§ 36-4509. Extension and termination of coverage under group accident and health policy and contracts of hospital or medical service or indemnity.

A.  When an insured employee or a dependent whose group insurance coverage is terminated and the coverage is subject to the provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), Pub. L. 99-272, April 7, 1986, 100 Stat. 82, neither subsection B or C of this section applies.

B.  In the case of an employee whose insurance is terminated for any reason other than termination of the group plan or termination for gross misconduct under a group policy providing hospital, medical or surgical, or Christian Science care and treatment expense benefits; or contract of hospital or medical service or indemnity; or prepaid health plan or health maintenance organization subscriber contract, such employee and the dependents of the employee shall be offered continuation of coverage under the group policy or contract for a period of at least sixty-three (63) days after such termination.  The carrier shall notify the terminated employee of the availability of this continuation of coverage option in writing within thirty (30) days of receiving notice from the plan sponsor of the employee’s termination of coverage.  The terminated employee shall request in writing the continuation of group coverage not later than the thirty-first day after the date the terminated employee is given notification of the availability of this continuation of coverage option.  Premiums may be charged for the continuation of coverage period.  The premiums charged shall be the premiums which would have been charged for the coverage provided under the group policy or contract had termination not occurred.  Continuation of coverage pursuant to this section may be terminated:

1.  For employee’s failure to make timely premium payments;

2.  On the date the group coverage terminates in its entirety if the group coverage terminates in its entirety during the continuation of coverage period; or

3.  If the employee and the dependents of the employee otherwise become entitled to similar insurance from some other source during the continuation of the coverage period.

C.  If an employee has been covered for at least six (6) months under any group accident and health insurance policy delivered in this state, providing hospital, medical or surgical, or Christian Science care and treatment expense benefits, or under a contract of hospital or medical service or indemnity, and the individual employee has had his employment terminated or the group itself is terminated, then the termination shall not affect coverage of the insured or his dependents for any continuous loss which commenced while the insurance was in force.  The extension of benefits beyond the period the insurance was in force may be predicated upon the continuous total disability of the person insured or his or her dependents or the expenses incurred in connection with a plan of surgical treatment, which shall include maternity care and delivery expenses, which commenced prior to the termination.  The coverage for the extension of benefits shall be for the maximum benefits under the terminated policy or for a time period of not less than three (3) months in the case of basic coverage or six (6) months in the case of major medical coverage.  Premium monies may be charged for the period of the extension of benefits.  The premiums charged shall be the premiums which would have been charged for the coverage provided under the group policy or contract had termination not occurred.

Added by Laws 1975, c. 110, § 1, eff. Jan. 1, 1976.  Amended by Laws 1985, c. 328, § 20, emerg. eff. July 29, 1985; Laws 1986, c. 251, § 42, eff. Nov. 1, 1986; Laws 1988, c. 18, § 1, eff. Nov. 1, 1988; Laws 2009, c. 207, § 1, emerg. eff. May 18, 2009; Laws 2012, c. 44, § 12, eff. Nov. 1, 2012.

Note

NOTE:  Laws 2009, c. 176, § 33 repealed by Laws 2010, c. 2, § 12, emerg. eff. March 3, 2010.