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2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.210. Insurance with other insurers providing benefits for loss on other than an expense incurred basis.

(a) There may be a provision as follows:
“Insurance With Other Insurers: If there is other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense incurred basis and of which this insurer has not been given written notice before the occurrence or commencement of loss, the only liability for the benefits under this policy shall be for the proportion of the indemnities otherwise provided hereunder for the loss that the like indemnities of which the insurer has notice (including the indemnities under this policy) bear to the total amount of all like indemnities for the loss, and for the return of the portion of the premium paid which exceeds the pro rata portion for the indemnities thus determined.”
(b) If the policy provision in (a) of this section is included in a policy that also contains the policy provision set out in AS 21.51.200, there shall be added to the caption of the foregoing provision the phrase “ - Other Benefits.” The insurer may, at its option, include in this provision a definition of “other valid coverage,” approved as to form by the director, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or a province of Canada, and to any other coverage the inclusion of which may be approved by the director. In the absence of this definition the term shall not include group insurance, or benefits provided by union welfare plans or by employer or employee benefit organizations. For the purpose of applying the foregoing policy provision with respect to an insured, an amount of benefit provided for such insured under any compulsory benefit statute (including any workers' compensation or employer's liability statute), whether provided by a governmental agency or otherwise, shall in all cases be considered to be “other valid coverage” of which the insurer has had notice. In applying the foregoing policy provision no third-party liability coverage shall be included as “other valid coverage.”
2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.220. Relation of earnings to insurance.

(a) There may be a provision as follows:
“Relation of Earnings to Insurance: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthly earnings of the insured at the time disability commenced or the average monthly earnings of the insured for the period of two years immediately preceding a disability for which claim is made, whichever is the greater, the insurer will be liable only for the proportionate amount of the benefits under this policy that the amount of the monthly earnings or the average monthly earnings of the insured bears to the total amount of monthly benefits for the same loss under all the coverage upon the insured at the time disability commences and for the return of the part of the premiums paid during the two years which exceed the pro rata amount of the premiums for the benefits actually paid hereunder; but this shall not operate to reduce the total monthly amount of benefits payable under all the coverage upon the insured below the sum of $200 or the sum of the monthly benefits specified in the coverages, whichever is the lesser, or operate to reduce benefits other than those payable for loss of time.”
(b) The policy provision in (a) of this section may be inserted only in a policy that the insured has the right to continue in force subject to its terms by the timely payment of premiums (1) until at least age 50, or (2) in the case of a policy issued after age 44, for at least five years from its date of issue. The insurer may, at its option, include in this provision a definition of “valid loss of time coverage,” approved as to form by the director, which definition shall be limited in subject matter to coverage provided by governmental agencies or by organizations subject to regulation by insurance law or by insurance authorities of this or another state of the United States or a province of Canada, or to any other coverage that may be approved for inclusion by the director or a combination of these coverages. In the absence of this definition the term may not include coverage provided for the insured under a compulsory benefit statute, including a workers' compensation or employer's liability statute, or benefits provided by union welfare plans or by employer or employee benefit organizations.
2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.240. Conformity with state statutes.

There may be a provision as follows:
“Conformity with State Statutes: Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on that date is amended to conform to the minimum requirements of the statutes.”
2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.260. Intoxicants and narcotics.

There may be a provision as follows:
“Intoxicants and Narcotics: The insurer shall not be liable for a loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of a narcotic unless administered on the advice of a physician.”
2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.270. Renewal at option of insurer.

Health insurance policies, other than accident insurance only policies, in which the insurer reserves the right to refuse renewal on an individual basis, must provide in substance in a provision or in an endorsement or rider attached to it that, subject to the right to terminate the policy upon nonpayment of premium when due, the right to refuse renewal may not be exercised to take effect before the renewal date occurring on or after and nearest each policy anniversary, or in the case of lapse and reinstatement, at the renewal date occurring on or after and nearest each anniversary of the last reinstatement, and a refusal of renewal shall be without prejudice to any claim originating while the policy is in force. The parenthetic reference to lapse and reinstatement may be omitted at the insurer's option.
2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.280. Order of certain provisions.

The provisions that are the subject of AS 21.51.040 - 21.51.260, or any corresponding provisions that are used in lieu thereof in accordance with these sections, shall be printed in the consecutive order of the provisions in the sections or, at the option of the insurer, the provision may appear as a unit in any part of the policy, with other provisions to which it may be logically related, provided that the resulting policy may not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered, or issued.
2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.290. Third-party ownership.

