NDAC 45-06-06.1-13
Restoration of coverage
Cite as N.D. Admin. Code ยง 45-06-06.1-13
1.
a.
Except as provided in subdivision b, a small employer carrier shall, as a condition of
continuing to transact business in this state with small employers, offer to provide a
health benefit plan as described in subsection 3 to any small employer whose coverage
was terminated or not renewed by such small employer carrier after January 1, 1994.
b.
The offer required under subdivision a shall not be required with respect to a health
benefit plan that was not renewed if:
(1)
The health benefit plan was not renewed for reasons permitted in subsection 1 of
North Dakota Century Code section 26.1-36.3-05; or
(2)
The nonrenewal was a result of the small employer voluntarily electing coverage
under a different health benefit plan.
2.
The offer made under subsection 1 shall be made in accordance with paragraph 4 of
subdivision b of subsection 4 of section 45-06-06.1-06. A small employer shall be given at
least ninety days to accept an offer made pursuant to subsection 1.
3.
A health benefit plan provided to a terminated small employer pursuant to subsection 1 shall
meet the following conditions:
a.
The health benefit plan shall contain benefits that are identical to the benefits in the
health benefit plan that was terminated or nonrenewed.
b.
The health benefit plan shall not be subject to any waiting periods, including exclusion
periods for preexisting conditions, or other limitations on coverage that exceed those
contained in the health benefit plan that was terminated or nonrenewed. In applying such
exclusions or limitations, the health benefit plan shall be treated as if it were continuously
in force from the date it was originally issued to the date that it is restored pursuant to this
section and North Dakota Century Code section 26.1-36.3-12.
c.
The health benefit plan shall not be subject to any provision that restricts or excludes
coverage or benefits for specific diseases, medical conditions, or services otherwise
covered by the plan.
d.
The health benefit plan shall provide coverage to all employees who are eligible
employees as of the date the plan is restored. The carrier shall offer coverage to each
dependent of such eligible employees.
e.
The premium rate for the health benefit plan shall be no more than the premium rate
charged to the small employer on the date the health benefit plan was terminated or
nonrenewed; provided that, if the number or case characteristics of the eligible
employees or their dependents of the small employer has changed between the date the
health benefit plan was terminated or nonrenewed and the date that it is restored, the
carrier may adjust the premium rates to reflect any changes in case characteristics of the
small employer. If the carrier has increased premium rates for other similar groups with
similar coverage to reflect general increases in health care costs and utilization, the
premium rate may further be adjusted to reflect the lowest such increase given to a
similar group. The premium rate for the health benefit plan may not be increased to
reflect any changes in risk characteristics of the small employer group until one year after
the date the health benefit plan is restored. Any such increase shall be subject to the
provisions of North Dakota Century Code section 26.1-36.3-04.
f.
A carrier may reinsure new entrants to the health benefit plan who enroll after the
restoration of coverage.