509B.3 Continuation of benefits. A group policy delivered or issued for delivery in this state which insures employees or members for accident or health insurance on an expense-incurred or service basis, other thanfor specific diseases or for accidental injuries only, shall provide that employees or memberswhose coverage under the group policy would otherwise terminate because of terminationof employment or membership may continue their accident or health insurance under thatgroup policy, for themselves and their eligible dependents, subject to all of the group policy’sterms and conditions applicable to those forms of insurance and subject to all of the followingconditions: 1. Continuation shall only be available to an employee or member if the employee or member was continuously insured under the group policy, and for similar benefits under anygroup policy which it replaced, during the entire three months’ period immediately precedingthe termination. 2. Continuation shall not be available for a person who is or could be covered by Medicare. Continuation shall not be available for a person who is or is eligible to be covered by anothergroup insured or uninsured arrangement which ilable for a person who is or could be covered by Medicare. Continuation shall not be available for a person who is or is eligible to be covered by anothergroup insured or uninsured arrangement which provides accident or health coverage, unlessthe person was covered by that other group policy immediately prior to the termination. 3. Continuation may exclude dental care, vision care, or prescription drug benefits or other benefits provided under the group policy which benefits are in addition to accident orhealth benefits. 4. a. An employee or member who wishes continuation of coverage must request continuation in writing to the employer or group policyholder within the ten-day periodfollowing the later of either of the following: (1) The date of the termination.(2) The date the employee is given notice of the right of continuation as provided in section 509B.5 by either the employer or the group policyholder. b. If proper notice is given, the employee or member is not eligible to elect continuation more than thirty-one days after the date of termination. 5. An employee or member electing continuation shall pay monthly to the employer or group policyholder, in advance, the amount ct continuation more than thirty-one days after the date of termination. 5. An employee or member electing continuation shall pay monthly to the employer or group policyholder, in advance, the amount of contribution required by the employer orgroup policyholder, but not more than the group rate otherwise due for the insurance beingcontinued under the group policy. If proper notice is given, the election of continuation by theemployee or member together with the first contribution required to establish contributionson a monthly basis in advance, shall be given to the employer or group policyholder withinthirty-one days of the date the group insurance would otherwise terminate. 6. Continuation of insurance under the group policy for any person shall terminate when the person becomes eligible for Medicare or another group insured or uninsured accident orhealth arrangement, or earlier, when any of the following first occurs: a. Nine months after the date the employee’s or member’s insurance under the policy would otherwise have terminated because of termination of employment or membership. b. the following first occurs: a. Nine months after the date the employee’s or member’s insurance under the policy would otherwise have terminated because of termination of employment or membership. b. At the end of the period for which contributions were made if the employee or member fails to make timely payment of a required contribution and if proper notice is given asprovided in section 509B.5, subsection 2. c. If the person covered is a former spouse, upon the former spouse’s remarriage.d. The date on which the group policy is terminated or, in the case of an employee, the date the employer terminates participation under the group policy. However, if this paragraphapplies and the coverage which would cease because of the employer’s termination isreplaced by similar coverage under a different group policy, all of the following apply: (1) The employee, member, spouse, or eligible dependent may become covered under the different group policy, for the balance of the period that the employee or member wouldhave remained covered under the prior group policy had a termination of the group policy asspecified in paragraph 'd' not occurred. icy, for the balance of the period that the employee or member wouldhave remained covered under the prior group policy had a termination of the group policy asspecified in paragraph 'd' not occurred. (2) The minimum level of benefits to be provided by the different group policy shall be the applicable level of benefits of the prior group policy, reduced by any benefits payable underthe prior group policy. Sat Dec 23 00:42:04 2023 Iowa Code 2024, Section 509B.3 (18, 0) §509B.3, CONTINUATION OF GROUP HEALTH INSURANCE 2 (3) The prior group policy shall continue to provide benefits to the extent of its accrued liabilities and extensions of benefits as if the prior group policy had not been replaced by thedifferent group policy. 7. A notification of the continuation privilege shall be included with or in each certificate of coverage and as otherwise provided in section 509B.5 and shall contain the time limits forrequesting the continued coverage. 8. The spouse of an employee or member, and any covered dependent children of the employee or member, whose coverage under the group policy would otherwise terminatebecause of dissolution or annulment of marriage or death of the employee or nd any covered dependent children of the employee or member, whose coverage under the group policy would otherwise terminatebecause of dissolution or annulment of marriage or death of the employee or member shallhave the same contribution and notice responsibilities and privileges as provided under thischapter to the employee or member upon termination of employment or membership. 86 Acts, ch 1124, §3; 87 Acts, ch 115, §62; 2012 Acts, ch 1023, §157 Sat Dec 23 00:42:04 2023 Iowa Code 2024, Section 509B.3 (18, 0)
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