The word “insured,” as used in this chapter, may not prevent a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under a policy to any indemnities, benefits, and rights provided in the policy.
2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.300. Requirement of other jurisdictions.

(a) A policy of a foreign or alien insurer, when delivered or issued for delivery to a person in this state, may contain any provision that is not less favorable to the insured or the beneficiary than the provisions of this chapter and that is prescribed or required by the law of the state or country under which the insurer is organized.
(b) A policy of a domestic insurer may, when issued for delivery in another state or country, contain any provision permitted or required by the laws of the other state or country.
2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.310. Conforming to statute.

(a) A policy provision that is not subject to this chapter may not make a policy, or any portion of a policy, less favorable to the insured or the beneficiary than the provisions of the policy that are subject to this chapter.
(b) A policy delivered or issued for delivery to a person in this state in violation of this chapter shall be held valid but shall be construed as provided in this chapter. When a provision in a policy subject to this chapter is in conflict with a provision of this chapter, the rights, duties, and obligations of the insurer, the insured and the beneficiary shall be governed by the provisions of this chapter.
2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.320. Age limit.

If the policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if the date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after that date, the coverage provided by the policy will continue in force until the end of the period for which premium has been accepted. If the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased before the acceptance of the premium or premiums, the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.
2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.330. Franchise health insurance.

(a) Health insurance on a franchise plan is that form of health insurance issued to
(1) five or more employees of a corporation, copartnership, or individual employer or a governmental corporation, agency, or department of them; or
(2) 10 or more members, employees, or employees of members of a trade or professional association or of a labor union or of any other association having had an active existence for at least two years if the association or union has a constitution or bylaws and is formed in good faith for purposes other than that of obtaining insurance.
(b) If these persons, with or without their dependents, are issued the same form of an individual policy varying only in amounts and kinds of coverage applied for by the persons under an arrangement whereby the premiums on the policies may be paid to the insurer periodically by the employer, with or without payroll deductions, or by the association for its members, or by some designated person acting on behalf of the employer, association, or union, the term “employees” as used herein may be considered to include the officers, managers, and employees and retired employees of the employer and the individual proprietor or partners if the employer is an individual proprietor or partnership.
2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.400. Renewability and certification.

A health care insurer that offers a health care insurance plan in the individual market shall comply with the guaranteed renewability requirements established under 42 U.S.C. 300gg-42 and shall comply with the certification of coverage requirements established under 42 U.S.C. 300gg-43.
2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.405. Rate requirements; filings; regulations.

(a) Rates charged for a health insurance policy may not be excessive, inadequate, or unfairly discriminatory.
(b) An insurer shall file with the director the premium rates charged for an individual health care insurance plan before using them. A premium rate or premium rate change must be on file with the director for a waiting period of at least 45 days before the effective date of the premium rate. That period may be extended by the director or the insurer for an additional 15 days if, during the initial 45-day waiting period, notice is given stating that additional time for consideration of the filing is needed. A filing may become effective at the end of the waiting period unless disapproved by the director during the waiting period. If an insurer fails to provide information requested by the director during the waiting period, the filing is considered withdrawn by the insurer, and the premium rate does not become effective.
(c) The director shall adopt regulations
(1) establishing procedures for filing and use of rates; and
(2) specifying information that must be submitted in a filing required under (b) of this section.
2023 Alaska Statutes › Title 21. Insurance › Chapter 51. Health Insurance Policies › Sec. 21.51.500. Definitions.

In this chapter,
(1) “health care exchange” means an American Health Benefit Exchange established under 42 U.S.C. 18031.
(2) “health care insurance plan” has the meaning given in AS 21.54.500;
(3) “health care insurer” has the meaning given in AS 21.54.500;
(4) “individual market” means the market for health care insurance offered to individuals other than in connection with a health benefit plan as defined in AS 21.54.500.
2023 Alaska Statutes › Title 21. Insurance › Chapter 53. Long-term Care Insurance › Sec. 21.53.010. Prohibited sale or advertising.

