LD 1190
pg. 15
Page 14 of 18 An Act To Create the Comprehensive Health Insurance Risk Pool Association Page 16 of 18
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LR 436
Item 1

 
§3911.__Eligibility for coverage

 
1.__Eligibility; application for coverage.__An individual
who is and continues to be a resident is eligible for coverage
under the plan if evidence is provided of rejection, a
requirement of restrictive riders, a rate increase or a
preexisting conditions limitation on a qualified plan, the
effect of which is to substantially reduce coverage from that
received by a person considered a standard risk by at least
one association member within 6 months of the date of the
certificate, or if the individual meets other eligibility
requirements adopted by rule by the superintendent that are
not inconsistent with this chapter and that evidence that a
person is unable to obtain coverage substantially similar to
that which may be obtained by a person who is considered a
standard risk.__Rules adopted pursuant to this subsection are
routine technical rules as defined in Title 5, chapter 375,
subchapter 2-A.

 
2.__Change of domicile.__The board shall develop standards
for eligibility for coverage by the association for any
natural person who changes that person's domicile to this
State and who at the time domicile is established in this
State is insured by an organization similar to the
association.__The eligible maximum lifetime benefits for that
covered person may not exceed the lifetime benefits available
through the association, less any benefits received from a
similar organization in the former domiciliary state.

 
3.__Eligibility without application.__The board shall
develop a list of medical or health conditions for which a
person is eligible for plan coverage without applying for
health insurance under subsection 1.__A person who can
demonstrate the existence or history of any medical or health
conditions on the list developed by the board may not be
required to provide the evidence specified in subsection 1.
The board may amend the list from time to time as appropriate.

 
4.__Exclusions from eligibility.__A person is not eligible
for coverage under the plan if:

 
A.__The person has or obtains health insurance coverage
substantially similar to or more comprehensive than a plan
policy or would be eligible to have coverage if the person
elected to obtain it, except that:

 
(1)__A person may maintain other coverage for the
period of time the person is satisfying a preexisting
condition waiting period under a plan policy; and


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