Sec. 21.54.120. Creditable coverage.
(a) A health care insurer that offers, issues for delivery, delivers, or renews in this state a health care insurance plan in the group market shall count a period of creditable coverage based on (1) the standard method authorized by 42 U.S.C. 300gg (Health Insurance Portability and Accountability Act of 1996) for determining creditable coverage […]
Sec. 21.54.130. Renewability, termination, and modification of coverage.
(a) Except for a multiple employer welfare arrangement, a health care insurer that offers, issues for delivery, delivers, or renews in this state a health care insurance plan in the group market shall renew or continue in force the coverage under the plan at the option of the plan sponsor unless (1) the plan sponsor […]
Sec. 21.54.140. Renewability of coverage for a multiple employer welfare arrangement.
A health benefit plan that is a multiple employer welfare arrangement subject to this title may not deny an employer whose employees are covered under the plan continued access to the same or a different plan according to the terms of the plan, except (1) for nonpayment of contributions; (2) for fraud or other intentional […]
Sec. 21.54.151. Mental health or substance use disorder benefits.
A health care insurer that offers a health care insurance plan in the group market shall comply with the mental health or substance use disorder benefit requirements established under 42 U.S.C. 300gg-26.
Sec. 21.54.160. “Excepted benefits” defined.
“Excepted benefits” means benefits under one or more or any combination of the following: (1) benefits under (A) coverage only for accident, disability income insurance, or both; (B) coverage issued as a supplement to liability insurance; (C) liability insurance, including general liability insurance and automobile liability insurance; (D) workers’ compensation or substantially similar insurance; (E) […]
Sec. 21.54.170. Determination of size of employer.
The determination of whether an employer is a large or small employer is subject to the following: (1) the size of an employer that was not in existence throughout the preceding calendar year must be based on the average number of employees that the employer is reasonably expected to employ on the business days in […]
Sec. 21.54.500. Definitions.
In this chapter, (1) “aggregate lifetime limit” means a dollar limit on the total amount that may be paid for benefits under a health care insurance plan offered in the group market with respect to an individual or unit of coverage; (2) “annual limit” means a dollar limit on the total amount that may be […]
Sec. 21.54.050. Payment of blanket health policy benefits.
(a) All benefits under a blanket health insurance policy shall be paid to (1) the person insured; (2) the designated beneficiary or beneficiaries of the person insured; (3) the estate of the person insured; (4) the parent, guardian, or other person actually supporting the person insured, if the person insured is a minor or otherwise […]
Sec. 21.54.060. Group health insurance defined.
(a) Group health insurance is that form of health insurance covering groups of persons as defined below, with or without one or more members of their families or one or more of their dependents, or covering one or more members of the families or one or more dependents of the groups of persons and issued […]
Sec. 21.54.070. Blanket health insurance defined.
Blanket health insurance is declared to be that form of health insurance covering groups of persons as enumerated in one of the following subdivisions: (1) under a policy or contract issued to a common carrier or to an operator, owner, or lessee of a means of transportation, who or which shall be considered the policyholder, […]