(1) Except as otherwise provided in subsection (2) of this section, a carrier providing coverage under a health benefit plan shall renew or continue the coverage at the option of the policyholder.
(2) A carrier may refuse to renew or discontinue coverage under a health benefit plan only for the following reasons:
Nonpayment of the required premium or failure to timely pay premiums in accordance with the terms of the health benefit plan;
The policyholder or the policyholder's representative has performed an act or practicethat constitutes fraud or has made an intentional misrepresentation of a material fact under the terms of coverage;
For small group health benefit plans, the policyholder fails to comply with the carrier's minimum participation or employer contribution requirements or the small employer is no longer actively engaged in the business in which it was engaged on the effective date of the plan;
In the case of a carrier that offers coverage through a managed care plan, there are nolonger any enrolled individuals or employees living, working, or residing within the carrier's established geographic service area and the carrier would deny enrollment in the plan pursuant section 10-16-105 (4)(a)(III);
In the case of an individual or small employer health benefit plan that is made available only through one or more bona fide associations, the membership of the policyholder or small employer in the association on the basis of which the coverage is provided ceases, but only if the coverage is terminated under this paragraph (e) uniformly without regard to any health-status-related factor relating to any covered person;
In the case of individual health benefit plans that are made available as student healthinsurance coverage, the student policyholder covered under the coverage ceases to be a student at the institution of higher education through which the student health insurance coverage is offered, as long as the coverage is terminated under this paragraph (f) uniformly without regard to any health-status-related factor related to any covered person;
The carrier elects to discontinue offering a particular individual or small group healthbenefit plan, but only if the carrier:
Provides notice of the decision not to renew coverage at least ninety days before thenonrenewal of the health benefit plan to each policyholder, individual, certificate holder, participant, or beneficiary covered by the plan;
Offers each policyholder covered by the plan the option to purchase any other healthbenefit plans currently being offered by the carrier in this state and specifies the special enrollment periods for the plans pursuant to section 10-16-105.7;
In exercising the option to discontinue that particular type of health benefit plan,acts uniformly without regard to the claims experience of the policyholders or any health-statusrelated factor relating to any individual, participant, or beneficiary covered by the plan or new individuals, participants, or beneficiaries who may become eligible for coverage;
Provides notice to the commissioner before providing the notice pursuant to subparagraph (I) of this paragraph (g) and certifies the following to the commissioner:
The premiums for other health benefit plans the carrier offers pursuant to subparagraph (II) of this paragraph (g) are not excessive, inadequate, or unfairly discriminatory relative to the plan that the carrier is discontinuing; and
The benefit levels the carrier offers in the other health benefit plans comply with therequirements of law applicable to individual and small employer health benefit plans; or
(h) (I) The carrier elects to discontinue offering and renewing all of its individual, small group, or large group health benefit plans delivered or issued for delivery in this state, but only if the carrier:
Provides notice of the decision to discontinue coverage, at least one hundred eightydays before the discontinuance, to all policyholders and covered persons; and
Provides the notice to the commissioner at least three business days before the datethe notice is sent to the affected policyholders and covered persons pursuant to sub-subparagraph (A) of this subparagraph (I).
(II) In the case of a discontinuance under subparagraph (I) of this paragraph (h), the carrier shall:
Continue to provide coverage through the first renewal period not to exceed twelvemonths after the notice provided pursuant to subparagraph (I) of this paragraph (h); and
Not write new health benefit plans of the same type as those the carrier discontinuedin this state for five years after the date of the notice to the commissioner pursuant to subsubparagraph (B) of subparagraph (I) of this paragraph (h).
A carrier offering individual or small employer health benefit plans shall clearly disclose in its contracts and marketing materials the conditions of renewability, which conditions must conform with the requirements of this section.
A carrier offering a large group health benefit plan may modify the plan at renewal ifthe carrier modifies the plan uniformly for all large groups covered by the same plan.
With respect to benefits provided under an individual or small employer health benefit plan, a carrier may make reasonable modifications if:
The modification is effective only upon renewal of the plan;
The carrier modifies the benefits uniformly for all individuals and groups covered bythe plan;
The carrier provides the proposed modification to policyholders and the commissioner at least ninety days before the effective date of the modification; and
The carrier provides each affected policyholder the opportunity to purchase any otherhealth benefit plan offered by the carrier.
(6) (a) The commissioner may promulgate rules as necessary to implement and administer this section. (b) Repealed.
Source: L. 2013: Entire section added, (HB 13-1266), ch. 217, p. 930, § 7, effective May 13.
Editor's note: Subsection (6)(b)(II) provided for the repeal of subsection (6)(b), effective January 1, 2015. (See L. 2013, p. 930.)