Section 3.31.520. Health care insurer duties and rules.

	(a)  A health care insurer that offers coverage to an individual under 19 years of age may not limit, exclude, or deny coverage based on health status or preexisting condition.  
	(b)  A health care insurer must comply with the requirements established by the association in order to cede a risk to the association.  
	(c)  A health care insurer shall establish and follow standard underwriting rules for determining when the risk of an eligible individual is ceded to the association and may consider health information obtained through the underwriting process or through other health records or data lawfully available to the health care insurer for purposes of determining whether to cede the risk to the association.  
	(d)  A health care insurer shall continue to administer and manage the policy for risk ceded to the association in accordance with the terms of the insurance policy and with the insurance law of this state.  
	(e)  A health care insurer shall offer individuals that may be ceded to the association the same plans offered to other individuals.  
	(f)  A health care insurer may not vary premium rates based on whether a risk is ceded to the association.  
	(g)  If a health care insurer does not cede the risk of an eligible individual to the association and the individual applies for and is enrolled in a health care insurance plan that is more comprehensive than the original plan, the health care insurer may cede the risk of the covered individual to the association.  
	(h)  Except as provided in (i) of this section, a health care insurer shall cede a risk to the association not later than 90 days after the effective date of the individual health care insurance plan.  
	(i)  A health care insurer may cede a risk to the association later than 90 days after the effective date of the individual health care insurance plan only if  
		(1) the risk is ceded not later than six months after the effective date of the individual health care insurance plan;  
		(2) the health care insurer has identified an error in the information submitted with the application; and  
		(3) the error is such that the health care insurer initially would have ceded the risk according to the health care insurer's underwriting rules.  
	(j)  A health care insurer shall continue to cede the risk of an individual who reaches 19 years of age or older to the association as long as the eligible individual remains insured under the same health care insurance plan.  

Authorities

21.06.090;21.55.220;21.55.400

Notes

Authority

AS 21.06.090 AS 21.55.220 AS 21.55.400

History

Eff. 2/2/2013, Register 205