An insurer, hospital or medical service corporation, or fraternal benefit society may not advertise, market, sell, deliver, or offer for delivery a long-term care insurance policy unless the policy complies with this chapter, AS 21.18, AS 21.45, the health insurance requirements imposed under AS 21.51, and, if a group policy, the group health insurance requirements imposed under AS 21.54, or unless it has been approved by and complies with the Interstate Insurance Product Regulation Compact under AS 21.42.700.
2023 Alaska Statutes › Title 21. Insurance › Chapter 53. Long-term Care Insurance › Sec. 21.53.020. Disclosure and performance standards.

An insurer, hospital or medical service corporation, or fraternal benefit society that delivers or issues for delivery a long-term care insurance policy may not
(1) cancel, fail to renew, or otherwise terminate the policy on the grounds of age or deterioration of the mental or physical health of the insured;
(2) include a provision requiring a new waiting period in the event existing coverage is converted to or replaced by a new or another form of health insurance within the same company, unless there is an increase in benefits voluntarily selected by the insured or group policyholder; or
(3) provide coverage only for skilled nursing care or provide significantly more coverage for skilled care in a facility than is provided for coverage for lower levels of care.
2023 Alaska Statutes › Title 21. Insurance › Chapter 53. Long-term Care Insurance › Sec. 21.53.030. Preexisting conditions.

(a) An insurer, hospital or medical service corporation, or fraternal benefit society may not include, in a long-term care insurance policy or certificate, a definition of “preexisting condition” that is more restrictive than the following: preexisting condition means a condition for which medical advice or treatment was recommended by, or received from, a provider of health care services within six months preceding the effective date of coverage of an insured person.
(b) In a long-term care insurance policy, an insurer, hospital or medical service corporation, or fraternal benefit society may not exclude coverage for a loss or confinement that is the result of a preexisting condition, unless the loss or confinement begins within six months following the effective date of coverage of an insured person.
(c) The director may extend the limitation periods established under (a) and (b) of this section for specific age group categories or specific policy forms, if the director finds that the extension is in the best interest of the public.
(d) This section does not prohibit an insurer, hospital or medical service corporation, or fraternal benefit society from using an application form designed to elicit the complete health history of an applicant, and, on the basis of the answers on the application, from applying that insurer's, hospital or medical service corporation's, or fraternal benefit society's established underwriting standards. Unless otherwise provided in the policy, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in (b) of this section expires. A long-term care insurance policy may not exclude, limit, or reduce, or use waivers or riders of any kind to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions after the waiting period described in (b) of this section, unless the waiver or rider has been specifically approved by the director.
2023 Alaska Statutes › Title 21. Insurance › Chapter 53. Long-term Care Insurance › Sec. 21.53.040. Prior hospital or institutional care conditions prohibited.

(a) A long-term care insurance policy may not be delivered or issued for delivery in this state if the policy conditions eligibility
(1) on a prior hospitalization requirement;
(2) on the receipt of a higher level of institutional care, when care is provided in an institutional setting;
(3) for noninstitutional benefits on a prior institutional stay of more than 30 days for which benefits are paid;
(4) on admission to an institutional care facility for the same or a related condition within a period of less than 30 days after discharge from the institution, if the policy provides benefits only following institutionalization; or
(5) for a benefit, other than a waiver of premium, postconfinement, postacute care, or recuperative benefit, on a prior institutionalization.
(b) A long-term care insurance policy containing a postconfinement, postacute care, or recuperative benefit must clearly label the limitations or conditions, including any required number of days of confinement, “Limitations or Conditions on Eligibility for Benefits” in a separate paragraph of the policy.
2023 Alaska Statutes › Title 21. Insurance › Chapter 53. Long-term Care Insurance › Sec. 21.53.060. Long-term care benefits under life insurance policies; denial of claims.

