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304.17A-240 Renewal or continuation -- Ground for nonrenewal, cancellation,
or discontinuance.
(1)
(2)
(3)
Except as provided in this section, an insurer shall renew or continue in force a
health benefit plan at the option of the insured.
An insurer may nonrenew, cancel, or discontinue a health benefit plan based
only on one (1) or more of the following:
(a) The insured has failed to pay premiums or contributions in accordance
with the terms of the plan or the insurer has not received timely premium
payments;
(b) The insured has performed an act or practice that constitutes fraud or
made an intentional misrepresentation of material fact under the terms of
the coverage;
(c) The insured has engaged in intentional and abusive noncompliance with
material provisions of the health benefit plan;
(d) The insurer is ceasing to offer coverage in the individual or group market
in accordance with subsection (3) of this section;
(e) In the case of an insurer that offers health benefit plans through a
network plan, the individual no longer resides, lives, or works in the
service area or in an area for which the insurer is authorized to do
business, but only if the coverage is terminated under this paragraph
uniformly without regard to any health status-related factor of covered
individuals, or there is no longer any enrollee in connection with the group
plan who resides, lives, or works in the service area of the insurer;
(f) In the case of a health benefit plan that is made available only through
one (1) or more bona fide associations, the membership of the individual
or employer in the association on the basis of which the coverage is
provided ceases, but only if the coverage is terminated under this
paragraph uniformly without regard to any health status-related factor of
covered individuals; or
(g) In the case of a health benefit plan issued to a group, the group no longer
meets participation requirements or contribution requirements as
established by the insurer.
(a) In any case in which an insurer decides to discontinue offering a
particular type of health benefit plan, coverage of the type may be
discontinued by the insurer upon approval by the commissioner only if:
1.
The insurer provides notice to each insured provided coverage of
this type in the market of the discontinuation at least ninety (90)
days prior to the date of the discontinuation of the coverage;
2.
The insurer offers, to each insured provided coverage of this type,
the option to purchase any other health benefit plan currently of that
type being offered by the insurer in that market; and
3.
In exercising the option to discontinue coverage of this type and in
offering the option of coverage under subparagraph 2. of this
paragraph, the insurer acts uniformly without regard to any health
status-related factor of enrolled insureds or insureds who may
(4)
(5)
become eligible for coverage.
(b) 1.
Subject to paragraph (a)3. of this subsection, in any case in which
an insurer elects to discontinue offering all health benefit plans in
Kentucky, health benefit plans may be discontinued by the insurer
only if:
a.
The insurer provides notice to the commissioner and to each
insured of the discontinuation at least one hundred eighty (180)
days prior to the date of the expiration of the coverage; and
b.
All health benefit plans issued or delivered for issuance in
Kentucky are discontinued and coverage under the health
benefit plans is not renewed.
2.
In the case of a discontinuation under subparagraph 1. of this
paragraph, the insurer may not provide for the issuance of any
health benefit plans in Kentucky during the five (5) year period
beginning on the date of the discontinuation of the last health benefit
plan not so renewed.
At the time of coverage renewal, an insurer may modify, with approval of the
commissioner, the health benefit plan for a policy form so long as the
modification is consistent with this chapter and effective on a uniform basis
among all individuals with that policy form.
In applying this section in the case of a health benefit plan that is made
available by an insurer only through one (1) or more associations, a reference
to an individual is deemed to include a reference to an association of which the
individual is a member, and a reference to an employer member is deemed to
include a reference to the employer.
Effective:July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1220, effective July 15, 2010. -Amended 2002 Ky. Acts ch. 249, sec. 4, effective July 15, 2002; and ch. 351,
sec. 5, effective July 15, 2002. -- Created 1998 Ky. Acts ch. 496, sec. 6,
effective April 10, 1998.
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