Carrier that offers coverage through network plan not required to offer coverage to employer that does not employ enrollees who reside or work in geographic area for which carrier is authorized to transact insurance.
1. A carrier that offers coverage through a network plan is not required to offer coverage to or accept an application from an employer that does not employ or no longer employs any enrollees who reside or work in the established geographic service area of the carrier or the geographic area for which the carrier is authorized to transact insurance, provided that such coverage is refused or terminated uniformly without regard to any health status-related factor for any employee of the employer.
2. As used in this section, “network plan” means a health benefit plan offered by a health carrier under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the carrier. The term does not include an arrangement for the financing of premiums.
Last modified: February 27, 2006