(a) In addition to the requirements of AS 21.45, at the time of policy delivery, a policy summary shall be included with an individual life insurance policy if the policy or policy rider provides long-term care benefits. In the case of direct response solicitations, the insurer shall deliver the policy summary upon the applicant's request but, regardless of request, shall deliver a policy summary not later than the time of policy delivery. The summary must include
(1) an explanation of how the long-term care benefits interact with other components of the policy, including deductions from death benefits;
(2) an illustration of the amount and length of benefits, and guaranteed lifetime benefits, if any, for each covered person;
(3) an explanation of each exclusion, reduction, and limitation on long-term care benefits;
(4) if applicable to the policy type,
(A) disclosure of the effects of exercising other rights under the policy;
(B) disclosure of guarantees related to the long-term care costs of insurance charges; and
(C) current and projected maximum lifetime benefits; and
(5) if the director adopts a regulation that permits but does not require inflation protection, and the policy does not provide for inflation protection, a statement that inflation protection is not available under the policy.
(b) If a long-term care benefit is paid under a life insurance policy by the acceleration of the policy death benefit, and is in benefit payment status, a monthly report shall be provided to the policyholder. The report must include
(1) long-term care benefits paid out during the month;
(2) an explanation of changes in the policy, including changes in death benefits or cash values, due to long-term care benefits being paid out; and
(3) the amount of long-term care benefits remaining.
(c) If a claim under a long-term care insurance policy is denied by an insurer, the insurer shall, within 60 days after the date of a written request by a policyholder or a representative of a policyholder,
(1) provide a written explanation of the reasons for the denial; and
(2) make available all information directly related to the denial.
2023 Alaska Statutes › Title 21. Insurance › Chapter 53. Long-term Care Insurance › Sec. 21.53.062. Incontestability period.

(a) If a long-term care insurance policy has been in force for less than six months, an insurer may rescind the policy or deny an otherwise valid long-term care claim under the policy on a showing of misrepresentation that is material to the acceptance for coverage.
(b) If a long-term care insurance policy has been in force for at least six months but less than two years, an insurer may rescind the policy or deny an otherwise valid long-term care claim under the policy on a showing of misrepresentation that is both material to the acceptance for coverage and pertains to the condition for which benefits are sought.
(c) If a long-term care insurance policy has been in force for two years or more, the policy is not contestable on the grounds of misrepresentation alone and may only be contested on a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.
(d) If an insurer has paid benefits under a long-term care insurance policy, the insurer may not recover the benefit payments if the policy is rescinded.
(e) This section applies to a life insurance policy that accelerates benefits for long-term care. However, if an insured dies, this section does not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care, and the remaining death benefit under the policy is subject to AS 21.45.040.
2023 Alaska Statutes › Title 21. Insurance › Chapter 53. Long-term Care Insurance › Sec. 21.53.064. Nonforfeiture benefits.

(a) Except as provided in (b) of this section, a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder has been offered the option of purchasing a policy including a nonforfeiture benefit. The insurer may offer a nonforfeiture benefit in the form of a rider to the policy. If a policyholder declines the nonforfeiture benefit, the insurer shall provide a contingent benefit upon lapse that is available for a specified period of time following a substantial increase in premium rates.
(b) With respect to group long-term care insurance, an insurer shall make the offer required in (a) of this section to the group policyholder. For a policy issued as group long-term care insurance, other than a continuing care retirement community or other similar entity, the insurer shall make the offer required in (a) of this section to each proposed certificate holder.
2023 Alaska Statutes › Title 21. Insurance › Chapter 53. Long-term Care Insurance › Sec. 21.53.068. Limitations related to producers and third-party administrators.

An insurer that authorizes issuance of a long-term care insurance policy by a producer or a third-party administrator under the underwriting authority of the insurer granted to the producer or third-party administrator using the insurer's underwriting guidelines may issue a long-term care insurance policy through the producer or third-party administrator only if the insurer does not compensate the issuer based on the number of policies issued.
2023 Alaska Statutes › Title 21. Insurance › Chapter 53. Long-term Care Insurance › Sec. 21.53.070. Group long-term care insurance.

Group long-term care insurance coverage may not be offered to a resident of this state under a group policy issued in another state, unless the state in which the policy is issued has statutory or regulatory provisions applicable to group long-term care insurance that are substantially similar to this chapter and the director determines that the issuance of the group policy is not contrary to the best interest of the public, results in economies of acquisition or administration, and the benefits are reasonable in relation to the premiums charged.
2023 Alaska Statutes › Title 21. Insurance › Chapter 53. Long-term Care Insurance › Sec. 21.53.080. Organizational requirements of associations.

An insurer, hospital or medical service corporation, or a fraternal benefit society may not issue group long-term care insurance to an association or a trust or the trustee of a fund established, created, or maintained for the benefit of members of one or more associations, unless the association or the insurer of the association files evidence with the director that the association has
(1) a minimum of 100 members;
(2) been organized and maintained in good faith for purposes other than that of obtaining insurance;
(3) been in active existence for at least one year; and
(4) a constitution and by-laws that require
(A) the association to hold regular meetings not less than annually to further purposes of the members;
(B) except for credit unions, the association to collect dues or solicit contributions from members; and
(C) the members to have voting privileges and representation on the governing board and committees.
2023 Alaska Statutes › Title 21. Insurance › Chapter 53. Long-term Care Insurance › Sec. 21.53.090. Required regulations.

