513C.6 Provisions on renewability of coverage. 1. An individual health benefit plan subject to this chapter is renewable with respect to an eligible individual or dependents, at the option of the individual, except for one or more ofthe following reasons: a. The individual fails to pay, or to make timely payment of, premiums or contributions pursuant to the terms of the individual health benefit plan. b. The individual performs an act or practice constituting fraud or makes an intentional misrepresentation of a material fact under the terms of the individual health benefit plan. c. A decision by the individual carrier to discontinue offering a particular type of individual health benefit plan in the state’s individual insurance market. An individual health benefitplan may be discontinued by the carrier in that market with the approval of the commissionerand only if the carrier does all of the following: (1) Provides advance notice of its decision to discontinue such plan to the commissioner. Notice to the commissioner, at a minimum, shall be no less than three days prior to the noticeprovided for in subparagraph (2) to affected individuals. n to discontinue such plan to the commissioner. Notice to the commissioner, at a minimum, shall be no less than three days prior to the noticeprovided for in subparagraph (2) to affected individuals. (2) Provides notice of its decision not to renew such plan to all affected individuals no less than ninety days prior to the nonrenewal date of any discontinued individual health benefitplans. (3) Offers to each individual of the discontinued plan the option to purchase any other health plan currently offered by the carrier to individuals in this state. (4) Acts uniformly in opting to discontinue the plan and in offering the option under subparagraph (3), without regard to the claims experience of any affected eligible individualor beneficiary under the discontinued plan or to a health status-related factor relating to anycovered individuals or beneficiaries who may become eligible for the coverage. d. A decision by the carrier to discontinue offering and to cease to renew all of its individual health benefit plans delivered or issued for delivery to individuals in this state. Acarrier making such decision shall do all of the following: (1) Provide advance notice of its decision to dividual health benefit plans delivered or issued for delivery to individuals in this state. Acarrier making such decision shall do all of the following: (1) Provide advance notice of its decision to discontinue such plan to the commissioner. Notice to the commissioner, at a minimum, shall be no less than three days prior to the noticeprovided for in subparagraph (2) to affected individuals. (2) Provide notice of its decision not to renew such plan to all individuals and to the commissioner in each state in which an individual under the discontinued plan is known toreside, no less than one hundred eighty days prior to the nonrenewal of the plan. e. The commissioner finds that the continuation of the coverage is not in the best interests of the individuals, or would impair the carrier’s ability to meet its contractual obligations. 2. At the time of coverage renewal, a carrier may modify the health insurance coverage for a policy form offered to individuals in the individual market so long as such modificationis consistent with state law and effective on a uniform basis among all individuals with thatpolicy form. 3. a policy form offered to individuals in the individual market so long as such modificationis consistent with state law and effective on a uniform basis among all individuals with thatpolicy form. 3. An individual carrier that elects not to renew an individual health benefit plan under subsection 1, paragraph 'd', shall not write any new business in the individual market in thisstate for a period of five years after the date of notice to the commissioner. 4. This section, with respect to a carrier doing business in one established geographic service area of the state, applies only to such carrier’s operations in that service area. 5. A carrier offering coverage through a network plan is not required to renew or continue in force coverage or to accept applications from an individual who no longer resides or lives in,or is no longer employed in, the service area of such carrier, or no longer resides or lives in, oris no longer employed in, a service area for which the carrier is authorized to do business, butonly if coverage is not offered or terminated uniformly without regard to health status-relatedfactors of a covered individual. 6. service area for which the carrier is authorized to do business, butonly if coverage is not offered or terminated uniformly without regard to health status-relatedfactors of a covered individual. 6. A carrier offering coverage through a bona fide association is not required to renew or continue in force coverage or to accept applications from an individual through anassociation if the membership of the individual in the association on which the basis ofcoverage is provided ceases, but only if the coverage is not offered or terminated under thisparagraph uniformly without regard to health status-related factors of a covered individual. Sat Dec 23 00:44:06 2023 Iowa Code 2024, Section 513C.6 (17, 0) §513C.6, INDIVIDUAL HEALTH INSURANCE MARKET REFORM 2 7. An individual who has coverage as a dependent under a basic or standard health benefit plan may, when that individual is no longer a dependent under such coverage, elect tocontinue coverage under the basic or standard health benefit plan if the individual so electsimmediately upon termination of the coverage under which the individual was covered as adependent. elect tocontinue coverage under the basic or standard health benefit plan if the individual so electsimmediately upon termination of the coverage under which the individual was covered as adependent. 95 Acts, ch 5, §8; 97 Acts, ch 103, §36; 2005 Acts, ch 70, §11, 51; 2017 Acts, ch 148, §53 Sat Dec 23 00:44:06 2023 Iowa Code 2024, Section 513C.6 (17, 0)
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