44-6917. Health benefit plan; renewable; exceptions.

(1) A health benefit plan shall be renewable with respect to all eligible employees or dependents, at the option of the plan sponsor, except in any of the following cases:

(a) The plan sponsor has failed to pay premiums or contributions in accordance with the terms of the health benefit plan or the health carrier has not received timely premium payments;

(b) The plan sponsor has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage;

(c) Noncompliance with the health carrier's minimum participation requirements;

(d) Noncompliance with the health carrier's employer contribution requirements;

(e) A health carrier decides to discontinue offering a particular type of group health benefit plan in this state. A health carrier discontinuing such plan shall:

(i) Provide advance notice of its decision to the commissioner of insurance in each state in which it is licensed;

(ii) Provide notice of the decision not to renew coverage to all affected plan sponsors, participants, and beneficiaries, and to the commissioner of insurance in each state in which an affected insured individual is known to reside, at least ninety days prior to the nonrenewal of any health benefit plans by the health carrier. Notice to the director shall be provided at least three working days prior to the notice to the affected plan sponsors, participants, and beneficiaries;

(iii) Offer to each plan sponsor provided the type of group health benefit plan the option to purchase all other health benefit plans currently being offered by the health carrier to plan sponsors in this state; and

(iv) In exercising the option to discontinue the particular type of group health benefit plan and in offering the option of coverage under subdivision (1)(e)(iii) of this section, act uniformly without regard to the claims experience of those plan sponsors or any health-status-related factor relating to any participants or beneficiaries covered or new participants or beneficiaries who may become eligible for such coverage;

(f) A health carrier decides to discontinue offering and nonrenews all its health benefit plans delivered or issued for delivery to plan sponsors in this state. A health carrier that discontinues such plans shall:

(i) Provide advance notice of its decision to the commissioner of insurance in each state in which it is licensed;

(ii) Provide notice of the decision not to renew coverage to all affected plan sponsors, participants, and beneficiaries, and to the commissioner of insurance in each state in which an affected insured individual is known to reside, at least one hundred eighty days prior to the nonrenewal of any health benefit plans by the health carrier. Notice to the director shall be provided at least three working days prior to the notice to the affected plan sponsors, participants, and beneficiaries; and

(iii) Discontinue all health insurance issued or delivered for issuance in the state's employer market and not renew coverage under any health benefit plan issued to an employer; and

(g) The director finds that the continuation of the coverage would:

(i) Not be in the best interests of the policyholders or certificate holders; or

(ii) Impair the health carrier's ability to meet its contractual obligations.

(2) A health carrier that elects not to renew all of its health benefit plans in the state under subdivision (1)(f) of this section shall be prohibited from writing new business in the large employer market in this state for a period of five years after the date of notice to the director.

(3) A health carrier offering coverage through a network plan shall not be required to offer coverage or accept applications pursuant to subsection (1) or (2) of this section in the case of the following:

(a) To an eligible person who no longer resides, lives, or works in the service area of the health carrier or in an area for which the health carrier is authorized to do business, but only if coverage is terminated under this section uniformly without regard to any health-status-related factor of covered individuals; or

(b) To a plan sponsor that no longer has any enrollee in connection with such plan who lives, resides, or works in the service area of the health carrier or in an area for which the health carrier is authorized to do business.

Source