, (B) Such coverage required pursuant to subparagraph (A) or (C) of this (C) For purposes of subparagraphs (A) and (B) of this paragraph, (D) In addition to subparagraph (A), (B) or (C) of this paragraph, (i) evidence-based items or services for mammography that have in (ii) with respect to women, such additional preventive care and (E) For purposes of this paragraph, "grandfathered health plan" means (F) Screening and diagnostic imaging for the detection of breast (11-a) (A) Every policy delivered or issued for delivery in this state (i) standard diagnostic testing including, but not limited to, a (ii) an annual standard diagnostic examination including, but not (B) Such coverage shall not be subject to annual deductibles or (12) (A) Every insurer delivering a group or blanket policy or issuing (i)
the American Hospital Formulary Service-Drug Information (ii) National Comprehensive Cancer Networks Drugs and Biologics (iii) Thomson Micromedex DrugDex; (iv) Elsevier Gold Standard's Clinical Pharmacology; or other (B) Notwithstanding the provisions of this paragraph, coverage shall (12-a) (A) Every policy delivered or issued for delivery in this state (B) An insurer providing coverage under this paragraph and any (i)
vary the terms of the policy for the purpose or with the effect of (ii) provide incentives (monetary or otherwise) to encourage a covered (iii) penalize in any way or reduce or limit the compensation of a (iv) provide incentives
(monetary or otherwise) to a health care (v) achieve compliance with this paragraph by imposing an increase in (13) Consistent with federal law every insurer delivering a
group (A) Coverage shall be subject to a copayment of twenty-five dollars (B) Brochures describing such coverage must be provided to the (C) The commensurate rate for the coverage must be approved by the (D) Such insurers shall report to the superintendent each year the (14) (A) Every group or blanket policy delivered or issued for (B) For purposes of subparagraphs (A) and (C) of this paragraph, (C) Such coverage required pursuant to subparagraph (A) or (B) of this (D) In addition to subparagraph (A), (B) or (C) of this paragraph, (i) evidence-based items or services for cervical cytology that have (ii) with respect to women, such additional preventive care and (E) For purposes of this paragraph, "grandfathered health plan" means (15)(A) Every group or blanket policy delivered or issued for delivery (B) Payment by an insurer pursuant to this section shall be payment in (C) An insurer shall provide reimbursement for those services (D) The provisions of this paragraph shall have no application to (E) As used in this paragraph: (i) "Prehospital emergency medical services" means the prompt (ii) "Emergency condition" means a medical or behavioral condition (16) (A) Every group or blanket policy that provides medical, major (1) All FDA-approved contraceptive drugs, devices, and other products. (a) where the FDA has approved one or more therapeutic and (b) if the covered therapeutic and pharmaceutical equivalent versions (c) this coverage shall include emergency contraception without (d) this coverage must allow for the dispensing of up to twelve months (2) Voluntary sterilization procedures pursuant to 42 U.S.C. 18022 and (3) Patient education and counseling on contraception; and (4) Follow-up services related to the drugs, devices, products, and (B) A group or blanket policy subject to this paragraph shall not (C) Except as otherwise authorized under this paragraph, a group or (D) Benefits
for an enrollee under this paragraph shall be the same (E) Notwithstanding any other provision of this subsection, a (1) For purposes of this subsection, a "religious employer" is an (a) The inculcation of religious values is the purpose of the entity. (b) The entity primarily employs persons who share the religious (c) The entity serves primarily persons who share the
religious tenets (d) The entity is a nonprofit organization as described in Section (2) Every religious employer that invokes the exemption provided under (F) (1) Where a
group policyholder makes an election not to purchase (2)
Where a group policyholder makes an election not to purchase (G) Nothing in this paragraph shall be construed as authorizing a (H) For the purposes of this paragraph, "over-the-counter (17) (A) Every group or blanket accident and health insurance policy (B) Every group or blanket policy that provides
physician services, (C) For purposes of this paragraph: (i)
"autism spectrum disorder" means any pervasive developmental (ii) "applied behavior analysis" means the design, implementation, and (iii) "behavioral health treatment" means counseling and treatment (iv) "diagnosis of autism spectrum disorder"
means assessments, (v) "pharmacy care" means medications prescribed by a licensed health (vi) "psychiatric care" means direct or consultative services provided (vii) "psychological care" means direct or consultative
services (viii) "therapeutic care" means services provided by licensed or (ix) "treatment of autism spectrum disorder" shall include the (1) behavioral health treatment; (2) psychiatric care; (3) psychological care; (4) medical care provided by a licensed health care provider; (5) therapeutic care, including therapeutic care which is deemed (6) pharmacy care in the event that the policy provides coverage for (D) Coverage may be denied on the basis that such treatment is being (E) Nothing in this paragraph shall be construed to affect any (G) Nothing in this paragraph shall be construed to prevent a group or (H)
