Iowa Admin. Code r. 191-71.13 - Restoration of coverage
(1)
a. Except as provided in
71.13(1)"b," a small employer carrier shall, as a condition of
continuing to transact business in this state with small employers, offer to
provide health insurance coverage as described in 71.13(3) to any small
employer carrier after January 1,1993, unless the carrier's termination is
pursuant to Iowa Code section
513B5..
b. The offer required under 71.13(1)
"a" shall not be required with respect to health insurance
coverage that was not renewed if:
(1) The
health insurance coverage was not renewed for reasons permitted in Iowa Code
section
513B5(1).,
or
(2) The nonrenewal was a result
of the small employer voluntarily electing coverage under different health
insurance coverage .
(2) The offer made under 71.13(1) shall occur
not later than 60 days after July 2,1993. A small employer shall be given at
least 60 days to accept an offer made pursuant to 71.13(1).
(3) A health insurance coverage provided to a
terminated small employer pursuant to 71.13(1) shall meet the following
conditions:
a. The health insurance coverage
shall contain benefits that are identical to the benefits in the health
insurance coverage that was terminated or nonrenewed.
b. The health insurance coverage shall not be
subject to any waiting periods (including exclusion periods for preexisting
conditions) or other limitations on coverage that exceed those contained in the
health insurance coverage that was terminated or nonrenewed. In applying such
exclusions or limitations, the health insurance coverage shall be treated as if
it were continuously in force from the date it was originally issued to the
date that it is restored pursuant to 191-71.13 (513B).
c. The health insurance coverage shall not be
subject to any provisions that restrict or exclude coverage or benefits for
specific diseases, medical conditions or services otherwise covered by the
plan.
d. The health insurance
coverage shall provide coverage to all employees who are eligible employees as
of the date the plan is restored. The carrier shall offer coverage to each
dependent of such eligible employees.
e. The premium rate for the health insurance
coverage shall be no more than the premium rate charged to the small employer
on the date the health insurance coverage was terminated or nonrenewed provided
that, if the number or case characteristics of the eligible employees (or their
dependents) of the small employer has changed between the date the health
insurance coverage was terminated or nonrenewed and the date that it is
restored, the carrier may adjust the premium rates to reflect any changes in
case characteristics of the small employer. If the carrier has increased
premium rates for other similar groups with similar coverage to reflect general
increases in health care costs and utilization, the premium rate may be further
adjusted to reflect the lowest such increase given to a similar group. The
premium rate for the health insurance coverage may not be increased to reflect
any changes in risk characteristics of the small employer group until one year
after the date the health insurance coverage is restored. Any such increase
shall be subject to the provisions of Iowa Code section
513B4..
f. The health insurance coverage
shall not be eligible to be reinsured under the provisions of Iowa Code section
513B. 12, except that the carrier may reinsure new entrants to the health
insurance coverage who enroll after the restoration of coverage.
Notes
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