H.B. 1563

VETOES

(C) A CARRIER THAT OFFERS COVERAGE TO A GROUP SHALL OFFER
COVERAGE TO ALL OF ITS MEMBERS.

(D) (1) A HEALTH MAINTENANCE ORGANIZATION NEED NOT OFFER
COVERAGE:

(I) TO AN INDIVIDUAL OR GROUP THAT IS NOT LOCATED IN THE
HEALTH MAINTENANCE ORGANIZATION'S APPROVED SERVICE AREAS;

(II) TO A MEMBER OF A GROUP. WHO DOES NOT RESIDE WITHIN
THE HEALTH MAINTENANCE ORGANIZATION'S APPROVED SERVICE AREAS; OR

(III) WITHIN AN AREA WHERE THE HEALTH MAINTENANCE
ORGANIZATION REASONABLY ANTICIPATES, AND DEMONSTRATES TO THE
SATISFACTION OF THE REGIONAL HEALTH COOPERATIVE AND THE COMMISSIONER,
THAT IT WILL NOT HAVE THE CAPACITY WITHIN THE AREA IN ITS NETWORK OF
PROVIDERS TO DELIVER SERVICE ADEQUATELY BECAUSE OF ITS OBLIGATIONS TO
EXISTING GROUP CONTRACT HOLDERS AND ENROLLEES.

(2) A PARTICIPATING CARRIER THAT DISCONTINUES OFFERING
COVERAGE UNDER PARAGRAPH (1)(III) OF THIS SUBSECTION MAY NOT OFFER
COVERAGE IN THAT REGIONAL AREA TO NEW INDIVIDUALS OR NEW ELIGIBLE
EMPLOYEES UNTIL THE LATER OF 180 DAYS FOLLOWING THE DATE OF THE LATEST
REFUSAL TO OFFER COVERAGE OR THE DATE ON WHICH THE PARTICIPATING
CARRIER NOTIFIES THE REGIONAL HEALTH COOPERATIVE THAT IT HAS REGAINED
CAPACITY TO DELIVER SERVICES TO EMPLOYER GROUPS. THE DATE MAY NOT BE
LESS THAN 120 DAYS AFTER THE LAST DAY OF AN OPEN ENROLLMENT PERIOD,
DETERMINED BY THE REGIONAL HEALTH COOPERATIVE FOR THE PROGRAM.

(3) A HEALTH MAINTENANCE ORGANIZATION THAT DOES NOT OFFER
COVERAGE UNDER PARAGRAPH (1)(III) OF THIS SUBSECTION MAY NOT OFFER
COVERAGE IN THE APPLICABLE AREA TO ANY INDIVIDUALS OR GROUPS UNTIL THE
LATER OF 180 DAYS FOLLOWING ANY REFUSAL TO DO SO, OR THE DATE ON WHICH
THE CARRIER NOTIFIES THE COMMISSIONER THAT IT HAS REGAINED CAPACITY TO
DELIVER SERVICES TO INDIVIDUALS OR GROUPS.

(E) A CARRIER MAY NOT BE REQUIRED TO OFFER COVERAGE UNDER
SUBSECTION (A) OF THIS SECTION FOR SO LONG AS THE COMMISSIONER FINDS THAT
THE COVERAGE WOULD PLACE THE CARRIER IN A FINANCIALLY IMPAIRED
CONDITION. .

749. RENEWAL OF HEALTH BENEFIT PLANS.

(A) A CARRIER SHALL RENEW HEALTH BENEFIT PLANS, EXCEPT IN ANY OF
THE FOLLOWING CASES;

(1) NONPAYMENT OF THE REQUIRED PREMIUMS;

(2) FRAUD OR MISREPRESENTATION OF AN ENROLLEE OR A
REPRESENTATIVE OF AN ENROLLEE;

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