Note
State innovation waiver task force; health care reform plan; reports to 2015-2017 legislature (dissolved June 30, 2017). L 2014, c 158; L 2015, c 184.
§431:2-201.5 Conformity to federal law. (a) The provisions of title 42 United States Code section 300gg, et seq., as they relate to group and individual health insurance shall apply to title 24, except:
(1) Where state law provides greater health benefits or coverage than title 42 United States Code section 300gg, et seq., state law shall be applicable; and
(2) This section shall not apply to or affect life insurance, endowment, or annuity contracts, or any supplemental contract thereto, described in section 431:10A-101(4).
(b) The following definitions shall be used when applying title 42 United States Code section 300gg, et seq.:
"Employee" means an employee who works on a full-time basis with a normal workweek of twenty hours or more.
"Group health issuer" means all persons offering health insurance coverage to any group or association, but shall not include those persons offering benefits exempted from title I of the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, under sections 732(c) and 733(c) of title I of the Employee Retirement Income Security Act of 1974 and sections 2747 and 2791(c) of the Public Health Service Act.
"Small employer" means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least one but no more than fifty employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year.
(c) All group health issuers shall offer all small group health plans to all small employers whose employees live, work, or reside in the group health issuer's service areas; provided that the commissioner may exempt a group health issuer if the commissioner determines that the group health issuer does not have the capacity to deliver services adequately to enrollees of additional groups given its obligation to existing employer groups; and provided further that the commissioner shall exempt from this subsection group health plans offered to small employers that employ only one employee, if the group health issuer offers the small employer groups at least one small group health plan that meets the requirements of chapter 393, and upon the determination by the commissioner that the group health issuer has the capacity to adequately deliver services to enrollees of the additional groups, subject to its obligations to existing employer groups.
(d) A group health issuer shall be prohibited from imposing any preexisting condition exclusion.
(e) The commissioner may adopt rules to implement, clarify, or conform title 24 to title 42 United States Code section 300gg, et seq.
(f) The adoption of the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, for the purposes of title 24 is not an adoption for any purposes for income taxes under chapter 235.
(g) The State shall have jurisdiction over any matter that title 42 United States Code section 300gg, et seq., permits, including jurisdiction over enforcement.
(h) As used in this section, "small group health plans" means the medical plans currently offered, advertised, or marketed by a group health issuer for small employers. [L 1997, c 291, §2; am L 1999, c 93, §5; am L 2000, c 151, §1; am L 2001, c 55, §19; am L 2004, c 122, §2; am L 2007, c 247, §1; am L 2008, c 120, §§1, 3; am L 2009, c 11, §14; am L 2013, c 192, §4]
Section: Previous 431-2-107 431-2-108 431-2-109 431-2-110 431-2-201 431-2-201.2 431-2-201.3 431-2-201.5 431-2-201.8 431-2-202 431-2-202.5 431-2-203 431-2-204 431-2-205 431-2-206 NextLast modified: October 27, 2016