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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
(4)
(5)
factor of enrolled insureds or insureds who may 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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