LD 394
pg. 19
Page 18 of 21 An Act To Create a High-risk Pool in the Health Insurance Market Page 20 of 21
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LR 516
Item 1

 
5.__Termination of coverage.__The coverage of any person
ceases:

 
A.__On the date a person is no longer a resident;

 
B.__Upon the death of the covered person;

 
C.__On the date state law requires cancellation of the
policy; or

 
D.__At the option of the association, 30 days after the
association makes any inquiry concerning the person's
eligibility or place of residence to which the person does
not reply.

 
The coverage of any person who ceases to meet the eligibility
requirements of this section may be terminated immediately.

 
6.__Unfair trade practice.__It constitutes an unfair trade
practice for any insurer, producer, employer or 3rd-party
administrator to refer an individual employee or a dependent of
an individual employee to the association, or to arrange for an
individual employee or a dependent of an individual employee to
apply to the plan, for the purpose of separating such an employee
or dependent from a group health benefits plan provided in
connection with the employee's employment.

 
§3912.__Actions against association or member insurers based upon

 
joint or collective actions

 
Participation in the association, the establishment of rates,
forms or procedures or any other joint or collective action
required by this chapter may not be the basis of any legal action
or criminal or civil liability or penalty against the association
or a member insurer.

 
§3913.__Reimbursement of member insurer

 
1.__Reimbursement.__A member insurer may seek reimbursement
from the association and the association shall reimburse the
member insurer to the extent claims made by a covered person
after February 1, 2006 exceed premiums paid on a calendar-year
basis by the covered person to the member insurer for a covered
person who meets the following criteria:

 
A. The member insurer sold an individual health plan to the
covered person between December 1, 1993 and February 1, 2006
and the policy that was sold has been continuously renewed
by the covered person; and


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