Coverage under this paragraph shall not apply financial (I) The criteria for medical necessity determinations under the policy (J) For purposes of this paragraph: (i) "financial requirement" means deductible, copayments, coinsurance (ii) "predominant" means that a financial requirement or treatment (iii) "treatment limitation" means limits on the frequency of (K) An insurer shall provide coverage under this paragraph, at a (18) (A) Definitions. For the purpose of this paragraph: (i) "Same reimbursement amount" shall mean that any coverage described (ii) "Mail order pharmacy" means a pharmacy whose primary business is (B) Any insurer delivering a group or blanket policy or issuing
a (19) Whenever in this section an insurer is required to provide * (20) Health care forensic examinations performed pursuant to section * NB There are 2 par (20)'s * (20) Every insurer delivering a group or blanket policy or issuing a * NB There are 2 par (20)'s (m) A group policy providing hospital, surgical or medical expense (1) Continuation shall cease on the date which the employee, member or (2) (A) An employee or member who wishes continuation of coverage must (B) An employee or member who wishes continuation of coverage under (3) An employee or member electing continuation must pay to the group (4) Subject to paragraph one of this subsection, continuation of (A) The date thirty-six months after the date the employee's or (B) The end of the period for which premium payments were made,
if the (C) In the case of an eligible dependent of an employee or member, the (i) the death of the employee or member; (ii) the divorce or legal separation of the employee or member from (iii) the employee or member becoming entitled to
benefits under title (iv) a dependent child ceasing to be a dependent child under the (D) The date on which the group policy is terminated or, in the case (i) The employee or member shall have the right to become covered (ii) The minimum level of benefits to be provided by the other group (iii) The prior group policy shall continue to provide benefits to the (5) A notification of the continuation privilege and the time period (6) This subsection shall not be
applicable where a continuation (7)(A) Special enrollment period. An individual who does not have an (B) Continuation coverage elected pursuant to subparagraph (A) of this (C) With respect to an individual who elects continuation coverage (8) For purposes of this subsection, the term "dependent" shall (n) In addition to all the rights of conversion and continuation (1) If the employee or member insured enters upon active duty as (2) If the employer or group policyholder does not voluntarily (3) If the employee or member insured elects the supplementary (4) If the employee or member insured elects the supplementary (A) the condition arose during the
period of active duty and the (B) a waiting period was imposed and had not been completed prior to (5) If the employee or member insured elects the
supplementary (A) when such employee or member insured is either reemployed or (B) when such employee or member insured is not reemployed or restored (i) To elect an individual conversion policy pursuant to subsection (ii) To elect continuation of coverage pursuant to subsections (e) and (6) If coverage under the group plan is suspended
during the period of (A) when the employee or member insured returns to participation in (B) when such employee or member insured is not reemployed or restored (i) To elect an individual conversion policy pursuant to subsection (ii) To elect continuation of coverage pursuant to subsections (e) and (7) A group policy providing hospital, surgical or medical expense (A) continuation shall not be available for: (i) any person who is (B) an employee or member insured who wishes continuation of coverage (C) an employee or member insured electing continuation pursuant to (8) The supplementary conversion and continuation rights provided for (A) policies not covered by Chapter 18 of the Employee Retirement (B) policies covered by Chapter 18 of the Employee Retirement Income (o) To be entitled to the right defined in subsection (n) of this (A) voluntarily or involuntarily enters upon active duty (other than (B) has his or her active duty voluntarily or involuntarily extended (C) serves no more than four years of active duty. (p)(1) Except as provided in this section, if an insurer delivers or (2) An insurer may nonrenew or discontinue coverage under such a group (A) The policyholder or a participating entity has failed to pay (B) The policyholder or a participating entity has performed an act or (C) The policyholder has failed to comply with a material plan (D) The insurer is ceasing to offer group or blanket policies in a (E) The policyholder ceases to meet the
requirements for a group under (F) In the case of an insurer that offers a group or blanket policy in (G) Such other reasons as are acceptable to the superintendent and (3)(A) In any case in which an insurer decides to discontinue offering (i) the insurer provides written notice to each policyholder provided (I) a statement that if the superintendent determines that the covered (II) an explanation as to how to contact the superintendent, and the (ii) the insurer offers to each policyholder provided coverage of this (iii) in exercising the option to discontinue coverage of this class (iv) at least ninety days prior to the date of discontinuance of such (B) If the superintendent determines that the insurer has