The director shall adopt regulations regarding
(1) the sale of long-term care insurance that provide minimum standards for
(A) terms of renewability;
(B) initial and subsequent conditions of eligibility;
(C) nonduplication of coverage provisions;
(D) coverage of dependents;
(E) benefit triggers;
(F) preexisting conditions and recurrent conditions;
(G) termination of insurance, including incontestability periods;
(H) continuation or conversion;
(I) probationary periods, limitations, exceptions, reductions, and elimination periods;
(J) requirements for replacement;
(K) producer training, education, compensation, and testing;
(L) marketing practices;
(M) independent review of benefit determinations;
(N) penalties and reporting practices; and
(O) premium rates, including rate filing requirements;
(2) standard definitions of long-term care insurance terms;
(3) nonforfeiture or minimum value requirements;
(4) consumer protection standards, including standards for full and fair disclosure setting out the manner and content of required disclosures; and
(5) the standard format and content of the outline of coverage required under AS 21.53.050.
2023 Alaska Statutes › Title 21. Insurance › Chapter 54. Health Insurance › Article 1. Group and Blanket Health Insurance. › Sec. 21.54.010. Required provisions of group policies.

Each group health insurance policy must contain in substance the following provisions:
(1) a provision that, in the absence of fraud, all statements made by applicants or the policyholder or by an insured person shall be considered representations and not warranties, and that a statement made for the purpose of effecting insurance may not void the insurance or reduce benefits unless contained in a written instrument signed by the policyholder or the insured person, a copy of which has been furnished to the policyholder or to the insured person or the beneficiary of the insured person;
(2) a provision that the insurer will furnish to the policyholder for delivery to each employee or member of the insured group, a statement in summary form of the essential features of the insurance coverage of the employee or member and to whom benefits are payable; if dependents are included in the coverage, only one certificate need be issued for each family unit;
(3) a provision that to the group originally insured may be added from time to time eligible new employees or members or dependents, as the case may be, in accordance with the terms of the policy.
2023 Alaska Statutes › Title 21. Insurance › Chapter 54. Health Insurance › Article 1. Group and Blanket Health Insurance. › Sec. 21.54.015. Rate requirements; filings; regulations; health care insurance restrictions.

(a) Rates charged for a group health insurance policy may not be excessive, inadequate, or unfairly discriminatory.
(b) A health care insurer may decline to cover or may restrict the coverage offered to a self-employed individual under an association plan authorized under AS 21.54.060(a)(6).
(c) Except for large employer health care insurance plan premium rates exempted by the director by regulation under (d) of this section, an insurer shall file with the director the premium rates charged for each health care insurance plan before using them. A premium rate or premium rate change must be on file with the director for a waiting period of at least 45 days before the effective date of the premium rate. That period may be extended by the director or the insurer for an additional 15 days if, during the initial 45-day waiting period, notice is given stating that additional time for consideration of the filing is needed. A filing may become effective at the end of the waiting period unless disapproved by the director during the waiting period. If an insurer fails to provide information requested by the director during the waiting period, the filing is considered withdrawn by the insurer, and the premium rate does not become effective.
(d) The director shall adopt regulations
(1) establishing procedures for the filing and use of rates; and
(2) specifying information that must be submitted in a filing required under (c) of this section.
2023 Alaska Statutes › Title 21. Insurance › Chapter 54. Health Insurance › Article 1. Group and Blanket Health Insurance. › Sec. 21.54.020. Direct payment to providers.

(a) On the written request of a covered person, a health care insurer shall pay amounts due under a health insurance policy directly to the provider of medical care services. A health insurance policy may not contain a provision that requires services be provided by a particular hospital or person, except as applicable to a health maintenance organization under AS 21.86. If a health care insurer makes a claim payment to the covered person after the covered person has given written notice electing direct payment to the provider of the service, the health care insurer shall also pay that amount to the provider of the service.
(b) A covered person may revoke an election of direct claim payment made under (a) of this section by giving written notice of the revocation to the health care insurer and to the provider of the service. The written notice of revocation to the health care insurer must certify that the covered person has given written notice of revocation to the provider of the service. Revocation of direct claim payment is not effective until the later of the date the health care insurer received the notice of revocation or the date the provider of the service received the revocation.
(c) The right of the covered person to request payment of indemnities under a blanket health insurance policy directly to the provider of the services or to another person may be transferred by a qualified domestic relations order to a person who is not the covered person. Rights under the qualified domestic relations order do not take effect until the order is received by the health care insurer. In this subsection, “qualified domestic relations order” means an order or judgment in a divorce or dissolution action under AS 25.24 that designates a person to determine to whom indemnities for a covered person should be paid under a health insurance policy.
(d) This section does not prohibit a health care insurer from recovering an amount mistakenly paid to a provider or a covered person.
2023 Alaska Statutes › Title 21. Insurance › Chapter 54. Health Insurance › Article 1. Group and Blanket Health Insurance. › Sec. 21.54.050. Payment of blanket health policy benefits.

