513B.9A  Eligibility to enroll.

1.  A carrier or organized delivery system offering group health insurance coverage shall not establish rules for eligibility, including continued eligibility, of an individual to enroll under the terms of the coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:

a.  Health status.

b.  Medical condition, including both physical and mental conditions.

c.  Claims experience.

d.  Receipt of health care.

e.  Medical history.

f.  Genetic information.

g.  Evidence of insurability, including conditions arising out of acts of domestic violence.

h.  Disability.

2.  Subsection 1 does not require group health insurance coverage to provide particular benefits other than those provided under the terms of the coverage, and does not prevent a coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the coverage.

3.  Rules for eligibility to enroll under group health insurance coverage include rules defining any applicable waiting periods for such enrollment.

4. a.  A carrier or organized delivery system offering health insurance coverage shall not require an individual, as a condition of enrollment or continued enrollment under the coverage, to pay a premium or contribution which is greater than a premium or contribution for a similarly situated individual enrolled in the coverage on the basis of a health status-related factor in relation to the individual or to a dependent of an individual enrolled under the coverage.

b.  Paragraph "a" shall not be construed to do either of the following:

(1)  Restrict the amount that an employer may be charged for health insurance coverage.

(2)  Prevent a carrier or organized delivery system offering group health insurance coverage from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.

Section History: Recent form

  97 Acts, ch 103, §23

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