376.454. Individual market, renewal or continuation at option of individual--nonrenewal or discontinuation permitted, when--discontinuation of a type of coverage, procedure.
Individual market, renewal or continuation at option ofindividual--nonrenewal or discontinuation permitted,when--discontinuation of a type of coverage, procedure.
376.454. 1. Except as provided in this section, a health insuranceissuer that provides individual health insurance coverage to an individualshall renew or continue in force such coverage at the option of theindividual.
2. A health insurance issuer may nonrenew or discontinue healthinsurance coverage of an individual in the individual market based only onone or more of the following:
(1) The individual has failed to pay premiums or contributions inaccordance with the terms of the health insurance coverage or the issuerhas not received timely premium payments;
(2) The individual has performed an act or practice that constitutesfraud or made an intentional misrepresentation of material fact under theterms of the coverage;
(3) The issuer is ceasing to offer coverage in the individual marketin accordance with subsection 4 of this section;
(4) In the case of a health insurance issuer that offers healthinsurance coverage in the market through a network plan, the individual nolonger resides, lives, or works in the service area or in an area for whichthe issuer is authorized to do business but only if such coverage isterminated under this subdivision uniformly without regard to any healthstatus-related factor of covered individuals;
(5) In the case of health insurance coverage that is made availablein the individual market only through one or more bona fide associations,the membership of the individual in the association on the basis of whichthe coverage is provided ceases, but only if such coverage is terminatedunder this subdivision uniformly without regard to any healthstatus-related factor of covered individuals.
3. In any case in which an issuer decides to discontinue offering aparticular type of health insurance coverage offered in the individualmarket, coverage of such type may be discontinued by the issuer only if:
(1) The issuer provides notice to each covered individual providedcoverage of this type in such market of such discontinuation at leastninety days prior to the date of the discontinuation of such coverage;
(2) The issuer offers to each individual in the individual marketprovided coverage of this type, the option to purchase any other individualhealth insurance coverage currently being offered by the issuer forindividuals in such market; and
(3) In exercising the option to discontinue coverage of this type andin offering the option of coverage under subdivision (2) of thissubsection, the issuer acts uniformly without regard to any healthstatus-related factor of enrolled individuals or individuals who may becomeeligible for such coverage.
4. (1) In any case in which a health insurance issuer elects todiscontinue offering all health insurance coverage in the individual marketin the state, health insurance coverage may be discontinued by the issueronly if:
(a) The issuer provides notice to the director and to each individualof such discontinuation at least one hundred eighty days prior to the dateof the expiration of such coverage; and
(b) All health insurance issued or delivered for issuance in thestate in such market is discontinued and coverage under such healthinsurance coverage in such market is not renewed.
(2) In the case of a discontinuation under subdivision (1) of thissubsection, the issuer shall not provide for the issuance of any healthinsurance coverage in the individual market for a five-year periodbeginning on the date of the discontinuation of the last health insurancecoverage not so renewed.
5. At the time of coverage renewal, a health insurance issuer maymodify the health insurance coverage for a policy form offered toindividuals in the individual market so long as such modification isconsistent with applicable law and effective on a uniform basis among allindividuals with that policy form. For purposes of this subsection,renewal shall be deemed to occur not more often than annually on theanniversary of the effective date of the individual's health insurancecoverage or as specified in the policy or contract.
6. In applying this section in the case of health insurance coveragethat is made available by a health insurance issuer in the individualmarket to individuals only through one or more associations, a reference toan individual is deemed to include a reference to such an association ofwhich the individual is a member.
7. An insurer shall provide a certification of creditable coverage asrequired by Public Law 104-191 and regulations pursuant thereto.
(L. 2007 H.B. 818)Effective 1-01-08