not complied (C) (i) If, within forty-five days after the insurer mails or delivers (ii) If, within twenty days of the superintendent's receipt of
all (D) The remedies as provided in this paragraph shall be in addition to (E) In any case in which an insurer elects to discontinue offering all (i) the insurer provides written notice to the superintendent and to (ii) all hospital, surgical and medical expense coverage issued or (iii) in addition to the notice to the superintendent referred to in (F) In the case of a discontinuance under subparagraph (E of this (4) At the time of coverage renewal, an insurer may modify the health (5) For purposes of this subsection the term "network plan" shall mean (6) For purposes of this
subsection, the term "dependent" shall (7) Notwithstanding paragraph three of this subsection, an insurer may (A) discontinues the existing class of policy in such market as of (B) provides written notice to
each policyholder provided coverage of (C) offers to each policyholder provided coverage of the class in the (D) in exercising the option to discontinue coverage of the class and (E) at least one hundred twenty days prior to the
date of the (q)(1) No insurer delivering or issuing for delivery in this state a (A) Health status. (B) Medical condition (including both physical and mental illnesses). (C) Claims experience. (D) Receipt of health care. (E) Medical history. (F) Genetic information. (G) Evidence of insurability (including conditions arising out of acts (H) Disability. (2) For purposes of paragraph one of this subsection, rules for (3) No insurer may, on the basis of
any health status-related factor (4) Nothing in this subsection shall require an insurer to issue a (5) Where an eligible insured or dependent of an insured rejects (A) The insured or dependent was covered under another plan or policy (B)(i)
Coverage under the other plan or policy was provided in (ii) Coverage under the other plan or policy was subsequently (I) termination of employment; (II) termination of the other plan or policy; (III) death of the spouse; (IV) legal separation, divorce, or annulment; (V) reduction in the number of hours of employment; or (iii) Policyholder contributions toward the payment of premium for the (C) Coverage must be applied for within thirty days of termination for (6) With respect to group or blanket policies delivered or issued for (7) For purposes of this subsection, the term "dependent" shall (r) (1) As used in this subsection, "child" means an unmarried child (2) In addition to the conversion privilege afforded by subsection
(e) (A) An employer shall not be required to pay all or part of the cost (B) An employee, member or child who wishes to elect continuation of (i) within sixty days following the date coverage would otherwise (ii) within sixty days after meeting the requirements for child status (iii) during an annual thirty-day open enrollment period, as described (C) An employee, member or child electing
continuation as described in (D) For any child electing coverage within sixty days of the date the (E) Coverage for a child pursuant to this subsection shall consist of (F) Coverage shall terminate on the first to occur of the following: (i) the date the child no longer meets the requirements of paragraph (ii) the end of the period for which premium payments were made, if (iii) the date on which the group policy is terminated and not (G) The insurer shall provide written notification of the continuation (i) in each certificate of coverage; and (ii) at least sixty days prior to termination at the specified age as (3)(A) Insurers shall submit such reports as may be requested by the (B) The superintendent may promulgate regulations to ensure the (s) An insurer subject to the provisions of this article or an (t) (1) Any insurer that delivers or issues for delivery in this state (2) The requirements of
paragraph one of this subsection shall apply Under what circumstance may an insurer discontinue a small employer group medical plan?A group health plan or a health insurance issuer can only rescind coverage in the case of fraud or an intentional misrepresentation of a material fact, regardless of whether the coverage is insured or self-insured, or whether the rescission applies to an entire group or only to an individual within the group.
How many days notice does the Affordable Care Act require insurers?Will I be notified before my plan is canceled? Yes. Your insurance company must give you at least 30 days notice before they can cancel your coverage for the reasons stated above. This gives you time to appeal the decision or find new coverage.
What responsibility do companies have to inform employees about changes in health coverage?Under the ACA, notice of material modifications to a plan must be provided to participants at least 60 days in advance of the effective date of change. SPDs must be provided within 90 days of the employee becoming a participant in the plan.
In what situation could an insurance policy's coverage be modified?In what situation could an insurance policy's coverage be modified? Applicant is a substandard risk.
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