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. 21.54.120. 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. 21.54.010. Required provisions of group policies.
Each group health insurance policy must contain in substance the following provisions: (1) a provision that, in the absence of fraud, all statements made by applicants or the policyholder or by an insured person shall be considered representations and not warranties, and that a statement made for the purpose of effecting insurance may not void […]
Sec. 21.54.015. Rate requirements; filings; regulations; health care insurance restrictions.
(a) Rates charged for a group health insurance policy may not be excessive, inadequate, or unfairly discriminatory. (b) A health care insurer may decline to cover or may restrict the coverage offered to a self-employed individual under an association plan authorized under AS 21.54.060(a)(6). (c) Except for large employer health care insurance plan premium rates […]
Sec. 21.54.020. Direct payment to providers.
(a) On the written request of a covered person, a health care insurer shall pay amounts due under a health insurance policy directly to the provider of medical care services. A health insurance policy may not contain a provision that requires services be provided by a particular hospital or person, except as applicable to a […]