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§27-19-62  Prohibition on rescission of coverage. –

Published: 2015

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Nonprofit Hospital Service Corporations

SECTION 27-19-62

   § 27-19-62  Prohibition on rescission of

coverage. –

(a)(1) Coverage under a health plan subject to the jurisdiction of the

commissioner under this chapter with respect to an individual, including a

group to which the individual belongs or family coverage in which the

individual is included, shall not be rescinded after the individual is covered

under the plan, unless:

   (A) The individual or a person seeking coverage on behalf of

the individual, performs an act, practice or omission that constitutes fraud; or

   (B) The individual makes an intentional misrepresentation of

material fact, as prohibited by the terms of the plan or coverage.

   (2) For purposes of paragraph (1)(A), a person seeking

coverage on behalf of an individual does not include an insurance producer or

employee or authorized representative of the health carrier.

   (b) At least thirty (30) days advance written notice shall be

provided to each health benefit plan enrollee or, for individual health

insurance coverage, primary subscriber, who would be affected by the proposed

rescission of coverage before coverage under the plan may be rescinded in

accordance with subsection (a) regardless of, in the case of group health

insurance coverage, whether the rescission applies to the entire group or only

to an individual within the group.

   (c) For purposes of this section, "to rescind" means to

cancel or to discontinue coverage with retroactive effect for reasons unrelated

to timely payment of required premiums or contribution to costs of coverage.

   (d) This section applies to grandfathered health plans.

History of Section.

(P.L. 2012, ch. 256, § 6; P.L. 2012, ch. 262, § 6.)