2009 Iowa Code
Title 13 - Commerce
Subtitle 1 - Insurance and Related Regulation
CHAPTER 513B - SMALL GROUP HEALTH COVERAGE
513B.5 - PROVISIONS ON RENEWABILITY OF COVERAGE.

        513B.5  PROVISIONS ON RENEWABILITY OF COVERAGE.
         1.  Health insurance coverage subject to this chapter is renewable
      with respect to all eligible employees or their dependents, at the
      option of the small employer, except for one or more of the following
      reasons:
         a.  The health insurance coverage sponsor fails to pay, or to
      make timely payment of, premiums or contributions pursuant to the
      terms of the health insurance coverage.
         b.  The health insurance coverage sponsor 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 or organized delivery
      system's minimum participation requirements.
         d.  Noncompliance with the carrier's or organized delivery
      system's employer contribution requirements.
         e.  A decision by the carrier or organized delivery system to
      discontinue offering a particular type of health insurance coverage
      in the state's small employer market.  Health insurance coverage may
      be discontinued by the carrier or organized delivery system in that
      market only if the carrier or organized delivery system does all of
      the following:
         (1)  Provides advance notice of its decision to discontinue such
      plan to the commissioner or director of public health.  Notice to the
      commissioner or director, at a minimum, shall be no less than three
      days prior to the notice provided for in subparagraph (2) to affected
      small employers, participants, and beneficiaries.
         (2)  Provides notice of its decision not to renew such plan to all
      affected small employers, participants, and beneficiaries no less
      than ninety days prior to the nonrenewal of the plan.
         (3)  Offers to each plan sponsor of the discontinued coverage, the
      option to purchase any other coverage currently offered by the
      carrier or organized delivery system to other employers in this
      state.
         (4)  Acts uniformly, in opting to discontinue the coverage and in
      offering the option under subparagraph (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 or organized delivery system to
      discontinue offering and to cease to renew all of its health
      insurance coverage delivered or issued for delivery to small
      employers in this state.  A carrier or organized delivery system
      making such decision shall do all of the following:
         (1)  Provide advance notice of its decision to discontinue such
      coverage to the commissioner or director of public health.  Notice to
      the commissioner or director, at a minimum, shall be no less than
      three days prior to the notice provided for in subparagraph (2) to
      affected small employers, participants, and beneficiaries.
         (2)  Provide notice of its decision not to renew such coverage to
      all affected small employers, participants, and beneficiaries no less
      than one hundred eighty days prior to the nonrenewal of the coverage.

         (3)  Discontinue all health insurance coverage issued or delivered
      for issuance to small employers in this state and cease renewal of
      such coverage.
         g.  The membership of an employer in an association, which is
      the basis for the coverage which is provided through such
      association, ceases, but only if the termination of coverage under
      this paragraph occurs uniformly without regard to any health
      status-related factor relating to any covered individual.
         h.  The commissioner or director of public health 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
      or organized delivery system's ability to meet its contractual
      obligations.
         i.  At the time of coverage renewal, a carrier or organized
      delivery system may modify the health insurance coverage for a
      product offered under group health insurance coverage in the small
      group market, for coverage that is available in such market other
      than only through one or more bona fide associations, 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.
         2.  A carrier or organized delivery system that elects not to
      renew health insurance coverage under subsection 1, paragraph
      "f", shall not write any new business in the small employer
      market in this state for a period of five years after the date of
      notice to the commissioner or director of public health.
         3.  This section, with respect to a carrier or organized delivery
      system doing business in one established geographic service area of
      the state, applies only to such carrier's or organized delivery
      system's operations in that service area.  

         91 Acts, ch 244, § 5; 92 Acts, ch 1167, § 8, 9; 93 Acts, ch 80, §
      6; 97 Acts, ch 103, §19
         Referred to in § 513B.10