Iowa Admin. Code r. 191-71.13

Current through Register Vol. 47, No. 13, December 25, 2024

Rule 191-71.13 - Restoration of coverage

(1)

a. Except as provided in 71.13(1)"b," a small employer carrier shall, as a condition of continuing to transact business in this state with small employers, offer to provide health insurance coverage as described in 71.13(3) to any small employer carrier after January 1,1993, unless the carrier's termination is pursuant to Iowa Code section 513B5..

b. The offer required under 71.13(1) "a" shall not be required with respect to health insurance coverage that was not renewed if:

(1) The health insurance coverage was not renewed for reasons permitted in Iowa Code section 513B5(1)., or

(2) The nonrenewal was a result of the small employer voluntarily electing coverage under different health insurance coverage.

(2) The offer made under 71.13(1) shall occur not later than 60 days after July 2,1993. A small employer shall be given at least 60 days to accept an offer made pursuant to 71.13(1).

(3) A health insurance coverage provided to a terminated small employer pursuant to 71.13(1) shall meet the following conditions:

a. The health insurance coverage shall contain benefits that are identical to the benefits in the health insurance coverage that was terminated or nonrenewed.

b. The health insurance coverage shall not be subject to any waiting periods (including exclusion periods for preexisting conditions) or other limitations on coverage that exceed those contained in the health insurance coverage that was terminated or nonrenewed. In applying such exclusions or limitations, the health insurance coverage shall be treated as if it were continuously in force from the date it was originally issued to the date that it is restored pursuant to 191-71.13 (513B).

c. The health insurance coverage shall not be subject to any provisions that restrict or exclude coverage or benefits for specific diseases, medical conditions or services otherwise covered by the plan.

d. The health insurance coverage shall provide coverage to all employees who are eligible employees as of the date the plan is restored. The carrier shall offer coverage to each dependent of such eligible employees.

e. The premium rate for the health insurance coverage shall be no more than the premium rate charged to the small employer on the date the health insurance coverage was terminated or nonrenewed provided that, if the number or case characteristics of the eligible employees (or their dependents) of the small employer has changed between the date the health insurance coverage was terminated or nonrenewed and the date that it is restored, the carrier may adjust the premium rates to reflect any changes in case characteristics of the small employer. If the carrier has increased premium rates for other similar groups with similar coverage to reflect general increases in health care costs and utilization, the premium rate may be further adjusted to reflect the lowest such increase given to a similar group. The premium rate for the health insurance coverage may not be increased to reflect any changes in risk characteristics of the small employer group until one year after the date the health insurance coverage is restored. Any such increase shall be subject to the provisions of Iowa Code section 513B4..

f. The health insurance coverage shall not be eligible to be reinsured under the provisions of Iowa Code section 513B. 12, except that the carrier may reinsure new entrants to the health insurance coverage who enroll after the restoration of coverage.

Iowa Admin. Code r. 191-71.13

Amended by IAB March 14, 2018/Volume XL, Number 19, effective 4/18/2018