Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.26 - Group Health Insurance Coverage Policy Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
(1) Group health insurance coverage subject
				to the rules in this division is renewable with respect to all eligible
				employees or their dependents at the option of the employer, except for one or
				more of the following reasons:
a. The health
				insurance coverage sponsor fails to pay or to make timely payments of premiums
				or contributions pursuant to the terms of the health insurance
				coverage.
b. The health insurance
				coverage sponsors, performs an act or practice constituting fraud or makes an
				intentional misrepresentation of a material fact under the terms of the
				coverage.
c. Noncompliance with the
				carrier's minimum participation requirements or employer contribution
				requirements.
d. For a network
				plan, no enrollees connected to the plan live, reside, or work in the service
				area of the issuer.
e. A carrier
				may choose to discontinue offering and cease to renew a particular type of
				health insurance coverage in the large group market if the carrier does all of
				the following:
(1) Provides advance notice of
				its decision to discontinue the plan to the commissioner or director a minimum
				of three days prior to the notice for affected employers, participants, and
				beneficiaries.
(2) Provides notice
				of its decision not to renew a plan to all affected employers, participants,
				and beneficiaries no less than 90 days prior to nonrenewal of a plan.
(3) Offers to each plan sponsor of the
				discontinued coverage the option to purchase any other coverage currently
				offered by the carrier to other employers in this state.
(4) Acts uniformly, in opting to discontinue
				the coverage and in offering the option under subparagraph
				35.26(1)
"e"
(3), without regard to the claims experience of
				the sponsors under the discontinued coverage or to a health status-related
				factor relating to any participants or beneficiaries covered or new
				participants or beneficiaries who may become eligible for the coverage.
f. A decision by the
				carrier to discontinue offering and cease to renew all of its health insurance
				delivered or issued for delivery to employers in this state shall do all of the
				following:
(1) Provide advance notice of its
				decision to discontinue such coverage to the commissioner or director. Notice
				to the commissioner or director, at a minimum, shall be no less than three days
				prior to the notice provided for in subparagraph
				35.26(1)
"f"
(2) to affected employers, participants, and
				beneficiaries.
(2) Provide notice
				of its decision not to renew such coverage to all affected employers,
				participants, and beneficiaries no less than 180 days prior to the nonrenewal
				of the coverage.
(3) Discontinue
				all health insurance coverage issued or delivered for issuance to employers in
				this state and cease renewal of such coverage.
g. The membership of an employer in a bona
				fide association, which is the basis for the coverage which is provided through
				such association, ceases, but only if the termination of coverage under this
				subrule occurs uniformly without regard to any health status-related factor
				relating to any covered individual.
h. The commissioner or director finds that
				the continuation of the coverage is not in the best interests of the
				policyholders or certificate holders, or would impair the carrier's ability to
				meet its contractual obligations.
i. At the time of coverage renewal, a carrier
				may modify the health insurance coverage for a product offered under group
				health insurance coverage in the group market, if such modification is
				consistent with the laws of this state and is effective on a uniform basis
				among group health insurance coverage with that product.