10375

A health insurance organization or issuer or insurance professional that takes an action that adversely affects a current or potential covered person or enrollee on the basis of a medical condition that the issuer or insurance professional knows or has reason to know is abuse-related shall explain the reason for its action to the covered person or enrollee in writing and shall be able to demonstrate that its action, and any applicable plan provision:(a) Does not have the purpose of treating the victim of abuse as a medical condition or underwriting criterion;(b) is not based upon any actual or perceived correlation between a medical condition and abuse;(c) is otherwise permissible by law and applies in the same manner and to the same extent to all current or potential covered persons or enrollees with a similar medical condition without regard to whether the condition or claim is abuse-related, and(d) except for claim actions, is based on a determination, made in conformance with sound actuarial principles and supported by reasonable statistical evidence, that there is a correlation between the medical condition and a material increase in insurance risk. History —Aug.

ce with sound actuarial principles and supported by reasonable statistical evidence, that there is a correlation between the medical condition and a material increase in insurance risk. History —Aug. 29, 2011, No. 194, added as § 72.050 on Aug. 23, 2012, No. 203, § 9, eff. 90 days after Aug. 23, 2012.