Guaranteed Renewal of Group Insurance An insurer must renew insured
group policies (at the employers option) except for:
- non payment of premium
- fraud
- violation of participation or contribution rules ( an insurance carrier may set its own participation or contribution rules, so long as they comply with state law)
- termination of coverage for all polices in a certain market
- movement outside the service area ( network plans) and
- for association plans, of an employers membership in the association ends.
Under certain circumstances an insurer may modify coverage. An insurer may also discontinue some or all coverages in certain markets.
Guaranteed Issue of Group Insurance
(applies to small group 2-50 employees)
In general, insurers that do business in the small group market in a state must accept any small group that applies for coverage. This provision is subject to certain exceptions:
- Network Limits:
An insurer that offers insurance through a network of providers may limit coverage to those group plans with employees who live, work, or reside in the service area.
- Participation or contribution rules:
An insurers is allowed to have minimum participation or contribution requirements.
In all cases an insurer cannot discontinue any coverage or deny issue of a policy based on a groups claim experience or an individuals health status. |