(a) All benefits under a blanket health insurance policy shall be paid to (1) the person insured; (2) the designated beneficiary or beneficiaries of the person insured; (3) the estate of the person insured; (4) the parent, guardian, or other person actually supporting the person insured, if the person insured is a minor or otherwise not competent to give a valid release; or (5) the employer, if the entire cost of the insurance has been paid by the employer. An insurer may, and upon written request of the covered person shall, within 30 working days after receiving a proof of loss statement, pay benefits directly to the provider of the hospital, nursing, medical, dental, or surgical services. The policy may not contain a provision requiring that services be provided by a particular hospital or person, except as applicable to a health maintenance organization under AS 21.86. If the insurer pays indemnities to the insured after the covered person has given the insurer written notice in the proof of loss statement of an election of direct payment of indemnities to the provider of the service, the insurer shall also pay those indemnities to the provider of the service.
(b) A covered person may revoke an election of direct payment of benefits made under (a) of this section by giving written notice of the revocation to the insurer and to the provider of the services. The written notice of revocation given to the insurer must certify that the covered person has given written notice of revocation to the provider of the services. Revocation of an election of direct payment is not effective until the notice of revocation is received by the insurer and the provider of the services.
(c) The right of the covered person to request payment of indemnities under a group health insurance policy directly to the provider of the services or to another person may be transferred to a person who is not the covered person by a qualified domestic relations order. Rights under the qualified domestic relations order do not take effect until the order is received by the insurer. In this subsection, “qualified domestic relations order” means an order or judgment in a divorce or dissolution action under AS 25.24 that designates a person to determine to whom indemnities for a covered person should be paid under a health insurance policy.
(d) This section does not prohibit an insurer from recovering an indemnity mistakenly paid to a provider or a covered person.
2023 Alaska Statutes › Title 21. Insurance › Chapter 54. Health Insurance › Article 1. Group and Blanket Health Insurance. › Sec. 21.54.070. Blanket health insurance defined.

Blanket health insurance is declared to be that form of health insurance covering groups of persons as enumerated in one of the following subdivisions:
(1) under a policy or contract issued to a common carrier or to an operator, owner, or lessee of a means of transportation, who or which shall be considered the policyholder, covering a group of persons who may become passengers defined by reference to their travel status on the common carrier or the means of transportation;
(2) under a policy or contract issued to an employer, who shall be considered the policyholder, covering a group of employees, dependents, or guests, defined by reference to specified hazards incident to an activity or activities or operations of the policyholder;
(3) under a policy or contract issued to a college, school, or other institution of learning, a school district or districts, or school jurisdictional unit, or to the head, principal, or governing board of an educational unit, who or which shall be considered the policyholder covering students, teachers, or employees;
(4) under a policy or contract issued to a religious, charitable, recreational, educational, or civic organization, or branch of them, which shall be considered the policyholder, covering a group of members or participants defined by reference to specified hazards incident to an activity or activities or operations sponsored or supervised by the policyholder;
(5) under a policy or contract issued to a sports team, camp, or sponsor of them, which shall be considered the policyholder, covering members, campers, employees, officials, or supervisors;
(6) under a policy or contract issued to a volunteer fire department, first aid, civil defense, or other volunteer organization, which shall be considered the policyholder, covering a group of members or participants defined by reference to specified hazards incident to an activity or activities or operations sponsored or supervised by the policyholder;
(7) under a policy or contract issued to a newspaper or other publisher, which shall be considered the policyholder, covering its carriers;
(8) under a policy or contract issued to an association, including a labor union, that has a constitution and bylaws and that has been organized and is maintained in good faith for purposes other than that of obtaining insurance, which shall be considered the policyholder, covering a group of members or participants defined by reference to specified hazards incident to an activity or activities or operations sponsored or supervised by the policyholder;
(9) under a policy or contract issued to cover any other risk or class of risks that, in the discretion of the director, may be properly eligible for blanket accident and sickness insurance; the discretion of the director may be exercised on an individual risk basis or class of risks, or both.
2023 Alaska Statutes › Title 21. Insurance › Chapter 54. Health Insurance › Article 2. Health Care Insurance Provisions, Requirements, and Restrictions. › Sec. 21.54.100. Unfair discrimination.

