38.2-3432.1 - Renewability.
§ 38.2-3432.1. Renewability.
A. Every health insurance issuer that offers health insurance coverage in thegroup market in this Commonwealth shall renew or continue in force suchcoverage with respect to all insureds at the option of the employer except:
1. For nonpayment of the required premiums by the policyholder, or contractholder, or where the health insurance issuer has not received timely premiumpayments;
2. When the health insurance issuer is ceasing to offer coverage in the smallgroup market in accordance with subdivisions 9 and 10;
3. For fraud or misrepresentation by the employer, with respect to theircoverage;
4. With regard to coverage provided to an eligible employee, for fraud ormisrepresentation by the employee with regard to his or her coverage;
5. For failure to comply with contribution and participation requirementsdefined by the health benefit plan;
6. For failure to comply with health benefit plan provisions that have beenapproved by the Commission;
7. When a health insurance issuer offers health insurance coverage in thegroup market through a network plan, and there is no longer an enrollee inconnection with such plan who lives, resides, or works in the service area ofthe health insurance issuer (or in the area for which the health insuranceissuer is authorized to do business) and, in the case of the group market,the health insurance issuer would deny enrollment with respect to such planunder the provisions of subdivision 9 or 10;
8. When health insurance coverage is made available in the group market onlythrough one or more bona fide associations, the membership of an employer inthe association (on the basis of which the coverage is provided) ceases butonly if such coverage is terminated under this subdivision uniformly withoutregard to any health status related factor relating to any covered individual;
9. When a health insurance issuer decides to discontinue offering aparticular type of group health insurance coverage in the group market inthis Commonwealth, coverage of such type may be discontinued by the healthinsurance issuer in accordance with the laws of this Commonwealth in suchmarket only if (i) the health insurance issuer provides notice to each plansponsor provided coverage of this type in such market (and participants andbeneficiaries covered under such coverage) of such discontinuation at leastninety days prior to the date of the discontinuation of such coverage; (ii)the health insurance issuer offers to each plan sponsor provided coverage ofthis type in such market, the option to purchase any other health insurancecoverage currently being offered by the health insurance issuer to a grouphealth plan in such market; and (iii) in exercising the option to discontinuecoverage of this type and in offering the option of coverage under thissubdivision, the health insurance issuer acts uniformly without regard to theclaims experience of those sponsors or any health status-related factorrelating to any participants or beneficiaries covered or new participants orbeneficiaries who may become eligible for such coverage;
10. In any case in which a health insurance issuer elects to discontinueoffering all health insurance coverage in the group market in thisCommonwealth, health insurance coverage may be discontinued by the healthinsurance issuer only in accordance with the laws of this Commonwealth andif: (i) the health insurance issuer provides notice to the Commission and toeach plan sponsor (and participants and beneficiaries covered under suchcoverage) of such discontinuation at least 180 days prior to the date of thediscontinuation of such coverage; and (ii) all health insurance issued ordelivered for issuance in this Commonwealth in such market (or markets) arediscontinued and coverage under such health insurance coverage in such market(or markets) is not renewed;
11. In the case of a discontinuation under subdivision 10 of this subsectionin a market, the health insurance issuer may not provide for the issuance ofany health insurance coverage in the market and this Commonwealth during thefive-year period beginning on the date of the discontinuation of the lasthealth insurance coverage not so renewed;
12. At the time of coverage renewal, a health insurance issuer may modify thehealth insurance coverage for a product offered to a group health plan orhealth insurance issuer offering group health insurance coverage in the groupmarket if, for coverage that is available in such market other than onlythrough one or more bona fide associations, such modification is consistentwith the laws of this Commonwealth and effective on a uniform basis amonggroup health plans or health insurance issuers offering group healthinsurance coverage with that product;
13. In applying this section in the case of health insurance coverage that ismade available by a health insurance issuer in the group market to employersonly through one or more associations, a reference to "plan sponsor" isdeemed, with respect to coverage provided to an employer member of theassociation, to include a reference to such employer; or
14. Benefits and premiums which have been added by rider to the essential orstandard benefit plans issued to small employers shall be renewable at thesole option of the health insurance issuer.
B. If coverage to the small employer market pursuant to this article ceasesto be written, administered or otherwise provided, such coverage shallcontinue to be governed by this article with respect to business conductedunder this article that was transacted prior to the effective date oftermination and that remains in force.
(1997, cc. 807, 913; 1998, c. 24.)