110 STAT. 1982
PUBLIC LAW 104-191—AUG. 21, 1996
"(2) CONVERSION POLICIES.—A
health insurance issuer
offering health insurance coverage in connection with group
health plans under this title shall not be deemed to be a
health insurance issuer offering individual health insurance
coverage solely because such issuer offers a conversion policy.
"(f) CONSTRUCTION.— Nothing in this section shall be
construed—
"(1) to restrict the amount of the premium rates that an
issuer may charge an individual for health insurance coverage
provided in the individual market under applicable State law;
or
"(2) to prevent a health insurance issuer offering health
insurance coverage in the individual market 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.
42 USC 300gg-
•«£€. 2742. GUARANTEED RENEWABILnY OF INDIVTOUAL HEALTH
42.
INSURANCE COVERAGE.
"(a) IN GENERAL. —Except as provided in this section, a health
insurance issuer that provides individual health insurance coverage
to an individual shall renew or continue in force such coverage
at the option of the individual.
"(b) GENERAL EXCEPTIONS.—A health insurance issuer may
nonrenew or discontinue health insurance coverage of an individual
in the individual market based only on one or more of the following:
"(1) NONPAYMENT OF PREMIUMS.—The individual has failed
to pay premiums or contributions in accordance with the terms
of the health insurance coverage or the issuer has not received
timely premium payments.
"(2) FRAUD.— The individual has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage.
"(3) TERMINATION OF PLAN. — The issuer is ceasing to offer
coverage in the individual market in accordance with subsection
(c) and applicable State law.
"(4) MOVEMENT OUTSIDE SERVICE AREA.— In the case of
a health insurance issuer that offers health insurance coverage
in the market through a network plan, the individual no longer
resides, lives, or works in the service area (or in an area
for which the issuer is authorized to do business) but only
if such coverage is terminated under this paragraph uniformly
without regard to any health status-related factor of covered
individuals.
"(5) ASSOCIATION MEMBERSHIP CEASES.—In the case of
health insurance coverage that is made available in the individual market only through one or more bona fide associations,
the membership of the individual in the association (on the
basis of which the coverage is provided) ceases but only if
such coverage is terminated under this paragraph uniformly
without regard to any health status-related mctor of covered
individuals.
"(c) REQUIREMENTS FOR UNIFORM TERMINATION OF COV-
ERAGE. —
"(1) PARTICULAR TYPE OF COVERAGE NOT OFFERED.— In any
case in which an issuer decides to discontinue offering a particular type of health insurance coverage offered in the individual
�
