SB 0918 Alters Health Ins. Plans Legislation
LR Number:L3446.01I Fiscal Note:3446-01
Committee:Insurance and Housing
Last Action:03/06/96 - Hearing Conducted S Insurance & Housing Committee
Effective Date:August 28, 1996
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Current Bill Summary

SB 918 - This act expands the reasons a group health benefit plan may terminate its policy to include together with nonpayment of required premium provisions, the provisions of fraud, misrepresentation and failure to cooperate with the health care provider. These provisions would become effective for policies to be delivered or issued for delivery on or after January 1, 1997.

The act also prohibits group health benefit plans from using preexisting condition provisions after January 1, 1997, if such health benefit plan contains: (1) a provision reserving the right to require a person eligible for coverage to furnish evidence of individual insurability, unless that person is a late enrollee; (2) a provision reserving the right to exclude certain industries; (3) a preexisting condition provision specifying any additional exclusions or limitations; (4) a preexisting condition provision that does not give credit for the time the person was under a preexisting condition exclusion or limitation, for comparable coverage from a previous health carrier; and (5) a provision excluding or limiting coverage regarding a preexisting condition for an eligible individual for more than a period of 12 continuous months.

No company will be required to renew coverage under a health benefit plan when the individual's coverage has been terminated for: (1) nonpayment of the required premium; (2) fraud or misrepresentation; or (3) repeated misuse of a provider network provision.