(a) A health care insurer that offers, issues for delivery, delivers, or renews a health care insurance plan in the group market may not establish rules for eligibility, including continued eligibility and waiting periods under the plan, for an individual or dependent of an individual based on
(1) health status;
(2) medical condition, including physical and mental illnesses;
(3) claims experience;
(4) receipt of health care;
(5) medical history;
(6) genetic information;
(7) evidence of insurability, including conditions arising from acts of domestic violence; or
(8) disability.
(b) A health care insurer may not require an individual, as a condition of enrollment or continued enrollment under a health care insurance plan offered in the group market, to pay a premium, contribution, or policy fee greater than a premium, contribution, or policy fee for a similarly situated individual already enrolled in the plan on the basis of a health status factor for the individual or a dependent of the individual.
2023 Alaska Statutes › Title 21. Insurance › Chapter 54. Health Insurance › Article 2. Health Care Insurance Provisions, Requirements, and Restrictions. › Sec. 21.54.105. Special enrollment requirements related to Medicaid and state child health plan coverage.

A health care insurer that offers, issues, delivers, or renews a health care insurance plan in the group market shall allow an eligible employee or dependent of an employee to enroll for coverage under the terms of the plan if the employee or dependent
(1) is covered by Medicaid under 42 U.S.C. 1396 - 1396u (Title XIX of the Social Security Act) or under a state child health plan under 42 U.S.C. 1397aa - 1397mm (Title XXI of the Social Security Act), coverage is terminated because of loss of eligibility, and the employee requests coverage under the health care insurance plan not later than 60 days after the date of termination; or
(2) becomes eligible for assistance under Medicaid under 42 U.S.C. 1396 - 1396u (Title XIX of the Social Security Act) or under a state child health plan under 42 U.S.C. 1397aa - 1397mm (Title XXI of the Social Security Act), with respect to coverage under a health care insurance plan, including under any waiver or demonstration project conducted under or in relation to the Medicaid or state child health plan, and the employee requests coverage under the health care insurance plan not later than 60 days after the date the employee or dependent is determined to be eligible for assistance.
2023 Alaska Statutes › Title 21. Insurance › Chapter 54. Health Insurance › Article 2. Health Care Insurance Provisions, Requirements, and Restrictions. › Sec. 21.54.110. Preexisting condition exclusion.

(a) A health care insurance plan offered, issued for delivery, delivered, or renewed in the group market may not contain a preexisting condition exclusion that
(1) relates to a condition, regardless of cause, for which medical advice, diagnosis, care, or treatment was recommended or received more than six months before the enrollment date;
(2) considers genetic information as a condition for which a preexisting condition exclusion may be imposed in absence of a diagnosis of the condition related to the information;
(3) extends for more than 12 months after the enrollment date of a covered individual; or
(4) excludes a condition relating to pregnancy.
(b) A period of a preexisting condition exclusion permissible under (a) of this section must be reduced by the aggregate of periods of creditable coverage, if any, as determined in AS 21.54.120, applicable to the participant or beneficiary as of the enrollment date. The aggregate of periods of creditable coverage is determined by adding together all periods of creditable coverage before the enrollment date, excluding periods of creditable coverage before a continuous break in coverage of more than 90 days. A waiting period or affiliation period may not be considered in determining the 90-day period. This subsection does not apply if an individual's most recent period of creditable coverage ended on a date more than 90 days before the enrollment date. This subsection does not preclude application of a waiting period to all new enrollees under a health care insurance plan.
(c) A health care insurance plan offered, issued for delivery, delivered, or renewed in this state in the group market may not apply a preexisting condition exclusion to an individual who is (1) a newborn covered under creditable coverage as of the last day of the 30-day period beginning with the date of birth; or (2) adopted or placed for adoption before attaining 18 years of age and who is covered under creditable coverage as of the last day of the 30-day period beginning with the date of adoption or placement for adoption. This subsection does not apply to an individual after the end of the first continuous 90-day period during all of which the individual was not covered under creditable coverage.
(d) A health care insurance plan offered, issued for delivery, delivered, or renewed in this state in the group market may exclude coverage for late enrollees for the greater of 18 months or an 18-month preexisting condition exclusion. If both a waiting period and a preexisting condition exclusion under (a) of this section are applicable to a late enrollee, the combined period may not exceed 18 months from the date the individual enrolls for coverage under a health care insurance plan.
2023 Alaska Statutes › Title 21. Insurance › Chapter 54. Health Insurance › Article 2. Health Care Insurance Provisions, Requirements, and Restrictions. › Sec. 21.54.120. Creditable coverage.

