2018 Mississippi Code
Title 83 - Insurance
Chapter 9 - Accident, Health and Medicare Supplement Insurance
Accident and Health Insurance
§ 83-9-35. Replacement of group or blanket health and accident policy or plan; succeeding carrier’s plan to continue certain benefits and provisions.
(1) This section shall apply to any health benefit plan that provides coverage to two (2) or more employees of an employer in this state if any of the following conditions are satisfied:
(a) Any portion of the premium or benefits is paid by or on behalf of the employer;
(b) An eligible employee or dependent is reimbursed, whether through wage adjustments or otherwise, by or on behalf of the employer for any portion of the premium; or
(c) The health benefit plan is treated by the employer or any of the eligible employees or dependents as part of a plan or program for the purposes of Sections 162, 125 or 106 of the United States Internal Revenue Code.
(2) This section shall not apply to a health benefit plan which is issued in good faith with no knowledge or intent that the plan will, at the time of issuance or thereafter, satisfy one or more of the conditions set forth in subsection (1), and the insurer has certified to the Department of Insurance that the policy form:
(a) Is not designed to be an employer-provided insurance.
(b) Is not intended to be an employer-provided insurance.
(c) Will not be advertised or marketed as employer-provided insurance.
(d) Will not be issued if the insurer knows that the policy will meet one (1) or more of the conditions set forth in subsection (1).
(3) This section shall not apply to an employer whose only role is collecting through payroll deductions the premiums of individual policies on behalf of employees.
(4) “Health benefit plan” means any group hospital or medical policy or group certificate delivered or issued for delivery in this state by an insurer; a nonprofit hospital, medical and surgical service corporation; a health maintenance organization; a fully insured multiple employer welfare arrangement; or any combination of these, except hospital daily indemnity plans, specified disease only policies, or other limited, supplemental benefit insurance policies.
(5) Whenever a health benefit plan of one carrier replaces a health benefit plan of similar benefits of another carrier:
(a) The prior carrier shall remain liable only to the extent of its accrued liabilities. The position of the prior carrier shall be the same whether the group policyholder or other entity secures replacement coverage from a new carrier, or a self-insurer, or foregoes the provision of coverage.
(b) Each person who was validly covered under the prior health plan, who is eligible for coverage in accordance with the succeeding carrier’s plan of benefits, with respect to classes eligible, shall be covered by that carrier’s plan of benefits. No previously covered person shall be considered ineligible for coverage solely because of his health condition or claims experience.
(c) The succeeding carrier, in determining whether a preexisting condition provision applies to an eligible employee or dependent, shall credit the time the person was covered under the prior plan if the previous coverage was continuous to a date not more than thirty (30) days prior to the effective date of the new coverage.
(d) The succeeding carrier, in applying any deductibles or waiting periods in its plan, shall give credit for the satisfaction or partial satisfaction of the same or similar provisions under a prior plan providing similar benefits. In the case of deductible provisions, the credit shall apply for the same or overlapping benefit periods and shall be given for expenses actually incurred and applied against the deductible provisions of the prior carrier’s plan during the ninety (90) days preceding the effective date of the succeeding carrier’s plan, but only to the extent these expenses are recognized under the terms of the succeeding carrier’s plan and are subject to a similar deductible provision.
(e) Whenever a determination of the prior carrier’s benefit is required by the succeeding carrier, at the succeeding carrier’s request, the prior carrier shall furnish a statement of the benefits available or pertinent information, sufficient to permit verification of the benefit determination or the determination itself by the succeeding carrier. For the purposes of this paragraph, benefits of the prior plan shall be determined in accordance with all of the definitions, conditions and covered expense provisions of the prior plan rather than those of the succeeding plan. The benefit determination will be made as if coverage was not replaced by the succeeding carrier.
(f) This section shall be applicable to any coverage offered and maintained as a result of membership or connection with any association or organization which exists for the purpose of offering health insurance to its members, and shall further be applicable to any health insurance policy or plan which is not made available to the general public on an individual basis with the exception of any State of Mississippi comprehensive health association.
