North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-11 - Regulation on the Crediting of Qualifying Previous Coverage Toward the Reduction of Preexisting Condition Exclusion Periods › Section 45-06-11-04 - Certification of coverage in the group market

Current through Supplement No. 393, July, 2024
1. A health carrier offering group health
				insurance coverage under a group health benefit plan is required to provide
				certificates of qualifying previous coverage in accordance with this section.
2. Any entity required to provide
				a certificate under this section for an individual is deemed to have satisfied
				the requirements of this section for that individual if another party provides
				the certificate, but only to the extent the information related to the
				individual's qualifying previous coverage and waiting period is provided by the
				other party.
3. A health carrier
				is not required to provide information regarding coverage provided to an
				individual by another party.
4. If
				an individual's coverage under a health carrier's policy ceases before an
				individual's coverage under the plan ceases, the health carrier is required to
				provide sufficient information to the plan to enable a certificate to be
				provided by the plan, after cessation of the individual's coverage under the
				plan, that reflects the period of coverage under the policy.
5. A certificate of coverage must be
				provided, without charge, for individuals and dependents, who are or were
				covered under a group health insurance policy, for the following:
a. An automatic certificate must be provided
				in the following circumstances:
(1) In the
				case of an individual who is a qualified beneficiary entitled to elect
				Consolidated Omnibus Budget Reconciliation Act [ Pub. L. 99-272; 100 Stat. 82]
				continuation coverage, an automatic certificate is required to be provided at
				the time the individual would lose coverage under the plan in the absence of
				Consolidated Omnibus Budget Reconciliation Act continuation coverage or
				alternative coverage elected instead of Consolidated Omnibus Budget
				Reconciliation Act continuation coverage.
(2) In the case of an individual who is not a
				qualified beneficiary entitled to elect Consolidated Omnibus Budget
				Reconciliation Act continuation coverage, an automatic certificate is required
				to be provided at the time the individual ceases to be covered under the plan.
				A health carrier satisfies this requirement if it provides the certificate
				within a reasonable time period after the individual ceases to be covered under
				the plan. In the case of an individual who is entitled to elect continuation
				coverage under North Dakota Century Code section 26.1-36-23 or 26.1-36-23.1, an
				automatic certificate is required to be furnished no later than thirty-one days
				after the individual ceases to be covered under the plan.
(3) In the case of an individual who has
				elected Consolidated Omnibus Budget Reconciliation Act continuation coverage,
				an automatic certificate must be provided at the time the individual's coverage
				under the plan ceases. The health carrier satisfies this requirement if it
				provides the automatic certificate within a reasonable time after coverage
				ceases. An automatic certificate is required to be provided to an individual
				regardless of whether the individual has previously received an automatic
				certificate.