(a) A health care insurer that offers, issues for delivery, delivers, or renews in this state a health care insurance plan in the group market shall count a period of creditable coverage based on
(1) the standard method authorized by 42 U.S.C. 300gg (Health Insurance Portability and Accountability Act of 1996) for determining creditable coverage without regard to the specific benefits covered during the period; or
(2) an alternative method based on coverage of benefits within each of several classes or categories of benefits specified in federal regulation if
(A) made on a uniform basis for all participants and beneficiaries; and
(B) the insurer counts a period of creditable coverage with respect to any class or category of benefits if any level of benefits is covered within the class or category.
(b) A health care insurer that offers, issues for delivery, delivers, or renews in this state a health care insurance plan in the group market shall provide a certification of coverage
(1) at the time an individual ceases to be covered under a health care insurance plan or becomes covered under a federal continuation provision;
(2) at the time an individual ceases to be covered under a federal continuation provision; and
(3) upon request by an individual or on behalf of an individual within 24 months after the date coverage under the health care insurance plan or a federal continuation provision ceases.
(c) A health care insurer that offers, issues for delivery, delivers, or renews in this state a health care insurance plan in the group market shall establish periods of creditable coverage with respect to an individual through certification under (b) of this section or as specified in federal regulation.
(d) A health care insurer that offers, issues for delivery, delivers, or renews in this state a health care insurance plan in the group market shall prominently state and describe the effect of the health care insurer's election to count a period of creditable coverage using a permissible alternative method
(1) in any disclosure statement concerning the health care insurance plan or coverage;
(2) to each enrollee at the time of enrollment; and
(3) to each employer at the time of offer or sale of coverage.
(e) A health care insurer issuing a certification under (b) of this section shall disclose information regarding coverage of classes and categories of health benefits available under the health care insurer's plan at the request of an entity that
(1) enrolls an individual who has provided the certification of coverage;
(2) elects to count a period of creditable coverage according to a permissible alternative method under (a)(2) of this section; and
(3) pays the health care insurer for the reasonable cost, if any, of disclosing the information described in this subsection.
2023 Alaska Statutes › Title 21. Insurance › Chapter 54. Health Insurance › Article 2. Health Care Insurance Provisions, Requirements, and Restrictions. › Sec. 21.54.140. Renewability of coverage for a multiple employer welfare arrangement.

A health benefit plan that is a multiple employer welfare arrangement subject to this title may not deny an employer whose employees are covered under the plan continued access to the same or a different plan according to the terms of the plan, except
(1) for nonpayment of contributions;
(2) for fraud or other intentional misrepresentation of material fact by the employer;
(3) for noncompliance with material plan provisions;
(4) where the plan is ceasing to offer any coverage in a geographic area;
(5) for a health benefit plan that offers benefits through a network plan if
(A) there is no longer an individual enrolled through the employer who lives, resides, or works in the service area of the network plan; and
(B) the multiple employer welfare arrangement applies this paragraph without regard to the claims experience of the employer or a health status factor in relation to an individual or an individual's dependent; and
(6) for failure to meet the terms of an applicable collective bargaining agreement to renew a collective bargaining or other agreement requiring or authorizing contributions to the plan or to employ employees covered by a collective bargaining agreement.
2023 Alaska Statutes › Title 21. Insurance › Chapter 54. Health Insurance › Article 2. Health Care Insurance Provisions, Requirements, and Restrictions. › Sec. 21.54.151. Mental health or substance use disorder benefits.

A health care insurer that offers a health care insurance plan in the group market shall comply with the mental health or substance use disorder benefit requirements established under 42 U.S.C. 300gg-26.