Text: HF02397 Text: HF02399 Text: HF02300 - HF02399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. Section 509B.3, Code 1995, is amended to read 1 2 as follows: 1 3 509B.3 CONTINUATION OF BENEFITS. 1 4 A group policy delivered or issued for delivery in this 1 5 state which insures employees or members for accident or 1 6 health insurance on an expense-incurred or service basis, 1 7 other than for specific diseases or for accidental injuries 1 8 only, shall provide that employees or members whose coverage 1 9 under the group policy would otherwise terminate because of 1 10 termination of employment or membership may continue their 1 11 accident or health insurance under that group policy, for 1 12 themselves and their eligible dependents, subject to all of 1 13 the group policy's terms and conditions applicable to those 1 14 forms of insurance and subject to all of the following condi- 1 15 tions: 1 16 1. Continuation shall only be available to an employee or 1 17 member if the employee or member was continuously insured un- 1 18 der the group policy, and for similar benefits under any group 1 19 policy which it replaced, during the entirethree months'1 20 three-month period immediately preceding the termination. 1 21 2. Continuation shall not be available for a person who is 1 22 or could be covered by medicare. Continuation shall not be 1 23 available for a person who is or is eligible to be covered by 1 24 another group insured or uninsured arrangement which provides 1 25 accident or health coverage, unless the person was covered by 1 26 that other group policy immediately prior to the termination. 1 27 3. Continuationmay exclude dental care, vision care, or1 28prescription drug benefits or other benefits provided under1 29the group policy which benefits are in addition to accident or1 30health benefitsshall include coverage which, as of the time 1 31 the coverage is being provided, is identical to the coverage 1 32 provided to similarly situated employees or members with 1 33 respect to whom a qualifying event has not occurred. 1 34 4. An employee or member who wishes continuation of 1 35 coverage must request continuation in writing to the employer 2 1 or group policyholder within theten-daysixty-day period 2 2 following the later of either of the following: 2 3 a. The date of the termination. 2 4 b. The date the employee is given notice of the right of 2 5 continuation as provided in section 509B.5 by either the em- 2 6 ployer or the group policyholder. 2 7 If proper notice is given, the employee or member is not 2 8 eligible to elect continuation more thanthirty-onesixty days 2 9 after the date of termination. 2 10 5. An employee or member electing continuation shall pay 2 11 monthly to the employer or group policyholder, in advance, the 2 12 amount of contribution required by the employer or group 2 13 policyholder, but not more than the group rate otherwise due 2 14 for the insurance being continued under the group policy. If 2 15 proper notice is given, the election of continuation by the 2 16 employee or member together with the first contribution 2 17 required to establish contributions on a monthly basis in 2 18 advance, shall be given to the employer or group policyholder 2 19 withinthirty-onesixty days of the date the group insurance 2 20 would otherwise terminate. 2 21 6. Continuation of insurance under the group policy for 2 22 any person shall terminate when the person becomes eligible 2 23 for medicare or another group insured or uninsured accident or 2 24 health arrangement, or earlier, when any of the following 2 25 first occurs: 2 26 a.NineThe later of the following: 2 27 (1) Eighteen months after the date the employee's or 2 28 member's insurance under the policy would otherwise have 2 29 terminated because of termination of employment or membership. 2 30 (2) Thirty-six months after the insurance under the policy 2 31 would otherwise have terminated, with respect to the surviving 2 32 or former spouse or children of an employee or member, because 2 33 of dissolution or annulment of the marriage of the employee or 2 34 member, or would have terminated because of the death of the 2 35 employee or member. 3 1 b. At the end of the period for which contributions were 3 2 made if the employee or member fails to make timely payment of 3 3 a required contribution and if proper notice is given as 3 4 provided in section 509B.5, subsection 2. 3 5 c.IfNotwithstanding paragraph "a", subparagraph (2), if 3 6 the person covered is a former spouse, upon the former 3 7 spouse's remarriage. 3 8 d. The date on which the group policy is terminated or, in 3 9 the case of an employee, the date the employer terminates 3 10 participation under the group policy. However, if this para- 3 11 graph applies and the coverage which would cease because of 3 12 the employer's termination is replaced by similar coverage 3 13 under a different group policy, all of the following apply: 3 14 (1) The employee, member, spouse, or eligible dependent 3 15 may become covered under the different group policy, for the 3 16 balance of the period that the employee or member would have 3 17 remained covered under the prior group policy had a termina- 3 18 tion of the group policy as specified in paragraph "d" not 3 19 occurred. 3 20 (2) The minimum level of benefits to be provided by the 3 21 different group policy shall be the applicable level of bene- 3 22 fits of the prior group policy, reduced by any benefits pay- 3 23 able under the prior group policy. 3 24 (3) The prior group policy shall continue to provide bene- 3 25 fits to the extent of its accrued liabilities and extensions 3 26 of benefits as if the prior group policy had not been replaced 3 27 by the different group policy. 3 28 7. A notification of the continuation privilege shall be 3 29 included with or in each certificate of coverage and as 3 30 otherwise provided in section 509B.5 and shall contain the 3 31 time limits for requesting the continued coverage. 3 32 8. The spouse of an employee or member, and any covered 3 33 dependent children of the employee or member, whose coverage 3 34 under the group policy would otherwise terminate because of 3 35 dissolution or annulment of marriage or death of the employee 4 1 or member shall have the same contribution and notice 4 2 responsibilities and privileges as provided under this chapter 4 3 to the employee or member upon termination of employment or 4 4 membership. 4 5 EXPLANATION 4 6 This bill amends section 509B.3 relating to the 4 7 continuation of group health insurance upon termination of 4 8 employment or membership of an individual covered under an 4 9 existing group policy. 4 10 The bill provides that continuation of coverage shall 4 11 include coverage which is identical to the coverage provided 4 12 to similarly situated beneficiaries with respect to whom a 4 13 qualifying event has not occurred. Currently, continuation 4 14 may exclude dental care, vision care, or prescription drug 4 15 benefits or other benefits provided under a group policy which 4 16 are in addition to accident and health benefits. 4 17 The bill increases the time period during which an employee 4 18 or member may opt for continuation of coverage from 10 to 60 4 19 days following the later of the date of termination or the 4 20 date the employee is given notice of the right of continuation 4 21 by either the employer or the group policyholder. The bill 4 22 increases the time period during which continuation of 4 23 benefits is available from nine months to 18 months after the 4 24 employee's or member's insurance would otherwise have 4 25 terminated because of termination of employment or membership, 4 26 and provides that such continuation, with respect to the 4 27 surviving spouse or former spouse or children of the employee 4 28 or member, is for a maximum time period of 36 months after 4 29 coverage would have otherwise terminated because of the 4 30 dissolution or annulment of the marriage of the employee or 4 31 member, or would have terminated because of the death of the 4 32 employee or member. 4 33 LSB 3785HH 76 4 34 mj/jj/8
Text: HF02397 Text: HF02399 Text: HF02300 - HF02399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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