20-2301. Definitions; late enrollee coverage A. In this chapter, unless the context otherwise requires: 1. " Accountable health plan" means an entity that offers, issues or otherwise provides a health benefits plan and that is approved by the director as an accountable health plan pursuant to section 20-2303. 2. " Affiliation period" means a period […]
20-2302. Scope of article A. This article applies to any health benefits plan that provides coverage to eligible employees or dependents in this state and that is issued by an accountable health plan if: 1. Any portion of the premium or benefits is paid by or on behalf of the employer. 2. The eligible employee […]
20-2303. Approval as accountable health plan; definition An entity may offer, issue or otherwise provide a health benefits plan only if the entity is authorized to transact insurance in this state and is approved as an accountable health plan by the director based on a determination that the entity meets the applicable requirements of this […]
20-2304. Availability of insurance; premium tax exemption A. As a condition of doing business in this state, each accountable health plan shall offer at least one health benefits plan on a guaranteed issuance basis to small employers as required by this section. All small employers qualify for this guaranteed offer of coverage. The accountable health […]
20-2306. Use of uniform employee health status questionnaire A. An accountable health plan shall use the uniform employee health status questionnaire prescribed by the department for all small groups for which the accountable health plan requires employees and their covered dependents to complete health status questionnaires. B. An accountable health plan may add to the […]
20-2307. Eligibility; annual open enrollment period A. Except as otherwise provided in this section or section 20-2308 or 20-2309, an accountable health plan may not exclude from coverage any employee or a spouse or a dependent child of the employee if the person meets the eligibility requirements established by the employer. B. Subsection A of […]
20-2308. Portability A newborn child, adopted child or child placed for adoption is an eligible individual if the child was timely enrolled and otherwise would have met the definition of an eligible individual as prescribed in section 20-1379 other than the required period of creditable coverage and the child is-not subject to any preexisting condition […]
20-2309. Renewability A. At least sixty days before the date of expiration of a health benefits plan, an accountable health plan that provides a health benefits plan shall provide for written notice to the employer of the terms for renewal of the plan. The notice shall include an explanation of the extent to which any […]
20-2310. Discrimination prohibited; preexisting conditions; wellness programs A. Except as provided in subsection B of this section, a health benefits plan may not deny, limit or condition the coverage or benefits based on a person’s health status-related factors or a lack of evidence of insurability. B. A health benefits plan shall not exclude coverage for […]
20-2311. Premium rates and rating practices A. The premium rate that an accountable health plan charges during a rating period for a health benefits plan issued to a small employer shall not vary by more than sixty percent from the index rate for health benefits plans involving the same or similar coverage, family size and […]
20-2313. Marketing practices A. An accountable health plan or its insurance producer shall not: 1. Discourage an employer from filing an application for a health benefits plan because of the health status-related factors, industry, occupation or geographic location of the employer. 2. Encourage or direct an employer to seek a health benefits plan from another […]
20-2321. Maternity benefits; adoption; coverage A. A contract that is issued to an enrollee pursuant to this article and that provides coverage for maternity benefits shall also provide that the maternity benefits apply to the costs of the birth of a child who is legally adopted by the enrollee if all of the following are […]
20-2322. Mental health services and benefits; definitions A. Beginning on January 1, 1998, any health benefits plan that is offered by an accountable health plan and that provides services or health benefits that include mental health services or mental health benefits shall comply with this section. B. If the health benefits plan does not include […]
20-2324. Bona fide associations; definitions A. An association qualifies as a path 1 bona fide association if the association meets the following requirements: 1. Has been formed and maintained in good faith for purposes other than obtaining insurance and does not condition membership in the association on the purchase of insurance that is sponsored by […]
20-2325. Diabetes; equipment; supplies A. Any health benefits plan that is offered by an accountable health plan and that provides coverage for diabetes shall also provide coverage for equipment and supplies that are medically necessary and that are prescribed by a health care provider, including: 1. Blood glucose monitors. 2. Blood glucose monitors for the […]
20-2326. Drugs; cancer treatment; definitions A. Any health benefits plan that is offered by an accountable health plan and that provides coverage for prescription drugs shall not limit or exclude coverage for any prescription drug prescribed for the treatment of cancer on the basis that the prescription drug has not been approved by the United […]
20-2327. Metabolic disorders; medical foods; definitions A. Any health benefits plan that is offered by an accountable health plan and that contains a prescription drug benefit shall provide coverage of medical foods to treat inherited metabolic disorders as provided by this section. B. The metabolic disorders triggering medical foods coverage under this section shall: 1. […]
20-2328. Accountable health plans; clinical trials; cancer; definitions A. An accountable health plan is not obligated to pay any costs, other than covered patient costs, that are directly associated with a cancer clinical trial that is offered in this state and in which the enrollee participates voluntarily. A cancer clinical trial is a course of […]
20-2329. Prescription contraceptive drugs and devices; definition A. An accountable health plan that provides a health benefits plan that provides coverage for: 1. Prescription drugs shall also provide coverage for any prescribed drug or device that is approved by the United States food and drug administration for use as a contraceptive. An accountable health plan […]
20-2330. Continuation of small group coverage; notice; duration; definitions A. For health benefit plans issued or renewed after December 31, 2018, a health benefits plan shall provide that an enrollee and any qualified dependent may continue coverage under the plan as provided in this section. B. A small employer shall notify the enrollee in writing […]
